Lovastatin vs. atorvastatin: Differences, similarities, and which one is better for you

Drug overview & main differences | Conditions treated | Efficacy | Insurance coverage and cost comparison | Side effects | Drug interactions | Warnings | FAQ

Lovastatin and atorvastatin are generic prescription drugs used to treat high cholesterol levels in the blood (hypercholesterolemia). High blood cholesterol levels can increase the risk of heart disease and atherosclerosis, which are diseases that can lead to other cardiovascular problems. Statin medications like lovastatin and atorvastatin are commonly prescribed to help lower cholesterol levels and decrease the risk of heart attack, stroke, and chest pain.

Lovastatin and atorvastatin are part of a class of drugs called HMG-coA reductase inhibitors, or statins. They work by blocking the enzyme needed to produce cholesterol in the liver. Many statin drugs can decrease low-density lipoprotein (LDL) cholesterol levels by 30-50% on average. 

Continue reading to learn more about the differences and similarities between lovastatin and atorvastatin.

What are the main differences between lovastatin and atorvastatin?

Lovastatin is also known by the brand names Mevacor, Altocor, and Altoprev. In addition to treating high cholesterol levels, it is used to prevent and treat coronary arteriosclerosis, or coronary artery disease.

Lovastatin is available as a 10 mg, 20 mg, and 40 mg immediate-release oral tablet. Altoprev is a brand-name extended-release version that is available as a 20 mg, 40 mg, or 60 mg oral tablet. Lovastatin immediate-release tablets are recommended to be taken with an evening meal while the extended-release tablets may be administered without food. Lovastatin is recommended to be taken at night because it has a short half-life of 1-2 hours, and it works best when most cholesterol is produced during the night, or when dietary intake is lowest. 

Atorvastatin is the generic name for Lipitor. It is used to treat high cholesterol levels and reduce the risk of heart attacks, strokes, and chest pain in people who currently have or are at risk of heart disease. 

Atorvastatin is available as a 10 mg, 20 mg, 40 mg, and 80 mg oral tablet. It is usually taken once daily in the morning or evening. Atorvastatin can be taken at any time of the day as long as it is taken around the same time every day. It has a long half-life of around 14 hours. Atorvastatin can be taken with or without food since food intake does not affect the absorption of atorvastatin. 

Conditions treated by lovastatin and atorvastatin

Statin medications like lovastatin and atorvastatin are approved by the Food and Drug Administration to treat people with high cholesterol levels. These medications can help lower total cholesterol (total-C) levels and low-density lipoprotein cholesterol (LDL-C) levels. These statins can help treat those with high levels of triglycerides (TG), another type of fat, or lipid, in the blood. Statins can also help increase high-density lipoprotein cholesterol (HDL-C) levels, which are known to be associated with protective effects on the heart.

Lovastatin and atorvastatin are lipid-lowering drugs approved to prevent heart attacks, stroke, and chest pain in patients with coronary heart disease. Other risk factors for complications from cardiovascular disease include Type 2 diabetes, high blood pressure, and smoking. The American Heart Association and American College of Cardiology recommend statins to those at high risk of developing cardiovascular complications. 

Is lovastatin or atorvastatin more effective?

Lovastatin and atorvastatin are effective statin drugs for lowering cholesterol levels. The most effective statin is the one that lowers cholesterol levels the most without causing severe side effects. Factors such as cost, dosage, and side effects can affect whether one statin will be better than another for a given person. 

A meta-analysis published in the European Journal of Preventative Care found that atorvastatin was more effective than lovastatin and other statins for preventing heart attacks in those with or at risk of heart disease. The study also evaluated the effectiveness of other statin drugs like simvastatin, pravastatin, fluvastatin, and rosuvastatin. When compared to placebo, all statins included in the study were found to be effective in the primary prevention of major coronary events.

According to a systematic review and network meta-analysis of 50 clinical trials published in the journal of Cardiovascular Therapeutics, rosuvastatin was found to be the most effective statin for lowering LDL-C levels. Atorvastatin ranked second for lowering LDL-C levels. Lovastatin ranked first for lowering total cholesterol and triglyceride levels, however. Other statin drugs included in the analysis included pitavastatin, simvastatin, pravastatin, fluvastatin, and lovastatin. 

Atorvastatin is considered a moderate-intensity or high-intensity statin therapy that can reduce LDL-C levels by 30-50% or more than 50% depending on the dosage. Lovastatin is considered a low-intensity or moderate-intensity statin therapy that can reduce LDL-C levels by less than 30% to between 30% and 50% depending on the dosage. It is important to consult a healthcare provider for medical advice regarding the most effective statin medication for your condition. 

Coverage and cost comparison of lovastatin vs. atorvastatin

Most Medicare and insurance plans will cover lovastatin. The copay will depend on the insurance plan and its coverage policy. Without insurance, lovastatin can cost an average cash price of $235. Savings options such as a prescription discount card for lovastatin may help reduce this cost to less than $25 at participating pharmacies.

Atorvastatin is usually covered by most Medicare and insurance plans. Most plans will cover most, if not all, of the cost of the medication. The average cash price of atorvastatin is $20-$30. A prescription discount card is available to help reduce the cost of an atorvastatin prescription. The exact cost of the prescription will depend on the dosage and quantity prescribed. 

Common side effects of lovastatin vs. atorvastatin

The most common side effects of lovastatin are abdominal pain, constipation, weakness, muscle pain, and headache. The most common side effects of atorvastatin are muscle pain, diarrhea, nasopharyngitis, joint pain, and urinary tract infections. Lovastatin and atorvastatin, like other statin drugs, can cause serious side effects in the muscles, such as myopathy and rhabdomyolysis. Symptoms of myopathy and rhabdomyolysis include muscle pain and weakness. Both statin drugs can also cause liver enzyme abnormalities, which may need to be monitored throughout treatment. 

Frequency is not based on data from a head-to-head trial. This may not be a complete list of adverse effects that can occur. Please refer to your doctor or healthcare provider to learn more.

Source: DailyMed (Lovastatin), DailyMed (Atorvastatin)

Drug interactions of lovastatin vs. atorvastatin

Lovastatin and atorvastatin can interact with many of the same drugs. Lovastatin and atorvastatin are primarily metabolized, or processed, in the liver by the CYP3A4 enzyme. Drugs that block the CYP3A4 enzyme are known as CYP3A4 inhibitors. When taken with CYP3A4 inhibitors, blood levels of lovastatin or atorvastatin can increase. Increased levels of statin medications can lead to an increased risk of muscle pain and other adverse events. Examples of CYP3A4 inhibitors include certain antibiotics, antifungals, and HIV protease inhibitors. Grapefruit juice can also act as a CYP3A4 inhibitor and should be avoided while taking a statin drug. 

Drugs that induce the CYP3A4 enzyme can increase the metabolism of lovastatin or atorvastatin and decrease statin blood levels. Decreased blood levels of a statin can lead to decreased effectiveness of the medication. CYP3A4 inducers include rifampin and carbamazepine. 

Using lovastatin or atorvastatin with fibrates or high doses of niacin can increase the risk of muscle-related side effects. The combined use of these statins with fibrates or niacin may need to be monitored. 

*Consult a healthcare professional for other drug interactions

Warnings of lovastatin and atorvastatin

The use of statins carries a risk of skeletal muscle effects such as myopathy and rhabdomyolysis. The risk of myopathy may be increased in older patients, patients with uncontrolled hypothyroidism, and patients with kidney problems. A healthcare provider should be consulted if muscle pain, weakness, or tenderness persists while on a statin. 

Immune-Mediated Necrotizing Myopathy (IMNM) is a type of autoimmune myopathy that has been reported with statin use. Individuals with persistent muscle pain and kidney problems may need to discontinue their use of statins. 

Statins, like lovastatin and atorvastatin, can cause increased liver enzyme levels. Liver enzyme levels may need to be checked before and during treatment with a statin. In patients with active liver disease, the use of lovastatin or atorvastatin is not recommended. 

The dosage of lovastatin may need to be adjusted in those with kidney problems. In contrast, the dosage of atorvastatin may not need to be adjusted in those with kidney problems. Consult a healthcare provider about other warnings and precautions before starting treatment with lovastatin or atorvastatin. 

Frequently asked questions about lovastatin vs. atorvastatin

What is lovastatin?

Lovastatin is a generic statin drug that is also known by the brand names Mevacor, Altocor, and Altoprev. It is available in immediate-release oral tablets with strengths of 10 mg, 20 mg, and 40 mg. It is also available in extended-release oral tablets with strengths of 20 mg, 40 mg, and 60 mg. Immediate-release lovastatin tablets are typically taken with an evening meal. 

What is atorvastatin?

Atorvastatin is a generic statin drug that is also known by the brand name Lipitor. It is available as a 10 mg, 20 mg, 40 mg, and 80 mg oral tablet. It is usually taken once daily in the morning or evening to lower blood cholesterol levels. 

Are lovastatin and atorvastatin the same?

Both lovastatin and atorvastatin are FDA-approved, cholesterol-lowering drugs. They both work as HMG-CoA reductase inhibitors that decrease the production of cholesterol in the liver. However, lovastatin has a shorter half-life than atorvastatin, and it is usually recommended to be taken at night. Atorvastatin has a longer half-life than lovastatin, and it can be taken in the morning or evening. Both statins can lower LDL cholesterol and increase HDL cholesterol. 

Is lovastatin or atorvastatin better?

Lovastatin and atorvastatin are both effective forms of statin therapy. Depending on the dosage prescribed, lovastatin is classified as a low- to moderate-intensity statin drug while atorvastatin is classified as a moderate- to high-intensity statin drug. Atorvastatin is generally considered a more potent drug than lovastatin for lowering LDL-cholesterol levels. However, atorvastatin may carry a higher risk of myopathy in higher doses compared to lovastatin. 

Can I use lovastatin or atorvastatin while pregnant?

Statin use is not recommended in women who are pregnant. Lovastatin and atorvastatin are in pregnancy category X. This means that these medications are likely to cause harm to an unborn fetus. Consult a prescribing healthcare provider for treatment options while pregnant. 

Can I use lovastatin or atorvastatin with alcohol?

Drinking alcohol in moderation is not likely to cause problems while taking lovastatin or atorvastatin. Statin drugs carry a risk of liver toxicity; these drugs can affect liver function and cause liver enzyme abnormalities. Consuming large amounts of alcohol can harm the liver and increase the risk of liver disease and other liver problems. The consumption of alcohol while taking a statin medication should be done with caution.