Pitavastatin 4 mg is NOT Equivalent to Rosuvastatin 5 mg
Pitavastatin 4 mg and rosuvastatin 5 mg belong to different statin intensity categories and are not interchangeable: pitavastatin 4 mg is classified as low-intensity therapy (<30% LDL-C reduction), while rosuvastatin 5 mg is moderate-intensity therapy (30-49% LDL-C reduction). 1, 2
Statin Intensity Classification
The 2018 ACC/AHA guidelines provide clear categorization based on expected LDL-C reduction:
- Rosuvastatin 5 mg achieves moderate-intensity statin therapy with 30-49% LDL-C reduction 1
- Pitavastatin 1-4 mg (all doses) achieves only low-intensity therapy with <30% LDL-C reduction 1, 2
- This fundamental difference in potency means pitavastatin 4 mg cannot substitute for rosuvastatin 5 mg when moderate-intensity therapy is indicated 1, 2
Comparative LDL-C Lowering Efficacy
Research data confirm the disparity in lipid-lowering power:
- Pitavastatin 4 mg reduces LDL-C by approximately 40-49% in clinical trials, making it equivalent to atorvastatin 20 mg, not rosuvastatin 5 mg 3, 4
- Rosuvastatin 5 mg reduces LDL-C by 42-52% on average, demonstrating superior efficacy to pitavastatin's maximum dose 5
- Pitavastatin 2-4 mg shows LDL-C lowering equivalent to atorvastatin 10-20 mg, placing it well below rosuvastatin 5 mg in potency 4
Clinical Implications for Switching
If a patient requires the LDL-C reduction provided by rosuvastatin 5 mg (moderate-intensity), switching to pitavastatin 4 mg will result in inadequate lipid control. 1, 2
Key considerations when these statins are compared:
- Both statins maintain LDL-C around 2.59 mmol/L when used at equipotent doses, but pitavastatin 4 mg is not equipotent to rosuvastatin 5 mg 6
- Pitavastatin demonstrates superior HDL-C elevation compared to other statins, with increases of 3-10% 7, 6
- Pitavastatin has a glucose-neutral profile, making it preferable in patients with diabetes or metabolic syndrome, but this does not compensate for lower LDL-C reduction 8, 3
When Pitavastatin May Be Preferred Despite Lower Potency
Specific clinical scenarios favor pitavastatin over rosuvastatin:
- Patients with diabetes, prediabetes, or metabolic syndrome benefit from pitavastatin's glucose-neutral effects and potential modest improvement in glycemic parameters 8
- Patients on antiretroviral therapy (especially protease inhibitors) experience minimal drug-drug interactions with pitavastatin 8
- Patients with elevated lipoprotein(a) avoid the Lp(a) increases seen with many other statins 8
- Patients with statin intolerance may tolerate pitavastatin, which shows adverse effect rates comparable to placebo 8
Common Pitfall to Avoid
Do not assume dose equivalence based on milligram amounts alone. The 4 mg dose of pitavastatin does not equal 5 mg of rosuvastatin; statin equivalence is determined by LDL-C reduction percentage and intensity classification, not by nominal dose. 1, 2