Rosuvastatin vs. Crestor: what's the difference?

Heart health is multifaceted, just like your finances. There are many ways to improve your finances, from cutting down monthly expenses to picking up side hustles to make more money, just as there are several ways to go about bolstering your heart health. Diet and exercise are great places to start, but for some people, that just isn't enough to improve important health markers like cholesterol and triglyceride levels. If you're in that position, your healthcare provider may have suggested considering a statin drug, such as rosuvastatin.

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Rosuvastatin, or rosuvastatin calcium, is the generic name for the statin sold as both a generic drug and the brand name prescription medication made by AstraZeneca, Crestor. Statins are a class of prescription drugs that aim to reduce elevated cholesterol levels in people with a high risk of developing cardiovascular disease (also called heart disease). Cardiovascular disease (CVD) is a group of conditions that may cause heart attacks, chest pain, and strokes. High cholesterol is one of the three key risk factors for developing CVD, which is the number one cause of death in the U.S and globally (CDC, 2019; WHO, 2017). 

Statins like rosuvastatin are also called HMG-CoA reductase inhibitors. They work by blocking the enzyme HMG-CoA reductase—this enzyme plays an important role in cholesterol production. Stopping the enzyme leads to lower low-density lipoprotein (LDL) or "bad cholesterol" levels. 

Rosuvastatin is approved by the U.S. Food and Drug Administration (FDA) to lower LDL cholesterol in people with hypercholesterolemia (abnormally high cholesterol) when diet and exercise alone aren't enough to bring levels down to their goal. It does this in two ways: by blocking an enzyme in the liver that's responsible for making cholesterol, and by encouraging your liver to break down cholesterol that's already in the blood so your body can get rid of it (Luvai, 2012).

Rosuvastatin is proven to be effective in lowering LDL cholesterol and total cholesterol—one review of 108 clinical trials found that rosuvastatin lowered LDL cholesterol by 46%-55% and total cholesterol by 29%-40% (Adams, 2014). The reduction increased as the rosuvastatin dosage increased. But LDL isn't the only type of cholesterol that matters. High-density lipoprotein or HDL cholesterol (often called "good" cholesterol) is important because it helps remove other types of cholesterol from your body and is also associated with a lower risk of heart disease (CDC, 2020-b). This same review also found that rosuvastatin increased HDL cholesterol levels by 7% (Adams, 2014).

Rosuvastatin can be used to do more than lowering cholesterol. Generic Crestor was FDA-approved in 2016 for the following uses (FDA-a, 2016):

• Treatment of high triglycerides (hypertriglyceridemia), along with diet modifications

• Treatment of patients with primary dysbetalipoproteinemia (Type III Hyperlipoproteinemia), a disorder where you have trouble breaking down cholesterol and triglycerides, along with diet modifications

• Treatment of homozygous familial hypercholesterolemia, a genetic condition where you not only have high LDL cholesterol but your liver has a hard time removing cholesterol from the body 

This list may seem limited compared to what clinical trials have shown generic Crestor can do in the body. In addition to lowering cholesterol, rosuvastatin has several "off-label" uses—this means that the FDA has not approved the drug for these uses. Clinical trials show that rosuvastatin can help stabilize arterial plaques, making it less likely they'll form a blood clot and, in turn, lowering your risk of heart attack (Thondapu, 2019). It also reduces plaque buildup in blood vessels (Dave, 2013).

Generic rosuvastatin is available in four different dosages: 5mg, 10mg, 20mg, and 40 mg, each taken once a day. It's common for healthcare providers to give patients 10mg as their starting dose, but this depends on the individual and the condition being treated. Patients of Asian descent, for example, may be given a lower dose of 5mg. Although researchers aren't sure why, trials have shown that rosuvastatin blood levels are sometimes increased in Asian patients, raising the likelihood of side effects (Wu, 2017). Regardless of your starting dose, blood tests will be run after 2-4 weeks of treatment to see if your dosage needs to be adjusted. It's important to mention any side effects you're experiencing at that time because this information may help your healthcare provider tailor the dosage to your individual state of health.

The condition being treated may also determine the dosage prescribed. When treating patients with homozygous familial hypercholesterolemia, clinical trials have shown the best results when treating with aggressive statin therapy and suggest rosuvastatin starting at higher doses (Lambert, 2014). This condition requires aggressive treatment because of the way familial hypercholesterolemia (FH) works. If you have one gene for FH, you have heterozygous familial hypercholesterolemia, characterized by extremely high LDL cholesterol and a family history of heart disease or stroke. But if both of your parents pass on the FH gene to you, you have homozygous familial hypercholesterolemia. Homozygous familial hypercholesterolemia is a much more severe condition, with extremely high cholesterol and heart attacks seen as early as childhood in people with this condition (CDC, 2020-a).

Regardless of your dosage, you should store your prescription at room temperature and out of the reach of children. In the case of a missed dose, you should take rosuvastatin as soon as you remember unless it's almost time for your next dose.

The most common side effects of rosuvastatin are headache, muscle aches, abdominal pain or stomach pain, weakness, and nausea. Rates of these side effects differed based on what dosage was studied. In clinical trials that looked at the efficacy of rosuvastatin, they found that the average frequency of side effects was (FDA, 2016-b):

• Headache: 5.5%

• Nausea: 3.4%

• Myalgia (muscle pain): 2.8%

• Asthenia (weakness or lack of energy): 2.7%

• Constipation: 2.4%

But it's important to remember that rosuvastatin comes in four possible strengths, and some side effects are more prevalent at some dosages than others. Headaches happen most commonly at 40 mg, while nausea and unexplained muscle pain occur most frequently at 20 mg (FDA, 2016-b). There have also been reports of memory loss and confusion while taking this drug; it can also affect several blood tests.

Although rare, there are more serious potential side effects of rosuvastatin, including muscle problems and liver problems. In some cases, muscle problems (myopathy) caused by rosuvastatin is indicative of muscle breakdown. This prescription drug may cause rhabdomyolysis, a breakdown of muscle tissue that may cause kidney problems in severe cases—watch for muscle pain, tenderness, and weakness (FDA-b, 2016). 

You should speak with your healthcare provider right away if you experience unexplained muscle pain (especially in combination with a fever), unusual tiredness or weakness, loss of appetite, upper belly pain, dark urine, or yellowing of the whites of your eyes or skin—these may be signs of a serious side effect such as muscle damage or liver damage. Get medical help immediately if you have severe allergic reaction symptoms such as swelling of the face, lips, or tongue (FDA-b, 2016).

Pregnant women should not use rosuvastatin—it is classified as Pregnancy Category X because it can harm the fetus. If you become pregnant while taking the drug, stop immediately, and inform your healthcare provider. Rosuvastatin is also not recommended for nursing mothers (FDA-b, 2016). 

Rosuvastatin may cause adverse effects if combined with other medications. If you're taking this medication to lower cholesterol, you may need to avoid the following medicines (FDA-b, 2016): 

• Fibrates such as gemfibrozil or fenofibrate

• Niacin

• Protease inhibitors such as ritonavir/, lopinavir, atazanavir, and simeprevir

• Blood thinners such as coumadin

• Cyclosporine

• Colchicine

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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.

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Current version

September 24, 2020

Written by

Linnea Zielinski

Fact checked by

Chimene Richa, MD

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About the medical reviewer

Chimene Richa, MD

Dr. Richa is a board-certified Ophthalmologist and medical writer for Ro.