Atorvastatin vs simvastatin: statins compared

At a glance

• Strength

  Atorvastatin

  Moderate to high intensity

  Simvastatin

  Low to moderate intensity

• When to take

  Atorvastatin

  Any time of day

  Simvastatin

  In the evening

• Interaction limits

  Atorvastatin

  Fewer, though some antibiotics and antifungals need care

  Simvastatin

  Many: dose caps with amlodipine, diltiazem and verapamil; several drugs must be avoided

• Grapefruit

  Atorvastatin

  Avoid large amounts

  Simvastatin

  Avoid

• Generic

  Atorvastatin

  Yes

  Simvastatin

  Yes

Strength and who needs it

Guidelines match statin intensity to risk. People who have had a heart attack or stroke, or who have very high LDL, usually need a high-intensity statin, which atorvastatin can provide at its higher doses. Simvastatin works well at moderate intensity, but its label restricts the highest dose because of a higher risk of muscle damage, so it does not offer the high intensity some people need.

Interactions

Simvastatin is broken down by the CYP3A4 enzyme and is sensitive to medicines that block it: it must not be taken with clarithromycin, itraconazole, some HIV medicines, gemfibrozil or cyclosporine, and its dose is capped with amlodipine, diltiazem and verapamil. Atorvastatin uses the same enzyme but is less affected, so it is often easier to combine with other medicines.

Side effects

Both can cause muscle aches, and rarely serious muscle damage, especially at higher doses or with interacting medicines; report unexplained muscle pain, weakness or dark urine. Both can slightly raise blood sugar. Many people who stop a statin because of aches tolerate a different statin or a lower dose.

Cost and switching

Both are long-established generics, and each pharmacy sets its own cash price, so quotes can differ between pharmacies; for a medicine taken every day, compare a 90-day supply with a 30-day supply too. Switching between them is straightforward with your prescriber, who will recheck cholesterol after six to twelve weeks.

Missed doses and pregnancy

If you miss atorvastatin, take it when you remember, but skip it if more than 12 hours have passed; for simvastatin, take it when you remember unless the next dose is near. Never take two doses together. Statins are generally avoided in pregnancy, so tell your prescriber if you are planning one.

Read more

• Atorvastatin guide
• Simvastatin guide
• Atorvastatin guide
• Simvastatin guide
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