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Pharmacy and Medications

Atorvastatin and simvastatin

06/29/2005

Question:

What is the difference in Attorvastatin and Simvastatin for lipid control ? Sometimes doctor suggest Attorvastatin whereas for some, they suggest simvastatin. Is there any difference in their mode of action. Which one is better with least side effects?

Answer:

Atorvastatin (Lipitor) and simvastatin (Zocor) are members of a class of medications known as HMG-CoA Reductase Inhibitors ("statins"). Both of these medications act by blocking an enzyme (HMG-CoA reductase) that is needed by the body to make cholesterol, thereby reducing the amount of cholesterol in the blood. Based on the studies that have been done on these medications, atorvastatin appears to be more effective at reducing LDL-cholesterol than simvastatin.

% Reduction in LDL-Cholesterol per Dose for Simvastatin and Atorvastatin

Dose\Drug

Simvastatin

Atorvastatin

10 mg

28%

38%

20 mg

35%

46%

40 mg

40%

51%

80 mg

48%

54%

Some physicians prefer simvastatin over atorvastatin because simvastatin has data (Scandinavian Simvastatin Survival Study) showing that it not only reduces cardiovascular morbidity and mortality, but also reduces all-cause mortality. There is no data to show whether or not atorvastatin produces similar reductions in mortality. Some people believe that because the statins work in the same way, they all reduce morbidity and mortality (regardless of whether or not there are studies that specifically support this outcome). In addition, some believe that because atorvastatin lowers LDL-cholesterol more than simvastatin, it may actually be more effective at reducing morbidity and mortality.

The side effects of both of these medications are very similar and include: constipation, diarrhea, gas, heartburn, stomach pain, dizziness, headache, nausea, skin rash, fever, muscle aches or cramps, unusual tiredness or weakness, and insomnia. Atorvastatin appears to have a slightly higher incidence of these adverse events than does simvastatin.

This response was prepared by Sarah Malott, a PharmD Candidate at the University of Cincinnati

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Response by:

Robert James Goetz, PharmD, DABAT
Assistant Professor of Pharmacy Practice
College of Medicine
University of Cincinnati