Statin Equivalence

This chart provides a reference for approximate equivalent doses of statins based on their expected LDL-C reduction. Doses are not necessarily interchangeable and clinical judgment is required.

Lipophilic Hydrophilic LDL-C
Reduction
Fluvastatin Pitavastatin Lovastatin Simvastatin Atorvastatin Rosuvastatin Pravastatin
40 mg 1 mg 20 mg 10 mg 20 mg 30%
80 mg 2 mg 40 mg 20 mg 10 mg 40 mg 38%
4 mg 80 mg 40 mg 20 mg 5 mg 80 mg 41%
80 mg 40 mg 10 mg 47%
80 mg 20 mg 55%
40 mg 63%

Low-Intensity and High-Intensity2

Statin Metabolization Pathways

Statin CYP2C9 CYP3A4 Pgp OATP1B1 OATP1B3
Atorvastatin ✔️ ✔️ ✔️
Fluvastatin ✔️ ✔️
Lovastatin ✔️ ✔️
Pravastatin ✔️ ✔️
Rosuvastatin ✔️ ✔️ ✔️
Simvastatin ✔️ ✔️ ✔️

Pgp: P-glycoprotein; OATP: organic anion-transporting polypeptide.

References

  1. FDA Drug Safety Communication: New restrictions, contraindications, and dose limitations for Zocor (simvastatin)
  2. Stone NJ, Robinson JG, Lichtenstein AH, et al. 2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults. Circulation. 2014;129(25_suppl_2).
  3. Climent E, Benaiges D, Pedro-Botet J. Hydrophilic or Lipophilic Statins? Front Cardiovasc Med. 2021 May 20;8:687585.