Crestor vs. Lipitor: which is better for me?

Both Crestor and Lipitor belong to a class of medications called statins. Crestor is the brand name for rosuvastatin, and Lipitor is the brand name for atorvastatin. The first member of this drug class that was approved by the FDA to treat high cholesterol was lovastatin, back in the late 1980s (Endo, 2010). In addition to these three, other statins on the market include Zocor (simvastatin), Pravachol (pravastatin), Lescol (fluvastatin), and Livalo (pitavastatin).

Statin medications act on a specific enzyme in the liver called hydroxymethylglutaryl-CoA (HMG-CoA) reductase. HMG-CoA reductase inhibitors block the enzyme's ability to make cholesterol, resulting in lower cholesterol in the bloodstream (Sizar, 2020). Crestor and Lipitor also specifically lower LDL ("bad cholesterol"), raise HDL ("good cholesterol"), and improve triglyceride levels (types of fat molecules in the bloodstream).

High cholesterol and elevated triglycerides are major risk factors for the development of heart disease. Cholesterol and fats build up on the inside of blood vessels, causing atherosclerosis. This, in turn, leads to angina (chest pain), heart attacks, and strokes. In fact, heart disease is the leading cause of death for men and women in the United States (CDC, 2020). Crestor and Lipitor, along with diet and exercise, can help lower your risk of developing these life-threatening conditions. Over 27% of adults in the U.S. over the age of 40 are taking a statin medication (Salami, 2017).

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Crestor is made by AstraZeneca and is considered the most potent (strongest) statin. Like other statins, Crestor lowers total cholesterol, LDL cholesterol, and triglycerides while increasing HDL cholesterol. However, it causes significantly better reductions in total cholesterol at lower doses compared to the other drugs in this class (Jones, 2003). It is available in 5 mg, 10 mg, 20 mg, and 40 mg doses (both generic and brand name) and is typically taken once daily. 

Common side effects include muscle aches (myalgia), headache, dizziness, nausea, and constipation. There have also been reports of memory problems and confusion in some people, along with elevation of blood sugar levels in people with diabetes (UpToDate-b, n.d.).

Muscle pain and weakness (myopathy) are more likely in people of Asian descent, and the elderly (UpToDate-b, n.d.). Pregnant or breastfeeding women should not take Crestor. A 30-day supply of Crestor will cost you around $243 (without insurance), while generic rosuvastatin is approximately $51 for a month's supply.

Lipitor is made by Pfizer and is one of the most commonly prescribed statins in the U.S. (Salami, 2017). It is effective at reducing total cholesterol, LDL cholesterol, and triglycerides. Lipitor also increases HDL cholesterol. It is available in 10 mg, 20 mg, 40 mg, and 80 mg tablets that are typically taken once daily. Common side effects include joint pain, diarrhea, nasopharyngitis (think "common cold" symptoms), and, less commonly, muscle aches/pains (UpToDate-a, n.d.). 

Less than 2% of people who take Lipitor have abnormal liver enzyme levels noted on liver function tests. Because of this, you should have blood tests to check your liver before starting this medication (UpToDate-a, n.d.). Rarely, people may have muscle breakdown (myopathy) that leads to liver damage and kidney failure (rhabdomyolysis). Lastly, a small percentage of people have a hemorrhagic stroke (bleeding in the brain), especially if they have had a recent stroke or are on a blood thinner. However, the overall benefit of taking a statin (decreased risk of stroke and heart disease) outweighs the risk of having a hemorrhagic stroke with Lipitor (UpToDate-a, n.d.). 

You should avoid drinking large quantities of grapefruit juice if you are taking Lipitor as the grapefruit juice can increase the amount of the drug circulating in your system (UpToDate-a, n.d.). Pregnant or breastfeeding women should not take Lipitor. A 30-day supply of Lipitor will cost you around $207 (without insurance), while generic atorvastatin is approximately $17–$19 for a month's supply.

Both Lipitor and Crestor are excellent medications to help improve high cholesterol and to decrease your risk of heart attacks and strokes. In studies, Crestor was more effective at lowering total cholesterol levels and raising HDL levels (Jones, 2003).

Despite this, there was no significant difference between the two drugs in how well they decreased the volume of atherosclerotic buildup in the arteries. Both Crestor and Lipitor are generally well tolerated with a similar rate of side effects. In the end, you should consult your healthcare provider to determine which one is right for you. Take into account cost, side effects, other medications you are taking, and any pre-existing conditions.

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How we reviewed this article

Every article on Health Guide goes through rigorous fact-checking by our team of medical reviewers. Our reviewers are trained medical professionals who ensure each article contains the most up-to-date information, and that medical details have been correctly interpreted by the writer.

Current version

July 20, 2020

Written by

Chimene Richa, MD

Fact checked by

Mike Bohl, MD, MPH, ALM

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About the medical reviewer

Mike Bohl, MD, MPH, ALM

Dr. Mike is a licensed physician and a former Director, Medical Content & Education at Ro.