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Drug Comparisons

Statins  (HMG-CoA Reductase Inhibitors)

' -- '  Signifies that equivalent tablet size is not available (comparable dose is either too high or too low)
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Equivalent Dosages -1

Atorvastatin (Lipitor ®):
-- (see tablet strengths)
Fluvastatin (Lescol ®): 
20 mg
Lovastatin (Mevacor ®):
10 mg
Pravastatin (Pravachol ®): 
10 mg
Rosuvastatin (Crestor ®): 
--
Simvastatin (Zocor ®):
5 mg

Equivalent Dosages - 2

Atorvastatin (Lipitor ®):
--
Fluvastatin (Lescol ®): 
40 mg
Lovastatin (Mevacor ®):
20 mg
Pravastatin (Pravachol ®): 
20 mg
Rosuvastatin (Crestor ®): 
--
Simvastatin (Zocor ®):
10 mg

Equivalent Dosages - 3

Atorvastatin (Lipitor ®):
10 mg
Fluvastatin (Lescol ®): 
80 mg
Lovastatin (Mevacor ®):
40 mg
Pravastatin (Pravachol ®): 
40 mg
Rosuvastatin (Crestor ®): 
5 mg
Simvastatin (Zocor ®):
20 mg

Equivalent Dosages - 4

Atorvastatin (Lipitor ®):
20 mg
Fluvastatin (Lescol ®): 
--
Lovastatin (Mevacor ®):
80 mg
Pravastatin (Pravachol ®): 
80 mg
Rosuvastatin (Crestor ®): 
5 - 10 mg
Simvastatin (Zocor ®):
40 mg

Equivalent Dosages - 5

Atorvastatin (Lipitor ®):
40 mg
Fluvastatin (Lescol ®): 
--
Lovastatin (Mevacor ®):
--
Pravastatin (Pravachol ®): 
--
Rosuvastatin (Crestor ®): 
10 - 20 mg
Simvastatin (Zocor ®):
80 mg

Atorvastatin (Lipitor ®)   

Supplied:  10 mg, 20 mg, 40 mg, 80 mg
Dosing
Hyperlipidemias:  Adults:  Oral: Initial: 10-20 mg once daily.  Patients requiring >45% reduction in LDL-C may be started at 40 mg once daily.  Range: 10 to 80 mg once daily.
Adjustments should be made at intervals of 2-4 weeks.

Fluvastatin (Lescol ®)

Supplied:  Capsule: 20 mg, 40 mg.  Tablet, extended release (Lescol® XL): 80 mg
Dosing
Dyslipidemia: Oral: (Adults):  Patients requiring >/= 25% decrease in LDL-C: 40 mg capsule once daily in the evening, 80 mg XL tablet once daily (anytime), or 40 mg capsule twice daily.  Patients requiring <25% decrease in LDL-C: Initial: 20 mg capsule once daily in the evening; may increase based on tolerability and response to a maximum recommended dose of 80 mg/day, given in 2 divided doses (capsule) or as a single daily dose (XL tablet).

Lovastatin (Mevacor ®)

Supplied:  Tablet: 10 mg, 20 mg, 40 mgTablet, extended release: 20 mg, 40 mg, 60 mg
Dosing
Dyslipidemia: Oral:  (Adults): Initial: 20 mg with evening meal, then adjust at 4-week intervals; maximum: 80 mg/day immediate release tablet or 60 mg/day extended release tablet.

Dosage modification/limits based on concurrent therapy:  Cyclosporine and other immunosuppressant drugs: Initial dose: 10 mg/day with a maximum recommended dose of 20 mg/day.
Concurrent therapy with fibrates, danazol, and/or lipid-lowering doses of niacin (>1 g/day): Maximum recommended dose: 20 mg/day. Concurrent use with fibrates should be avoided unless risk to benefit favors use.  Concurrent therapy with amiodarone or verapamil: Maximum recommended dose: 40 mg/day of regular release or 20 mg/day with extended release.

Pravastatin (Pravachol ®)

Supplied:  10 mg, 20 mg, 40 mg, 80 mg
Dosing
Hyperlipidemias: Oral:  (Adults): Initial: 40 mg once daily; titrate dosage to response (usual range: 10-80 mg) (maximum dose: 80 mg once daily).

Dosage adjustment based on concomitant cyclosporine: Oral: Initial: 10 mg/day, titrate with caution (maximum dose: 20 mg/day).

Rosuvastatin (Crestor ®)

Supplied:  5 mg, 10 mg, 20 mg, 40 mg
Dosing
Hypercholesterolemia; mixed dyslipidemia: Oral: (Adults):  Initial dose: 10 mg once daily (20 mg in patients with severe hypercholesterolemia).   Conservative dosing: Patients requiring less aggressive treatment or predisposed to myopathy (including patients of Asian descent): 5 mg once daily.   Titration: After 2 weeks, may be increased by 5-10 mg once daily; dosing range: 5 to 40 mg/day (maximum dose: 40 mg once daily).
Dosage adjustment with concomitant medications: Oral: Cyclosporine: Rosuvastatin dose should not exceed 5 mg/day.  Gemfibrozil: Rosuvastatin dose should not exceed 10 mg/day.  Dosage adjustment for persistent, unexplained proteinuria while on 40 mg/day: Reduce dose and evaluate causes.

Simvastatin (Zocor ®)

Supplied:  5 mg, 10 mg, 20 mg, 40 mg, 80 mg
Dosing
:   Oral: (Adults):  Prevention of cardiovascular events, hyperlipidemias: Oral: 20-40 mg once daily in the evening; range: 5 to 80 mg/day.
Homozygous familial hypercholesterolemia: Oral: 40 mg once daily in the evening or 80 mg/day (given as 20 mg, 20 mg, and 40 mg evening dose). 
Patients requiring only moderate reduction of LDL-cholesterol: May be started at 10 mg once daily
Patients requiring reduction of >45% in low-density lipoprotein (LDL) cholesterol: May be started at 40 mg once daily in the evening.  Patients with CHD or at high risk for CHD: Dosing should be started at 40 mg once daily in the evening; simvastatin may be started simultaneously with diet.

Dosage adjustment for simvastatin with concomitant medications:  Cyclosporine or danazol: Patient must first demonstrate tolerance to simvastatin >/= 5 mg once daily: Initial: 5 mg, should not exceed 10 mg/day.  Fibrates or niacin: Dose should not exceed 10 mg/day. Amiodarone or verapamil: Dose should not exceed 20 mg/day.

References

Crestor (rosuvastatin) package insert. Wilmington, DE: AstraZeneca Pharmaceuticals LP; Aug 2003.
Drug Facts & Comparisons. St. Louis, MO. Facts & Comparisons. 2005.
Helfand, Mark, Carson, Susan, Kelley, Cathy. Drug Class Review on HMG-CoA Reductase Inhibitors (Statins). 2006. http://www.ohsu.edu/drugeffectiveness/reports/final.cfm  Accessed: Sept 2007.
Lescol (fluvastatin) package insert. East Hanover, NJ: Novartis Pharmaceuticals Corporation; October 2001.
Mevacor (lovastatin) package insert. West Point, PA: Merck & Co., Inc.; June 2002.
Lipitor (atorvastatin) package insert. Morris Plains, NJ: Parke-Davis; April 2002.
Pravachol (pravastatin) package insert. Princeton, NJ: Bristol-Myers Squibb; December 2001.
Zocor (simvastatin) package insert. Whitehouse Station, NJ: Merck & Co., Inc; May 2002.
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