Indications for use of atorvastatin and instructions. Which is better: the effectiveness of Simvastatin or Atorvastatin, comparative analysis of drugs. Is it possible to take Simvastatin and Atorvastatin together?
Both drugs lower blood cholesterol levels and belong to the group of statins (synthetic drugs that lower lipid levels). These medications are available only in tablets and are taken orally; they have similar indications, contraindications for use, and their effectiveness depends on the dose. It is recommended to take Rosuvastatin or Simvastatin after the ineffectiveness of dietary measures, increasing physical activity in middle-aged people for a period of about six months. Together with these measures, these drugs are used for hereditary forms of hypercholesterolemia (high blood cholesterol) and clinical manifestations of atherosclerosis.
What is the difference between Rosuvastatin and Simvastatin?
These drugs are used only as prescribed by a doctor.
The drugs belong to different generations of statins, the use of which began in 1971 in Japan. Some differences between these tablets are presented in the table.
| Features | ||
|---|---|---|
| The need for drug conversion in the liver before effective action (impaired cholesterol synthesis) | Eat | No |
| Half-life (the longer, the less frequent the frequency of administration) | 5-6 hours | 19 hours |
| Start of action | 2-4 weeks | 5-7 days |
| Initial dose | 10 mg | 5 mg |
| Average dosage | 20-40 mg | 10 mg |
| Maximum daily dose | 80 mg | 40 mg |
| Effect on blood lipid spectrum | Reduces the content of LDL, VLDL, TG, total cholesterol | Additionally increases HDL levels |
| Effect on carbohydrate metabolism | May provoke the development of type 2 diabetes | Does not affect |
| Number of side effects | Up to 1% | Less pronounced, less common |
| Time of receipt | Evening | Doesn't matter |
| Country of issue | Serbia, Russia | UK, Russia |
| Number of analogues | 25 | 12 |
The main positive effect of Simvastatin (like any statin) is considered to be a decrease in the level of “bad” cholesterol (LDL, VLDL), it changes the walls of the arteries with the development of plaques that narrow the lumen of the vessels. The results of using these drugs are monitored by analyzing the lipid spectrum (all fractions of blood lipids). An increase in the absolute amount of “good” cholesterol (HDL) when using Rosuvastatin (as opposed to Simvastatin) becomes a pleasant bonus. This lipid fraction can prevent the development of atherosclerosis and further reduce the risk of death from vascular accidents.
30 tab. 10 mg each How does a doctor choose
The doctor prescribes statins taking into account many factors that influence the effectiveness of treatment. To determine what is best for a particular patient, the doctor analyzes the results of basic and additional research methods. This:
- Patient complaints.
- Past illnesses.
- Heredity.
- Results of ECG (electrocardiogram), MRI (magnetic resonance imaging), ultrasound (ultrasound) of blood vessels, heart.
If a high level of “bad” lipids is accompanied by manifestations of ischemic heart disease (coronary heart disease), atherosclerosis of the brain vessels, lower extremities, a specialist in the treatment of these diseases prescribes any statin together with other medications (for example, Simvastatin). The peculiarities of the action of the drugs are discussed with the patient in the event of the development of any side effects (more common with Simvastatin), or the patient’s concern about taking the best combination of drugs without taking into account their cost. Existing type 2 diabetes mellitus and restrictions on physical activity force Rosuvastatin to be prescribed as the drug of choice. This representative of the latest generation of statins is distinguished by the fact that it can be taken without fear of unpleasant “side effects” associated with the effect on the liver, and the effect can be assessed more quickly.
30 tab. 20 mg each (RF) What will the patient choose?
The choice of medication depends on a competent assessment of the advantages and disadvantages of the combination of drugs for the treatment of atherosclerosis and its complications. You can independently try to understand the meaning of medical prescriptions by visiting Internet forums and medical consultation sites. It is much safer to discuss all the details with the attending physician, who knows all the results of the examination. The decisive factors for choosing an option are:
- Maximum effectiveness with a small dosage of the chemical.
- Minimal side effect.
- Reasonable price.
Rosuvastatin meets the first two selection criteria; it is recommended by experts in the fight against atherosclerosis as the safest tablet for long-term use (many years). The price of this drug is 2 or more times higher than the cost of Simvastatin, which depends on the country of manufacture and brand. For example, the brand drug Crestor can cost 10 times more, amounting to more than 5,000 rubles. for a month of treatment. Domestic generics (for example, Rosuvastatin-SZ) will cost an order of magnitude cheaper. The final choice of remedy depends on the patient’s conviction of the need for treatment, which encourages him to continue taking the medicine for many years and to consult a doctor for mandatory monitoring of the effectiveness of the prescriptions.
Among all diseases in Russia, atherosclerosis occupies one of the first places. To prevent complications of this disease (secondary and sometimes primary), the use of drugs belonging to the group of statins, for example Rosuvastatin or Atorvastatin, is justified.
Statins
Statins are drugs whose effectiveness in the treatment of atherosclerosis has been proven. With their help, it is relatively easy to reduce blood cholesterol levels. The effectiveness of these drugs is determined by the simplicity of the mechanism of action and excellent tolerability by patients suffering from hypercholesterolemia.
At the same time, it is worth noting that the group of statins is a broad category, represented by a large number of drugs. This entails confusion, errors in the choice of therapeutic methods on the part of inexperienced doctors and failure to observe the fundamental differences between drugs in this group.
The article describes two means - the most common in their group. When prescribing one or the other, it is fundamentally important to understand the difference, which will help optimize the treatment of each individual patient and increase the likelihood of recovery. Do not forget about the safety of the chosen product.
What are statins?
Statins are a group of lipid-lowering drugs that are effective and safe to use. The modern standard of medical care is almost unthinkable without them, since these funds are used for a wide range of patients in the field of cardiology.
All drugs in this group, when compared, have approximately the same effect: they reduce the level of cholesterol in the patient’s blood. At the same time, it is worth noting that, despite all the variety, drugs have significant differences from each other, which must be taken into account when choosing a treatment method. In certain situations, the type of statin chosen plays a decisive role in the outcome of therapy.
Cholesterol All statins can be classified. There is a lot of information on this topic, but the first thing you should pay attention to when choosing is the generation of the medicine:
- 1st generation statins – Lovastatin and Cardiostatin;
- II generation statins - Fluvastatin, Pravastatin or Simvastatin;
- III generation statins – Atorvastatin or Cerivastatin;
- IV generation statins – Rosuvastatin, Pitavastatin.
All drugs in this therapeutic group are of natural or artificial origin and are prescribed to patients in varying dosages. Whether a drug is classified as high-dose, medium-dose or low-dose also plays a decisive role in the choice. It is worth noting that the drugs in question have the following characteristics:
- Rosuvastatin is a medicine that belongs to the latest (fourth) generation statins, of synthetic origin, with an average dosage of the active substance;
Rosuvastatin - Atorvastatin is a third-generation drug, synthetic in origin, containing a high dosage of the active substance.
Atorvastatin It is important that all statins have approximately the same mechanism of action in humans. This does not depend on the class of the drug or its origin. These medications block the enzyme HMG-CoA reductase, which is detected in liver tissue and is responsible for the production of cholesterol. At the same time, the amount of both total cholesterol and low-density lipoproteins, which play a major role in the development of vascular atherosclerosis, decreases. This entails a decrease in the severity of symptoms of the disease and an improvement in the patient’s well-being.
Atorvastatin and Rosuvastatin are drugs of the same group that improve the condition of the internal walls of blood vessels. They are used for any form of disease associated with high cholesterol levels, after myocardial infarction and ischemic stroke (for secondary prevention). During the treatment process, doctors often have to make a choice, choosing either one or another drug, making comparisons and analyzing effectiveness.
Rosuvastatin
Rosuvastatin is a synthetic drug whose effect has been tested in practice. Its medicinal properties have been proven and its use is economical. Indications for the use of Rosuvastatin are as follows:
- acute heart attack;
- secondary hypertension;
- atherosclerosis;
- stroke.
It is important to keep in mind when prescribing this drug that its use guarantees greater patient safety than when taking Atorvastatin, while the effectiveness may differ to a lesser extent.
The procedure for using Rosuvastatin is typical for all drugs in this category. In the first days of treatment, it is not recommended to drink more than 10 mg of medication per day. If no side effects are observed, the dose may be increased to 40 mg per day. Rosuvastatin is not used in the treatment of patients whose disease (hypercholesterolemia) is genetically determined or hereditary.
Pills The medicine is considered safe for the liver; it does not destroy muscle fibers. The first positive changes are noticeable from the first days of treatment. Maximum effectiveness is achieved when the patient uses Rosuvastatin regularly for 30 days. Statistics have revealed that a month after starting the drug, the drug helps reduce cholesterol levels by 50%, and at the same time, HDL levels increase by 10%.
Efficacy of the drug
Long-term comparative studies showed that when using Rosuvastatin (40 mg dosage) and Atorvastatin (80 mg dosage), the first drug was slightly more effective than the second. Cholesterol levels dropped by 47 and 43 percent, respectively. The increase in the level of “good” cholesterol was somewhat surprising: when taking Rosuvastatin, it crossed the 12% mark, while using Atorvastatin gave an increase of only 6%.
Helpers in the fight against cholesterol Working directly in the liver, the drug increases the number of receptors designed to recognize LDL molecules. As a result, their uptake by hepatocytes and subsequent catabolism increases. In the blood, low-density lipoproteins are reduced by 50-55%. This reduces the atherogenic index and improves the lipid profile in those taking the drug.
When taking Rosuvastatin for a month, the effect of the drug gains strength, reaching a maximum by the 30th day of use. Next, the therapeutic effect enters the stage of stagnation. Doctors are starting to talk about maintaining the achieved results.
Since Rosuvastatin belongs to the group of statins of the latest, fourth generation, a standard dosage of 40 mg is sufficient to obtain the maximum effect. The medicine is well tolerated by patients; unlike previous generations of statins, it is metabolized minimally in the liver, 10%, and 90% is excreted unchanged.
Atorvastatin
Atorvastatin is a statin, an inhibitor of the enzyme responsible for the production of cholesterol. The use of the described medication entails blocking the action of HMG-CoA reductase. When using Atorvastatin, it is recommended to follow a diet that helps reduce “bad” cholesterol. Among all the drugs in the statin group, it is considered one of the safest and at the same time effective.
Patients who can be treated with Atorvastatin belong to different groups: men and women, adults and children, people suffering from cardiovascular diseases. In therapy, the same dosages of drugs from different groups of statins can be used, but Atorvastatin will be more effective.
The use of the medicine conventionally takes place in two stages. At first, the daily dose should not exceed 20 mg per day. If the patient does not notice any side effects, the dosage is increased to 40 mg. If the patient is diagnosed with complex diseases of the cardiovascular system, then the effective dose will be 80 mg of the drug per day.
Efficacy of Atorvastatin
Atorvastatin is one of the best, most effective statins and at the same time practically the safest. Taking 10 mg of the drug leads to an improvement in indicators by 36%, and regular daily use of 40 mg of the drug reduces cholesterol levels by 51%. This is a result that modern medicine considers quite good.
It is important that the use of Atorvastatin reduces the risk of strokes and cerebral infarctions. The incidence of recurrent stroke decreased by 43% among patients treated with Atorvastatin.
The Russian market presents drugs based on Atorvastatin, the names of which are as follows:
- Atokor;
- Liprimar;
- Atoris;
- Torvacard;
- Tulip;
- Lipona and others.
Torvacard All the drugs mentioned above are third-generation statins and are aimed at reducing cholesterol levels in the patient’s blood. The differences between them are minimal.
Comparison of drugs
Despite fairly similar indications for use and pharmacokinetics, Atorvastatin and Rosuvastatin have some differences. First of all, we note the following:
- Absorption from the intestine. This parameter determines the method of taking the drug. Thus, Atorvastatin is absorbed much less well if taken at the same time as food. Rosuvastatin, on the contrary, should be taken with food, since it is absorbed in a constant amount, and the absorption of the drug is not affected by the nature of the meal and its volume.
- Indications and contraindications. Both drugs are indicated for the treatment of cases where it is necessary to reduce blood cholesterol levels. The most important point that leads to fundamental differences between drugs is the process of metabolism, that is, transformation in the body. Atorvastatin is actively affected by liver enzymes, and excretion is carried out along with bile. This means that the use of the drug is contraindicated in patients with liver disease. At the same time, Rosuvastatin is practically not metabolized in the body; excretion occurs in feces; patients with liver diseases are allowed to use the medicine.
- Efficacy of drugs. Reducing low-density cholesterol and increasing the amount of “good” cholesterol is the main goal of drugs such as Atorvastatin and Rosuvastatin. The second remedy in clinical trials proved slightly more effective than the first. The incidence of side effects when taking both drugs is approximately the same.
The decision as to what is best for a particular patient rests solely with the attending physician, using instructions for use and personal comparison. When choosing, he should rely on such criteria as the effectiveness and order of taking the medication, the type of metabolism, concomitant diseases and, of course, the cost of the drug. In some situations, the last point may be critical.
Every doctor should know how Atorvastatin differs from Rosuvastatin. The differences between the drugs are minor, but it is worth remembering that the clinical effect of Rosuvastatin is more pronounced, and Atorvastatin is safer.
Contraindications and side effects when taking statins
When taking statins, you should consider the following contraindications:
- pathological kidney diseases;
- cataract;
- abnormalities in the functioning of the thyroid gland;
- pregnancy and preparation for it;
- disturbances in liver function;
- individual reaction of the body to the components of the drug.
Attention! Independent use of statins for preventive purposes is prohibited. You must get a doctor's prescription. It is better if the patient undergoes a preventive examination before this.
Depending on the presence of other risk factors, atherosclerosis and its clinical manifestations (past or present), doctors divided all adults into 3 risk groups, each of which has its own acceptable cholesterol level.
The role of cholesterol in human death is simple: it fills blood vessels along with fats, forming atherosclerotic plaques on the walls. The beginning of the tragedy occurs when platelets are attached to it, blocking the vessel.
Blood supply stops if the plaque is in a heart vessel, myocardial infarction develops, if in the brain - a stroke, if in the extremities - gangrene of the legs.
For many years, the only method in the arsenal of doctors to combat high cholesterol was to control its level followed by the prescription of statins, a class of drugs for lowering cholesterol and treating atherosclerosis. New research in medicine has forced specialists to take a different look at this problem.
The latest information on the latest generation statins is presented at https://davlenie.guru/statiny-poslednego-pokoleniya.html
Statins – what are they?
These drugs rank first in the number of patients who take them. The mechanism of action of lipid-lowering medications is based on the inhibition of enzymes with the complex name “HMG-CoA reductase,” which provoke the production of new cholesterol in the liver.
Statins restore damaged blood vessels when atherosclerosis has not yet been identified, but “bad” cholesterol is already accumulating in the walls. They improve medications and the rheological capabilities of blood: they reduce viscosity and prevent the appearance of blood clots.
In terms of effectiveness, the leading drugs for high cholesterol are the new generation, based on atorvastatin, cerivastatin, rosuvastatin and pitavastatin.
Statins not only reduce the concentration of bad cholesterol, but also increase the content of good cholesterol. The results from the use of drugs in this group can be seen within a month after regular use. Statins are prescribed once a day, at night; a combination of cardiological drugs in one tablet is allowed.
Self-medication with statins is unacceptable, since the doctor’s recommendations are based on the results of biochemical blood tests, in particular, LDL readings. When this parameter does not exceed 6.5 mmol/l, it is reduced by adjusting diet and lifestyle. If these measures are not enough, after six months the doctor prescribes statins.
It is not easy for the uninitiated consumer to understand: rosuvastatin and atorvastatin - what is the difference between these and other similar drugs that inhibit the enzyme that synthesizes cholesterol? Rosuvastatin is a new generation drug that compares favorably with its predecessors.
At doses equivalent to atorvastatin, it has a more pronounced effect. An important argument will be its lower toxicity.
You can learn more about how to take statins correctly from the video
Medicines that prolong life
If non-drug therapy was ineffective, traditionally the main indication for prescribing inhibitors was hypercholesterolemia (including high levels of cholesterol of a genetic nature).
Today, statins are prescribed even with normal cholesterol levels:
- Patients with coronary artery disease;
- After myocardial infarction;
- After any operation on the coronary arteries (stenting, bypass surgery);
- If the patient has suffered a stroke;
- For diabetes mellitus with high LDL levels.
The effect of statins is much broader than simply normalizing cholesterol levels; globally, they are drugs that prolong life. The decisive factor when prescribing statins is actively progressing atherosclerosis. All of the above pathologies, as well as hereditary predisposition, provide an increased risk of vascular damage.
Using statins along with heart medications significantly reduces the likelihood of sudden death from heart failure.
This class of medications is contraindicated for hepatitis, cirrhosis and other liver pathologies. Statins are not recommended during pregnancy and breastfeeding. Women of childbearing age should not take them unless they are protected by reliable contraception. Statins are not prescribed if allergic reactions are detected.
Statins do not have a negative effect on other processes - the metabolism of proteins, carbohydrates, purines, so they can be safely used by diabetics, patients with gout and other diseases.
Side effects
During production, such medications are subject to the strictest control for side effects. Rosuvastatin, for example, was studied for two years, atorvasatin, lovastatin and simvastatin for 3-5 years. In addition to convincing statistics on the prevention of heart attacks, there are other advantages.
The risk of adverse effects during long-term treatment with statins does not exceed 1%. Among these effects:
More than 1% of patients may experience dizziness, chest pain, cough, swelling, high sensitivity to active solar radiation, skin irritation (from redness to eczema).
For more information about whether there is always a need to take statins, see this video
Compatibility with other medications
Standard therapy includes:
Numerous studies confirm the safety of using these medications in combination.
In some cases, combining different drugs in one tablet (for example, pravastatin + aspirin) reduces the risk of heart attack (only 7.6%) compared to taking these drugs separately (9% for pravastatin and 11% for aspirin).
Traditionally, statins were prescribed to be taken at night, separately from other types of medications. Today, pharmacists offer a combination of several drugs in one tablet; doctors find this option more preferable. Among these drugs are Duplekor, Caduet, which combine atorvastatin and amlodipine in one tablet.
A new complex treatment agent, Polypill, is also being tested.
If cholesterol levels exceed 7.4 mmol/l, statins are combined with fibrates (an alternative group of cholesterol-lowering drugs). Which statins are the most effective and safe in a particular case is decided by the doctor, who analyzes all possible risks.
It is unacceptable to take statins with grapefruit juice, as it contains components that inhibit the absorption of statins. An increase in their content in the blood is dangerous due to the accumulation of toxins.
Treatment with drugs in this group is incompatible with alcoholic beverages and some antibiotics: such as clarithromycin and erythromycin, which create additional stress on the liver.
Other antibiotics are quite compatible with drugs that lower cholesterol. The condition of the liver should be monitored every 3 months, checking the level of liver enzymes in blood tests.
The benefits and harms of statins
When studying prescriptions, every sane patient thinks about the effectiveness of the drugs: how much will the benefits of statins outweigh the possible harm that is talked about so much? Information about new medications with a minimum of undesirable consequences will help dispel doubts.
The following advantages speak in favor of their effectiveness:
- Reducing the percentage of deaths from heart disease by 40% over 5 years.
- Reducing the likelihood of heart attack and stroke by 30%.
- Reduction of cholesterol levels by 45-55% (with regular and long-term use). To analyze the dynamics, you need to check your blood monthly for cholesterol levels.
- The use of a therapeutic dose of the latest generation statins does not produce toxic effects. For a long time it was believed that statins could increase the risk of developing liver cancer, type 2 diabetes, cataracts, and dementia. Modern research has refuted this misconception and proven that similar consequences arise for other reasons. Diabetics have been monitored in Denmark since 1996. The likelihood of diabetes complications such as retinopathy and polyneuropathy decreased by 40 and 34%.
- A large selection of similar drugs of varying prices with a common active ingredient. On thematic forums they often ask: simvastatin or atorvastatin - which is better? The first option is a representative of natural statins, the second is a modern synthetic one. Despite all the differences in structure and metabolic pathways, the drugs have similar pharmacological effects. They differ significantly in price: simvostatin is much cheaper than atorvastatin.
Among the disadvantages, one can note the high cost of Crestor, Rosucard, Lescol Forte and other original statins of the latest generation; for each name of the listed drugs, you can always choose a generic with an affordable price.
Watch the video for the original view of the French professor Debray on the problem of “pros and cons of statin treatment”
Review of statins
A list of statins, drugs whose names are most often found in medical prescriptions, is presented in the table.
| Active ingredient |
Name and concentration of the base substance |
Where is it produced? | Average cost, rub. |
|
First generation drugs |
|||
| Simvastatin | Vasilip (10, 20, 40 mg) | In Slovenia | 444 |
| Simgal (10, 20 or 40) | In Israel and the Czech Republic | 461 | |
| Simvacard (10, 20, 40) | In the Czech Republic | 332 | |
| Simlo (10, 20, 40) | In India | 302 | |
| Simvastatin (10, 20,40) | In Russia, Serbia | 125 | |
| Pravastatin | Lipostat (10, 20) | In Russia, Italy, USA | 170 |
| Lovastatin | Holetar (20) | In Slovenia | 323 |
| Cardiostatin (20, 40) | In the Russian Federation | 306 | |
|
Second generation drugs |
|||
| Fluvastatin | Leskol Forte (80) | In Switzerland, Spain | 2315 |
|
Third generation drugs |
|||
| Atorvastatin | Liptonorm (20) | In India, Russia | 344 |
| Liprimar (10, 20, 40, 80) | In Germany, USA, Ireland | 944 | |
| Tulip (10, 20, 40) | In Slovenia, Switzerland | 772 | |
| Torvacard (10, 40) | In the Czech Republic | 852 | |
| Atoris (10, 20, 30, 40) | In Slovenia, Russian Federation | 859 | |
|
Fourth generation drugs |
|||
| Rosuvastatin | Crestor (5, 10, 20, 40) | In Russia, England, Germany | 1367 |
| Rosecard (10, 20, 40) | In the Czech Republic | 1400 | |
| Rozulip (10, 20) | In Hungary | 771 | |
| Tevastor (5, 10, 20) | In Israel | 531 | |
| Pitavastatin | Livazo (1, 2, 4 mg) | In Italy | 2350 |
The price range for statins is impressive, but generic drugs are almost as good as the original medications on the list, so everyone can choose an analogue according to their budget.
Methods for correcting cholesterol levels
If cholesterol is slightly elevated and there is no particular risk of heart failure, you should try to normalize the level with diet. Interestingly, some plant-based foods contain natural statins. The possibilities of garlic and turmeric have been most studied in this regard.
In addition to them, the correct diet includes gentle heat treatment of foods (stewing, steaming, baked or boiled). Fatty and fried foods are excluded, there are restrictions on the amount of eggs, dairy and offal.
Cholesterol is vital for the body as a building material for cells, so it is important not to exclude, but only to limit the consumption of certain types of foods.
Vegetable fiber (vegetables, cereals, legumes) and polyunsaturated fatty acids Shch-3 (red fish, fish oil), which normalize cholesterol metabolism, are useful.
Recovery is impossible without active exercise and giving up bad habits (smoking, alcohol abuse).
If the above methods do not give the desired result, lipid-lowering drugs are prescribed.
In conclusion, it is worth emphasizing that with all the understandable fears of patients about taking statins - cholesterol-lowering drugs - and the widespread opinion about the harmful consequences of such treatment, their prescription is absolutely justified in case of serious atherosclerosis with severe consequences, since these drugs quite realistically prolong life and improve its quality.
Of course, it’s easier to take a pill, but if you have slightly elevated cholesterol without the slightest signs of vascular damage, it’s still better to just stick to a healthy lifestyle and periodically monitor your cholesterol levels.
Professor E. Malysheva convincingly talks about statins that prolong life
Atorvastatin and simvastatin are medications that are used to treat high levels of cholesterol and triglycerides in the blood. In general, treatment with both drugs reduces the levels of bad cholesterol and triglycerides in the blood and increases the level of good cholesterol in the process. The differences between the two treatments lie in the differences between the drugs themselves. First, atorvastatin is a more potent drug than simvastatin, which means that taking small doses of atorvastatin may be equivalent to taking larger doses of simvastatin. Second, although these drugs are used for the same therapeutic purposes, they interact differently with other drugs, and any one of them may potentially not be suitable for a person depending on their overall health, as the interactions between drugs can lead to dangerous consequences.
In general, what Atorvastatin is a more powerful drug than simvastatin means it is more potent when it comes to lowering cholesterol and triglycerides. The difference in potency suggests that patients taking simvastatin have the opportunity to get the next level of treatment with atorvastatin if they need a more potent drug to treat their disease.
Of course, this also indicates that if a patient requires significant reductions in bad cholesterol and triglycerides, atorvastatin rather than simvastatin may be the initial choice.
Although atorvastatin and simvastatin differ in potency, the treatment chosen depends on the person's specific condition, and thus it is possible that a dose of atorvastatin for one person may have the same potency as a dose of simvastatin for another.
Sometimes drugs may not work as usual if other drugs are present in the body. And although some drugs do not negatively affect the effectiveness of other drugs, when drugs do interact negatively with each other, it can become a problem for the person taking them. For example, drug levels in the body may increase and dangerous medical conditions may develop. Although both atorvastatin and simvastatin belong to the same group of drugs called statins, they differ in how they interact with other drugs; in fact, statins may interfere with the functioning of other statins in the body.
In addition to atorvastatin and simvastatin, the same group of drugs also includes fluvastatin, pravastatin and rosuvastatin.
Antidepressants, birth control pills, and heart and high blood pressure medications are examples of medications that affect the way atorvastatin works. In addition, drugs that are used to treat HIV or AIDS may also interact with this drug. Medicines that interact with simvastatin include antifungals, blood thinners, and medications with niacin. Drugs that weaken the immune system cannot be combined with simvastatin.
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Patients suffering from lipid metabolism disorders are often faced with a choice, which is better - Atorvastatin or Rosuvastatin? Although Rosuvastatin has been increasingly used recently, it is impossible to give an exact answer to this question, because each medicine has both advantages and disadvantages.
Both drugs must be taken for pathologies such as mixed or homozygous hypercholesterolemia (increased LDL levels), hypertriglyceridemia (excess triglycerol) and atherosclerosis (narrowing of the lumen of blood vessels as a result of sedimentation of cholesterol plaques). They are also used to prevent complications of atherosclerosis - hypertension, coronary artery disease, stroke and heart attack.
Since there are differences between contraindications, adverse reactions, pharmacokinetics and pharmacodynamics, it is necessary to find out which drug is more effective and safe.
What are statins?
Statins include a fairly large group of drugs used to reduce the concentration of LDL and VLDL in the blood.
In modern medical practice, it is impossible to do without statins in the prevention and treatment of atherosclerosis, hypercholesterolemia (mixed or homozygous), as well as cardiovascular diseases.
In general, drugs in this group have the same therapeutic effect, i.e. reduce the level of LDL and VLDL. However, due to the variety of active and auxiliary components, there are some differences that must be taken into account to avoid adverse reactions.
Statins are usually divided into I (Cardiostatin, Lovastatin), II (Pravastatin, Fluvastatin), III (Atorvastatin, Cerivastatin) and IV generation (Pitavastatin, Rosuvastatin).
Statins can be of natural or synthetic origin. For a specialist, it is important to select low-, medium- or high-dose drugs for the patient.
Rosuvastatin and Atorvastatin are often used to lower cholesterol levels. Each of the drugs has features:
Rosuvastatin is a fourth generation statin. The lipid-lowering agent is completely synthetic with an average dosage of the active component. It is produced under different brand names, for example, Crestor, Mertenil, Rosucard, Rozart, etc.
Atorvastatin is a third generation statin. Just like its analogue, it is of synthetic origin, but contains a high dose of the active substance.
There are synonyms for the drug such as Atoris, Liprimar, Toovakard, Vasator, etc.
Chemical composition of drugs
Sugar level
Both medications are available in tablet form. Rosuvastatin is produced in several dosages - 5, 10 and 20 mg of the active component of the same name. Atorvastatin is available in dosages of 10, 20, 40 and 80 mg of the active substance. Below is a table comparing the auxiliary components of two well-known representatives of statins.
The main difference between Rosuvastatin and Atorvastatin is their physicochemical properties. The advantage of Rosuvastatin is that it is easily broken down in blood plasma and other liquids, i.e. is hydrophilic. Atorvastatin has another feature: it is fat soluble, i.e. is lipophilic.
Based on these features, the action of Rosuvastatin is mainly aimed at the cells of the liver parenchyma, and Atorvastatin - at the structures of the brain.
Pharmacokinetics and pharmacodynamics - differences
Already at the stage of taking the tablets, differences in their absorption are observed. Thus, the use of Rosuvastatin does not depend on the time of day or food intake. At the same time, Atorvastatin should not be taken simultaneously with food, because this negatively affects the absorption of the active component. The maximum content of Atorvastatin is achieved after 1-2 hours, and Rosuvastatin - after 5 hours.
Another difference between statins is their metabolism. In the human body, Atorvastatin is converted into an inactive form with the help of liver enzymes. Thus, the activity of the drug is directly related to the functioning of the liver.
It is also affected by drugs used simultaneously with Atorvastatin. Its analogue, on the contrary, due to its lower dosage, practically does not react with other drugs. Although this does not eliminate the presence of adverse reactions.
Atorvastatin is excreted primarily in bile.
Unlike many representatives of statins, Rosuvastatin is almost not metabolized in the liver: more than 90% of the substance is removed unchanged by the intestines and only 5-10% by the kidneys.
Contraindications and adverse reactions
The presence of contraindications and negative effects are important factors when choosing the most optimal drug. Below are the main diseases and conditions for which taking medications is prohibited, as well as possible side effects.
| Contraindications | |
| Rosuvastatin | Atorvastatin |
| Individual sensitivity. Pregnancy and lactation. Damage to hepatocytes and elevated levels of liver enzymes. Children and teenagers under 18 years of age. Myopathy or predisposition to it. Complex treatment with Cyclosporine and fibrates. Renal dysfunction. Chronic alcoholism. Myotoxicity when taking other HMG-CoA reductase inhibitors. Representatives of the Mongoloid race (only the minimum dosage is allowed). |
Hypersensitivity to components. Increased activity of liver enzymes. Childbearing and lactation period. Children and adolescents under 18 years of age, with the exception of treatment of heterozygous hereditary hypercholesterolemia. Lack of adequate contraception. Use of HIV protease blockers. Active liver pathologies. |
| Adverse reactions | |
| Headaches, coordination problems, general malaise. Development of proteinuria and hematuria. Skin rash, hives, itching. Disorders of the musculoskeletal system. Dyspepsia, stool disorders, inflammation of the pancreas (pancreatitis). Non-insulin dependent diabetes mellitus. Growth of mammary glands in men. Presence of dry cough, shortness of breath. Stevens-Johnson syndrome. |
Development of nasopharyngitis, infections of the urinary system. The occurrence of thrombocytopenia. Hypo- and hyperglycemia, anorexia. Head pain, paresthesia, development of peripheral neuropathy, hypoesthesia, amnesia, dizziness, dysgeusia. Hearing impairment, tinnitus, visual impairment. Sore throat, nosebleeds. Dyspeptic disorder, belching, epigastric pain, development of pancreatitis. Urticaria, skin rashes, Quincke's edema. The appearance of gynecomastia. Various disorders of the musculoskeletal system. Hepatitis, liver failure, cholestasis. Hyperthermia, asthenia, malaise. Increased activity of liver enzymes, CK and a positive test for leukocytes in urine. |
Efficiency and consumer opinion
The main task of statin drugs is to reduce the concentration of LDL in the blood and increase the level of HDL.
Therefore, when choosing between Atorvastatin and Rosuvastatin, you need to compare how effectively they reduce cholesterol levels.
A recent scientific study has proven that Rosuvastatin is a more effective drug.
The results of the clinical trials are presented below:
- With equal doses of drugs, Rosuvastatin reduces the content by 10% more effectively than its analogue. This advantage allows the medicine to be used by patients with severe hypercholesterolemia.
- The incidence of cardiovascular complications and fatal outcome is higher with Atorvastatin.
- The incidence of adverse reactions for both drugs is the same.
A comparison of the effectiveness of reducing the concentration of “bad” cholesterol proves the fact that Rosuvastatin is a more effective drug. However, we must not forget about such factors as the presence of contraindications, side effects and cost. A comparison of the prices of the two drugs is presented in the table.
| Dosage, number of tablets | Rosuvastatin | Atorvastatin |
| 5mg No. 30 | 335 rub. | — |
| 10mg No. 30 | 360 rub. | 125 rub. |
| 20 mg No. 30 | 485 rub. | 150 rub. |
| 40 mg No. 30 | — | 245 rub. |
| 80 mg No. 30 | — | 490 rub. |
Thus, Atorvastatin is a cheaper alternative that can be afforded by people with low incomes.
Here's what patients think about the drugs: Rosuvastatin is well tolerated and without problems. Taking it reduces bad cholesterol
A comparison of medicines helps to conclude that at the present stage of development of medicine, the first positions among the best are occupied by IV generation statins, incl. Rosuvastatin.
The drug Rosuvastatin and its analogues are described in the video in this article.
