A friend found hypercholesterolemia, and the doctor suggested that he use statins to treat him, saying that it is okay to choose atorvastatin or rosuvastatin. As a result, the friend had difficulty choosing and asked Huazi how to choose?
Huazi said that atorvastatin and rosuvastatin are both powerful statins, have a strong lowering effect on cholesterol, and are long-acting statins, the efficacy is not affected by the time and diet, it can be said that the two are not inferior. However, when taking the drug, atorvastatin is usually used first, and if it is not sensitive to the drug or has adverse reactions, it is considered to switch to rosuvastatin.
First, atorvastatin and rosuvastatin are both powerful statins
The intensity of action of statins is divided into the magnitude of the reduction in low-density lipoprotein cholesterol (LDL-C). Among them, only atorvastat and rosuvastatin, also known as potent statin, are reduced by more than 50% of LDL-C levels, and the others are called intermediate statins.
In related trials, rosuvastatin is more effective, and at the maximum dose, LDL-C levels can be reduced by about 63%. At the maximum dose, atorvastatin can reduce LDL-C levels by about 55%. The intensity of the two is similar, and if someone is insensitive to one or has an adverse reaction, they can use the other instead.
2. Atorvastatin is usually preferred for Chinese
In practical use, treatment with atorvastatin is usually preferred. This is because statins are genetically differentiated and Chinese more sensitive than Europeans and Americans. In particular, rosuvastatin, at the same dose, Chinese area under the drug concentration curve after taking, can reach 2 times that of European and American races.
Therefore, the maximum dose of rosuvastatin in Europe and the United States is 40mg per day, while in the Chinese drug label, the maximum dose is only 20mg per day. The instructions for atorvastatin, like China and Europe and the United States, the maximum dose is 80mg per day.
The larger the area under the drug concentration curve, the higher the probability of adverse reactions. In clinical trials, the incidence of myalgia caused by rosuvastatin was also slightly higher than that of atorvastatin. So people who have never had statin prefer atorvastatin, which is safer.
Third, atorvastatin and rosuvastatin can be substituted for each other
Rhizuvastatin may be considered instead of atorvastatin if the desired lipid-lowering effect is not achieved, or when severe liver function abnormalities, muscle pain, or blood glucose abnormalities occur. Because there are individual differences in statins, replacement may achieve better drug effects.
Atorvastatin is mainly metabolized by the liver and interacts with other drugs greatly. Rosuvastatin is mainly excreted through feces, a small amount is metabolized by the kidneys and liver, and has little interaction with other drugs. Therefore, if there are multiple diseases that need to be combined with multiple drugs, rosuvastatin can also be preferred.
The quality of renal function will affect the excretion of rosuvastatin, and people with severe renal insufficiency cannot use rosuvastatin, and can only choose atorvastatin.
Fourth, it is not recommended to use large doses of statins
10 mg of atorvastatin is equivalent to 5 mg of rosuvastatin, 20 mg of atorvastatin is equivalent to 10 mg of rosuvastatin... By analogy, atorvastatin can be used at 80 mg daily, but rosuvastatin cannot be used at 40 mg per day.
Statins have a "plus 6 principle," which means that when the dose of statins is doubled, the control of LDL-C levels can only increase by 6%. Therefore, although atorvastatin can use a daily dose of 80mg, the probability of adverse reactions with the use of large doses of statin is high, so it is generally not recommended to use the maximum dose.
If LDL-C levels are not up to standard, the preferred option is to use a medium-dose statin in combination with a cholesterol absorption inhibitor (ezezermab). Or in combination with PCSK9 inhibitors (iiloxizumab, aliszeumab).
To sum up, atorvastatin and rosuvastatin, both are strong statins, and both have long-acting effects. In practice, people who have never used statins will have a better safety profile when preferring atorvastatin. Medications need to be used under the guidance of a doctor, if you have any doubts about medication, please consult a doctor or pharmacist. I am a pharmacist Huazi, welcome to follow me and share more health knowledge.