Statin Dose Comparison: Read Intensity Without Assuming Equivalence
A statin comparison chart can help you understand treatment intensity. It cannot tell you that two doses are interchangeable for you. Atorvastatin, rosuvastatin, and simvastatin differ in potency, interaction limits, and dosing restrictions. Even when two regimens share an intensity category, their effects on your cholesterol may differ.
A useful comparison identifies the intended intensity, the cholesterol response already measured, and restrictions affecting a proposed replacement. These details make the chart useful at an appointment.
Read categories, not conversions
Intensity describes the average percentage reduction in LDL cholesterol: high intensity is at least 50%, moderate intensity is 30% to less than 50%, and low intensity is less than 30%. These are group averages, not promises about an individual result.[2]
| Statin | High intensity | Moderate intensity | Low intensity |
|---|---|---|---|
| Atorvastatin | 40–80 mg daily | 10–20 mg daily | Not listed |
| Rosuvastatin | 20–40 mg daily | 5–10 mg daily | Not listed |
| Simvastatin | Not listed | 20–40 mg daily | 10 mg daily |
These are guideline dose categories, not prescriptions or milligram-for-milligram equivalents.[2] “Not listed” means no regimen appears in that category for this comparison. It does not establish that another dose is appropriate, approved for your circumstances, or free of restrictions. The three agents here answer the most common paired comparisons.
Similar intensity does not mean identical response
Simvastatin 40 mg and atorvastatin 10 mg both fall within moderate intensity, but that does not make them the same treatment. A broad category can contain meaningful differences in LDL lowering. Your measured response also depends on whether you take the medicine consistently and on your individual biology.
A rosuvastatin review included 108 short-term trials involving 19,596 participants. Across doses of 10–40 mg, average LDL reductions were approximately 46–55% over 3–12 weeks.[5] Those findings describe short-term lipid effects, not an exact conversion formula, a guaranteed personal percentage, or cardiovascular outcomes from switching.
The current AHA guideline summary also makes clear that intensity is only part of the decision. Percentage LDL reduction remains important, while absolute LDL and non-HDL goals depend on risk. The guideline uses PREVENT rather than the older Pooled Cohort Equations.[1] This chart is not the full current treatment algorithm.
Interaction limits can override the attractive option
A dose may look suitable in a potency table yet be unsuitable alongside another medicine. The simvastatin label limits dosing to 10 mg daily with verapamil, diltiazem, or dronedarone, and 20 mg daily with amiodarone, amlodipine, or ranolazine.[3] These are prescribing boundaries requiring review—not instructions to change your own dose.
Rosuvastatin also has interaction-specific restrictions. Its different metabolism does not mean that all combinations are unrestricted.[4] Review the actual medication list, including supplements, rather than selecting a statin based on a reputation for fewer interactions. A statin change does not automatically require changes to every blood pressure medicine.
Kidney function and tolerability matter
For severe renal impairment, defined in the rosuvastatin label as creatinine clearance below 30 mL/min in someone not receiving hemodialysis, the labeled starting dose is 5 mg and the maximum is 10 mg.[4] This illustrates why kidney function can rule out a table entry. It does not establish one statin as universally safest in chronic kidney disease.
Simvastatin 80 mg is restricted to people who have already taken it chronically—such as for at least 12 months—without muscle toxicity. It is not a dose to start or escalate to because a chart suggests greater lowering.[3]
Check the result, not just the chart
A switch should have an agreed plan for checking cholesterol response and tolerability. Do not infer a start date, mandatory break, or follow-up calendar from an intensity category. New unexplained muscle pain or weakness warrants prompt contact; severe symptoms or dark urine need urgent assessment.[3,4]
Warfarin requires INR review around relevant statin changes, without a universal monitoring timetable.[3,4] Pregnancy or breastfeeding also changes the medication review: FDA removed the blanket pregnancy contraindication, but most pregnant patients should stop statins, with rare high-risk exceptions assessed individually.[6] None of these decisions can be settled by matching milligrams.
Frequently asked questions
What is the equivalent dose of rosuvastatin to atorvastatin?
Use the intensity categories in the table as a starting point, then compare the actual LDL response and product restrictions. A shared category does not establish a precise milligram conversion.[2]
Is simvastatin 40 mg the same as atorvastatin 10 mg?
No. Both are moderate intensity, but that category covers a range of average LDL reductions. Their interaction restrictions and your response can differ, so category membership alone does not justify substituting one for the other.[2,3]
How long after switching statins should I recheck my cholesterol?
Arrange the timing with your prescriber when the switch is planned. The follow-up should assess the new regimen’s LDL response and tolerability. An intensity table does not supply a personal testing schedule, and new concerning symptoms should not wait for a cholesterol check.
Can I switch from simvastatin to rosuvastatin without a break?
The comparison table cannot determine whether you need a break. The reason for switching, current symptoms, interactions, and kidney function affect the plan. Confirm when to stop the old medicine and start the new one rather than assuming a washout period or overlapping them.
What is a high-intensity statin?
A regimen expected to reduce LDL cholesterol by at least 50% on average. The table lists the atorvastatin and rosuvastatin regimens in this category; the response still needs to be measured.[2]
Does switching statins affect my blood pressure medication?
Review compatibility with the full medication list. Simvastatin has specific limits with several blood-pressure medicines.[3] A statin change alone does not prove the blood-pressure prescription needs retitration.
What are the signs that my statin dose is too high after switching?
Report new unexplained muscle symptoms. Severe weakness or dark urine needs urgent assessment.[3,4] A symptom cannot identify the correct replacement dose by itself.
Is pitavastatin equivalent to atorvastatin?
There is no universal milligram equivalence. Pitavastatin is a different medicine; a comparison requires its current product restrictions, the intended treatment intensity, and your measured response. Its omission from this three-drug table is not clearance to substitute it.
Can I take a statin with apixaban or rivaroxaban?
Have a pharmacist review the specific statin, anticoagulant, doses, kidney function, and other medicines. This conversion table does not test anticoagulant combinations or establish rosuvastatin as automatically preferred. It also does not justify changing an anticoagulant dose.
What statin is safest in chronic kidney disease?
There is no single safest choice for everyone with CKD. Kidney function, other medicines, previous adverse effects, and treatment goals matter. Rosuvastatin has specific restrictions in severe renal impairment, so a high-intensity table entry may not be suitable.[4]
Why was simvastatin 80 mg restricted by the FDA?
Higher muscle-injury risk led to restrictions for established long-term users.[3] It is not a new-start or dose-escalation option; an unmet cholesterol goal requires a prescribing review.
References
Sources checked October 14, 2026.
- American Heart Association. 2026 Guideline on the Management of Dyslipidemia: Top Things to Know. March 13, 2026. Official summary.
- American College of Cardiology. Statin Intolerance Tool. Public statin-intensity section. Clinical tool.
- Organon. ZOCOR (simvastatin) prescribing information. DailyMed updated March 28, 2025; labeling revised August 2023. Label.
- AstraZeneca. CRESTOR (rosuvastatin) prescribing information. FDA, April 2026. Label PDF.
- Adams SP, Sekhon SS, Wright JM. Lipid-lowering efficacy of rosuvastatin. 2014. PMID: 25415541. PubMed abstract.
- U.S. Food and Drug Administration. FDA requests removal of strongest warning against using cholesterol-lowering statins during pregnancy. July 20, 2021. Safety communication.
