Simvastatin vs. Atorvastatin: Which Is Better at Lowering Cholesterol?

Table of ContentsView AllTable of ContentsMain Similarities and DifferencesWhich Is More Effective?Side Effects and SafetyPrecautionsInteractionsHow to Take

Table of ContentsView All

View All

Table of Contents

Main Similarities and Differences

Which Is More Effective?

Side Effects and Safety

Precautions

Interactions

How to Take

Which Is More Effective for Lowering Cholesterol?

Atorvastatin is more effective in lowering cholesterol, as it has been shown in clinical studies to reduce LDL levels more than simvastatin.

Your healthcare provider will determine which intensity of statin is best for you.

Can You Switch Between Simvastatin and Atorvastatin?

You can potentially switch between simvastatin and atorvastatin under the supervision of a healthcare provider. Typically, you might switch between statins if your cholesterol levels are not at goal or if you’re experiencing side effects such as muscle pain.

If you do switch between medications, you’ll need to have your cholesterol levels regularly checked to ensure the new medication is working. Whether you are interested in switching or starting a new statin, always work closely with your healthcare provider to ensure you’re on the proper cholesterol treatment.

Both simvastatin and atorvastatin share common side effects because they are both statin medications. Common statin side effects include:

Muscle Pain

The most common side effect of statins experienced in people ismuscle pain or weakness.

The muscle pain usually presents as muscle soreness, tiredness, or weakness on both sides of the legs, back, or arms.It may occur within a few weeks or months of starting statin therapy, but it can develop anytime. Increasing the intensity of the statin or the dose usually raises the risk of developing muscle pain.

Liver Monitoring

Since statins work in the liver, it is important that your healthcare provider routinely monitors your liver function to make sure the statin is not causing any liver damage.Your liver function may be affect if you have signs or symptoms of:

Pregnancy and Breastfeeding

According to statin medication labels, these medications are not recommended for use while pregnant. The FDA is requesting to remove this restriction, recognizing that statins can prevent serious or fatal events in high-risk pregnant people.

However, if you are breastfeeding, statins are not recommended because the medications may pass into the breast milk. Let your healthcare provider know if you are pregnant, trying to become pregnant, or breastfeeding.

Diabetes

Using any statin may increase yourblood sugar levels. However, statins can also reduce your risk of a heart attack and stroke. This is especially significant in people with diabetes, a condition in which the body doesn’t produce or use the hormone insulin properly, which regulates blood sugar.

Diabetes significantly increases the risk of developing heart disease and stroke since high blood sugar levels can damage blood vessels over time. In addition to lowering cholesterol, regularly monitoring blood sugar levels is important in diabetes.

Liver Disease

Statins are not recommended if you have severe liver disease because they can damage the liver.If you have liver disease, talk to your healthcare provider about the risks and benefits of a statin.

Drugs to Avoid With Simvastatin

Simvastatin mayinteractwith some food and medications, such as:

When these medications are combined with simvastatin, they can increase simvastatin levels in the body. This can heighten the risk of muscle pain and liver damage. Before starting any new medication or supplement while taking simvastatin, consult your healthcare provider to ensure there are no harmful interactions.

The above medications may also interact with atorvastatin but to a lesser extent. Dosage adjustments may be necessary.

Amiodarone, Verapamil, and Diltiazem

Pacerone (amiodarone) is a heart medication used to regulate heart rhythm. Amiodarone can increase simvastatin levels in the blood, potentially leading to muscle pain or liver damage. To minimize this risk, the daily simvastatin dosage should not exceed 20 mg while taking amiodarone.

Verelan (verapamil) and Cardizem (diltiazem) are heart medications that slow heart rate and reduce blood pressure. When taken with simvastatin, however, the risk of muscle pain and liver damage increases due to higher blood levels of simvastatin.

To minimize this risk, the daily simvastatin dosage should not exceed 10 mg while taking verapamil or diltiazem.

These interactions can also occur with atorvastatin, with an increased risk at higher doses.

Gemfibrozil and Niacin

Lopid (gemfibrozil) or Niacor (niacin), two other cholesterol-lowering medications, should not be combined with any statin because they can increase the risk of muscle damage when taken together.

Dosing Guidance

Your healthcare provider will determine your need for a high-intensity statin based on your medical history, including any existing heart conditions, diabetes, or current cholesterol levels.

When to Take Simvastatin or Atorvastatin?

Simvastatin is best taken in the evening because your body produces the most cholesterol at night.

In contrast,atorvastatin can be taken any time of the daybecause it is a longer-acting statin than simvastatin. This means its effects will last longer than shorter-acting statins, such as simvastatin.

Take atorvastatin consistently at the same time each day to help maintain a steady level of medication in your system.

What Happens If You Miss a Dose?

If you miss a simvastatin dose, take it as soon as you remember. If it is close to your next dose, skip the missed dose.

If you miss an atorvastatin dose, skip the missed dose and go back to your normal scheduled dose. Do not take two doses at the same time.

Summary

The choice between simvastatin and atorvastatin depends on individual factors, including cholesterol levels, other health conditions, and potential side effects. Consult with a healthcare provider to find the most appropriate medication and dosage for you.

11 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Grundy SM, Stone NJ, Bailey AL, et al.2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Blood Cholesterol: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines.J Am Coll Cardiol. 2019;73(24):3168-3209. doi:10.1016/j.jacc.2018.11.002Karlson BW, Wiklund O, Palmer MK, et al.Variability of low-density lipoprotein cholesterol response with different doses of atorvastatin, rosuvastatin, and simvastatin: results from VOYAGER.Eur Heart J Cardiovasc Pharmacother. 2016;2(4):212-217. doi:10.1093/ehjcvp/pvw006DailyMed.Label: Zocor- simvastatin tablet, film coated.DailyMed.Label: Lipitor- atorvastatin calcium tablet, film coated.Chou R, Cantor A, Dana T, et al. Statin use for the primary prevention of cardiovascular disease in adults: a systematic review for the U.S. Preventive Services Task Force [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US); 2022. (Evidence Synthesis, No. 219.)Table 1, Statin Dosing and ACC/AHA Classification of Intensity.DailyMed.Label: Zocor- simvastatin tablet, film coated.Ruscica M, Ferri N, Banach M, et al.Side effects of statins: from pathophysiology and epidemiology to diagnostic and therapeutic implications.Cardiovasc Res. 2023;118(17):3288-3304. doi:10.1093/cvr/cvac020Pergolizzi JV Jr, Coluzzi F, Colucci RD, et al.Statins and muscle pain.Expert Rev Clin Pharmacol. 2020;13(3):299-310. doi: 10.1080/17512433.2020.1734451Akimoto H, Negishi A, Oshima S, et al.Onset timing of statin-induced musculoskeletal adverse events and concomitant drug-associated shift in onset timing of MAEs.Pharmacol Res Perspect. 2018;6(6):e00439. doi:10.1002/prp2.439Food and Drug Administration.Statins: drug safety communication - FDA requests removal of strongest warning against using cholesterol-lowering statins during pregnancy.American Diabetes Association Professional Practice Committee.10. Cardiovascular disease and risk management: standards of care in diabetes-2024.Diabetes Care. 2024;47(Suppl 1):S179-S218. doi:10.2337/dc24-S010

11 Sources

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Grundy SM, Stone NJ, Bailey AL, et al.2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Blood Cholesterol: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines.J Am Coll Cardiol. 2019;73(24):3168-3209. doi:10.1016/j.jacc.2018.11.002Karlson BW, Wiklund O, Palmer MK, et al.Variability of low-density lipoprotein cholesterol response with different doses of atorvastatin, rosuvastatin, and simvastatin: results from VOYAGER.Eur Heart J Cardiovasc Pharmacother. 2016;2(4):212-217. doi:10.1093/ehjcvp/pvw006DailyMed.Label: Zocor- simvastatin tablet, film coated.DailyMed.Label: Lipitor- atorvastatin calcium tablet, film coated.Chou R, Cantor A, Dana T, et al. Statin use for the primary prevention of cardiovascular disease in adults: a systematic review for the U.S. Preventive Services Task Force [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US); 2022. (Evidence Synthesis, No. 219.)Table 1, Statin Dosing and ACC/AHA Classification of Intensity.DailyMed.Label: Zocor- simvastatin tablet, film coated.Ruscica M, Ferri N, Banach M, et al.Side effects of statins: from pathophysiology and epidemiology to diagnostic and therapeutic implications.Cardiovasc Res. 2023;118(17):3288-3304. doi:10.1093/cvr/cvac020Pergolizzi JV Jr, Coluzzi F, Colucci RD, et al.Statins and muscle pain.Expert Rev Clin Pharmacol. 2020;13(3):299-310. doi: 10.1080/17512433.2020.1734451Akimoto H, Negishi A, Oshima S, et al.Onset timing of statin-induced musculoskeletal adverse events and concomitant drug-associated shift in onset timing of MAEs.Pharmacol Res Perspect. 2018;6(6):e00439. doi:10.1002/prp2.439Food and Drug Administration.Statins: drug safety communication - FDA requests removal of strongest warning against using cholesterol-lowering statins during pregnancy.American Diabetes Association Professional Practice Committee.10. Cardiovascular disease and risk management: standards of care in diabetes-2024.Diabetes Care. 2024;47(Suppl 1):S179-S218. doi:10.2337/dc24-S010

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

Grundy SM, Stone NJ, Bailey AL, et al.2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Blood Cholesterol: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines.J Am Coll Cardiol. 2019;73(24):3168-3209. doi:10.1016/j.jacc.2018.11.002Karlson BW, Wiklund O, Palmer MK, et al.Variability of low-density lipoprotein cholesterol response with different doses of atorvastatin, rosuvastatin, and simvastatin: results from VOYAGER.Eur Heart J Cardiovasc Pharmacother. 2016;2(4):212-217. doi:10.1093/ehjcvp/pvw006DailyMed.Label: Zocor- simvastatin tablet, film coated.DailyMed.Label: Lipitor- atorvastatin calcium tablet, film coated.Chou R, Cantor A, Dana T, et al. Statin use for the primary prevention of cardiovascular disease in adults: a systematic review for the U.S. Preventive Services Task Force [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US); 2022. (Evidence Synthesis, No. 219.)Table 1, Statin Dosing and ACC/AHA Classification of Intensity.DailyMed.Label: Zocor- simvastatin tablet, film coated.Ruscica M, Ferri N, Banach M, et al.Side effects of statins: from pathophysiology and epidemiology to diagnostic and therapeutic implications.Cardiovasc Res. 2023;118(17):3288-3304. doi:10.1093/cvr/cvac020Pergolizzi JV Jr, Coluzzi F, Colucci RD, et al.Statins and muscle pain.Expert Rev Clin Pharmacol. 2020;13(3):299-310. doi: 10.1080/17512433.2020.1734451Akimoto H, Negishi A, Oshima S, et al.Onset timing of statin-induced musculoskeletal adverse events and concomitant drug-associated shift in onset timing of MAEs.Pharmacol Res Perspect. 2018;6(6):e00439. doi:10.1002/prp2.439Food and Drug Administration.Statins: drug safety communication - FDA requests removal of strongest warning against using cholesterol-lowering statins during pregnancy.American Diabetes Association Professional Practice Committee.10. Cardiovascular disease and risk management: standards of care in diabetes-2024.Diabetes Care. 2024;47(Suppl 1):S179-S218. doi:10.2337/dc24-S010

Grundy SM, Stone NJ, Bailey AL, et al.2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Blood Cholesterol: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines.J Am Coll Cardiol. 2019;73(24):3168-3209. doi:10.1016/j.jacc.2018.11.002

Karlson BW, Wiklund O, Palmer MK, et al.Variability of low-density lipoprotein cholesterol response with different doses of atorvastatin, rosuvastatin, and simvastatin: results from VOYAGER.Eur Heart J Cardiovasc Pharmacother. 2016;2(4):212-217. doi:10.1093/ehjcvp/pvw006

DailyMed.Label: Zocor- simvastatin tablet, film coated.

DailyMed.Label: Lipitor- atorvastatin calcium tablet, film coated.

Chou R, Cantor A, Dana T, et al. Statin use for the primary prevention of cardiovascular disease in adults: a systematic review for the U.S. Preventive Services Task Force [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US); 2022. (Evidence Synthesis, No. 219.)Table 1, Statin Dosing and ACC/AHA Classification of Intensity.

Ruscica M, Ferri N, Banach M, et al.Side effects of statins: from pathophysiology and epidemiology to diagnostic and therapeutic implications.Cardiovasc Res. 2023;118(17):3288-3304. doi:10.1093/cvr/cvac020

Pergolizzi JV Jr, Coluzzi F, Colucci RD, et al.Statins and muscle pain.Expert Rev Clin Pharmacol. 2020;13(3):299-310. doi: 10.1080/17512433.2020.1734451

Akimoto H, Negishi A, Oshima S, et al.Onset timing of statin-induced musculoskeletal adverse events and concomitant drug-associated shift in onset timing of MAEs.Pharmacol Res Perspect. 2018;6(6):e00439. doi:10.1002/prp2.439

Food and Drug Administration.Statins: drug safety communication - FDA requests removal of strongest warning against using cholesterol-lowering statins during pregnancy.

American Diabetes Association Professional Practice Committee.10. Cardiovascular disease and risk management: standards of care in diabetes-2024.Diabetes Care. 2024;47(Suppl 1):S179-S218. doi:10.2337/dc24-S010

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