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Drug vs. Drug

Rosuvastatin vs. atorvastatin side effects

Struggling with statin side effects? Find out how rosuvastatin and atorvastatin differ in terms of muscle pain, dosage, and long-term impact.
Ashley Broadwater, writer for SingleCare
By | Jul. 11, 2025 Medically reviewed by Josephine Bawab, Pharm.D.
Comparing two white tablets: Rosuvastatin vs. atorvastatin side effects

Key takeaways

  • Some of the most common side effects of rosuvastatin are headache, nausea, and myalgia.

  • Some of the most common side effects of atorvastatin are nasopharyngitis, arthralgia, and diarrhea.

  • Typically, rosuvastatin has fewer side effects.

In this article:

Rosuvastatin and atorvastatin are generic versions of a cholesterol-lowering prescription drug. The brand-name versions of these drugs are Crestor and Lipitor. Both of these medications are HMG-CoA reductase inhibitors, also known as statins. Healthcare professionals may also prescribe a different statin, such as pravastatin, simvastatin, pitavastatin, or lovastatin, to treat similar conditions.

Statins lower high cholesterol (hypercholesterolemia) by specifically lowering low-density lipoprotein (LDL) cholesterol, known as “bad” cholesterol. They also increase “good” cholesterol, which is high-density lipoprotein (HDL) cholesterol, in the blood. Additionally, statins can reduce blood pressure, as suggested in research published in Hypertension. This can reduce an adult’s risk of a heart attack or heart disease and general cardiovascular risk. Statins can treat coronary artery disease (CAD) and atherosclerosis, too. The main difference between the two medications is that rosuvastatin is less likely to cause side effects.

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Comparing side effects: Rosuvastatin vs. atorvastatin

Generally speaking, the side effects of statin therapy, according to the Mayo Clinic, include muscle aches, muscle damage, liver damage, increased blood sugar or Type 2 diabetes, and neurological side effects. However, rosuvastatin typically causes fewer problems than atorvastatin.

“In my experience, rosuvastatin has less muscle side effects than atorvastatin,” says Dr. Yu-Ming Ni, MD, a board-certified cardiologist and lipidologist at MemorialCare Heart & Vascular Institute in Fountain Valley, California. He explains that this is because rosuvastatin is water-soluble, so it’s less likely to get into muscle cells and cause issues. 

The potency and dosage of each medication also make a difference when it comes to side effects. “One of the first things I do is explain the difference between rosuvastatin and atorvastatin,” says Dr. Erika Gray, Pharm.D., founder and chief medical officer at ToolBox Genomics. “Rosuvastatin is considered about two times more potent than atorvastatin, which means patients are often prescribed a lower dose of rosuvastatin, and they tend to experience less side effects. Statin side effects are very much dose-dependent, meaning the higher the dose, the higher the risk of side effects.” 

She adds that the dose also depends on why the person is taking it. For example, someone who has acute coronary syndrome will likely take the maximum dose, meaning they’re more likely to struggle with the muscle pain side effects.

Rosuvastatin is also more effective—at least in reducing the risk of recurrent stroke, myocardial infarction, and all-cause mortality in patients with acute ischemic stroke—according to a 2025 study in the Journal of the American Heart Association.

Rosuvastatin side effects

Below, see the more common (and sometimes serious) adverse effects of rosuvastatin and how many participants reported them in one or more clinical trials. 

  • Headache: 5.5-6.4%-
  • Nausea: 2.4-3.4
  • Myalgia (muscle pain): 2.8-12.7%
  • Asthenia (lack of strength and energy): 2.7%
  • Constipation: 2.4-3.3%
  • Arthralgia (joint pain): 3.8-10.1%
  • Dizziness: 4%
  • Increased CPK (muscle enzyme): 2.6%
  • Abdominal pain: 2.4%
  • ALT (liver enzyme) greater than 3x the upper limit of normal (ULN): 2.2%
  • Diabetes mellitus: 2.8%

Atorvastatin side effects

Below, see the more common and sometimes serious side effects of atorvastatin and how many people reported them in clinical trials. 

  • Nasopharyngitis (common cold): 8.3%
  • Arthralgia: 6.9%
  • Diarrhea: 6.8%
  • Pain in extremity: 6%
  • Urinary tract infection: 5.7%
  • Dyspepsia (indigestion): 4.7%
  • Nausea: 4%
  • Musculoskeletal pain: 3.8%
  • Muscle spasms: 3.6%
  • Myalgia: 3.5%
  • Insomnia: 3%
  • Pharyngolaryngeal (throat and voice) pain: 2.3%

How soon do the side effects start?

Unfortunately, there’s no clear-cut answer to how quickly side effects kick in; it can vary depending on the patient. For example, Dr. Ni’s patients have experienced muscle-related side effects from these two medications within a day or two. At the same time, Dr. Gray notes they typically emerge within a one-to-four-week timeframe.

“Additionally, with atorvastatin, I tell patients and their caregivers to be on the lookout for memory or mood changes at the two-month mark, as many patients experience ‘brain fog,’” Dr. Gray adds. “If this happens, I always encourage them to have a conversation with their prescriber to see if they can take a lower dose or take the statin every other day.”

How long do rosuvastatin vs. atorvastatin side effects last?

Some side effects of statins are temporary, such as blurred vision, short-term memory loss, muscle aches, headaches, nausea, and insomnia.

The doctors say the body takes around the same amount of time to adjust to rosuvastatin and atorvastatin: two to three weeks. “However, with brain fog or fatigue, those symptoms often take longer to improve, especially if patients are not taking CoQ10 or if they have suboptimally performing mitochondria,” Dr. Gray adds.

What are the long-term side effects?

Both rosuvastatin and atorvastatin can be taken for years; they are long-term treatments. One of the main long-term side effects of statins, though, is a slightly higher risk of new-onset diabetes. “We estimate that this is 1-2% over a five-year period,” Dr. Ni says. “Since this risk is small, I feel that the benefits of being on statins in terms of preventing cardiovascular disease exceed the potential risk of new-onset diabetes, and therefore, I routinely recommend proceeding with statin therapy.”

He adds that people who have the typical risk factors for diabetes are naturally more at risk, but other than that, there aren’t risk factors that make this long-term side effect more likely.

“Checking glucose and insulin levels for insulin resistance is also important to see if a patient is developing or having worsening of Type 2 diabetes,” Dr. Gray agrees. She also monitors her patients for increasing liver enzymes, muscle damage, cognitive changes, and nutrition deficiencies. Some risk factors she lists include being older than 65 years of age, having difficulty tolerating statins, not exercising, taking medications that block CYP3A4, chronic alcohol use, decreased muscle mass, and a CoQ10 deficiency. 

How to avoid side effects

To some extent, these side effects are avoidable. The doctors recommend taking the following steps while on atorvastatin or rosuvastatin:

  1. Stay hydrated: To no one’s surprise, drinking enough water is key. “It is important to stay well-hydrated when taking any medication, especially statins, so that you can properly clear any toxins through the kidneys,” Dr. Ni says. 
  2. Know drug interactions: Dr. Ni encourages talking to a doctor about other medications that might interact with the statin and increase the risk of side effects. For atorvastatin, that entails specific antifungals, antivirals, and antibiotics. For rosuvastatin, be careful with antivirals, fibrates, and antacids. Additionally, grapefruit juice (which interacts with multiple medications) is safer with rosuvastatin than atorvastatin.
  3. Take it at night: It’s best to take statins at night so they can do their work while the body is at its peak cholesterol production. However, be aware that they can cause insomnia.
  4. Eat with or without (some) foods: Rosuvastatin and atorvastatin can be taken with or without food; eating won’t affect their absorption. Just be sure to avoid or limit certain foods, like grapefruits, while on these medications. On the other hand, Dr. Gray says that adding supplements, such as a CoQ10 supplement and an omega-3 supplement, can help keep your brain healthy.
  5. Take it daily: Both medications need to be taken once every day, preferably at the same time.
  6. Start with a small dose: “I recommend patients start with a low dose (if possible) or increase the frequency to every other day with rosuvastatin,” Dr. Gray says. “The caveat to this is that their prescriber may want to start with a higher dose to treat a particular condition.”
  7. Consider pharmacogenomic testing: Dr. Gray encourages this if patients experience muscle pain to assess whether they have an increased risk of muscle damage.
  8. Ask if it’s not safe for you: Patients who are 75 years and older should not start a statin if they don’t have known vascular disease or Type 2 diabetes.

How to treat the side effects of rosuvastatin vs. atorvastatin

An at-home remedy can relieve many of the possible side effects of these two medications. Below are some treatment examples that may help:

  • Headache or other pain: Ibuprofen, cold compresses, sleep
  • Nausea: Dramamine, Pepto Bismol, ginger, controlled breathing, acupressure 
  • Constipation: Eating more fiber, exercising, and drinking enough water
  • Diarrhea: Imodium, drinking plenty of fluids, and opting for bland foods
  • Urinary tract infection: Drinking extra water, drinking cranberry juice, and taking an antibiotic
  • Insomnia: Ambien, melatonin, lowering caffeine intake, relaxing before bed

However, some side effects are more serious—even life-threatening—and require medical attention. One example is rhabdomyolysis, which is when muscles break down, as well as organ damage.

Really, seeing a healthcare provider about any medical concern is in a patient’s best interest.

People can buy either medication at a cheaper cost using a SingleCare prescription discount card.

The bottom line

  • Rosuvastatin and atorvastatin share some side effects, like pain, nausea, and myalgia. However, rosuvastatin typically has fewer side effects, making it the “better” option for some people.
  • As always, remember that talking to a healthcare professional is most important. They can provide a personalized cholesterol treatment plan.
  • People can avoid some of the side effects of statins by starting with a small dose, taking it as prescribed at night, and staying hydrated.