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Key takeaways
Simvastatin, a commonly prescribed cholesterol medication, is not always effective and can have unbearable side effects.
When simvastatin therapy doesn’t work or causes side effects, healthcare professionals usually prescribe a different statin, because potency and adverse effects vary within the class.
Under the guidance of a healthcare provider, various categories of cholesterol-lowering medications or natural methods can be combined with statin therapy to lower cholesterol levels further or used as an alternative to minimize adverse effects.
Searching for a substitute for simvastatin is a common situation. Even though the drug can lower the risk of heart attack, it has some unsavory characteristics. Well known is the potential for statin drugs like Zocor (the brand name for simvastatin) to cause muscle side effects like myalgia (muscle pain) and myopathy (weakness). Drug interactions are another problem. However, the positive benefits of statins for heart health typically outweigh the risk of possible side effects. Finding an alternative statin or a non-statin option for cholesterol management should not be difficult, but the process of changing medications should be done carefully and under the guidance of your healthcare provider.
What can I take as an alternative to simvastatin?
Just because simvastatin therapy is failing due to adverse effects, drug interactions, or disappointing effectiveness does not mean that another statin will not work out.
Within the drug class, there is substantial variability in potency and metabolism. The robust evidence from clinical trials supporting the use of statins often warrants trying multiple class members before giving up, according to the American Heart Association. If you do move on from statin therapy, other treatment options include cholesterol absorption blockers, fibrates, and PCSK9 inhibitors as non-statin alternatives.
| Compare simvastatin alternatives | |||
|---|---|---|---|
| Drug name | Price without insurance | SingleCare price | Savings options |
| Zocor (simvastatin) | $997 per 90, 20 mg tablets | $7 per 90, 20 mg tablets of generic simvastatin at Kroger | See latest prices |
| Lipitor (atorvastatin) | $692 for 30, 40 mg tablets | $8 for 30, 40 mg tablets of generic atorvastatin at Kroger | See latest prices |
| Crestor (rosuvastatin) | $361 per
30, 10 mg tablets |
$8 per
30, 10 mg tablets of generic rosuvastatin at Kroger |
See latest prices |
| Pravastatin | $310 per
90, 40 mg tablets of generic pravastatin |
$17 per
90, 40 mg tablets of generic pravastatin at Kroger |
See latest prices |
| Lovastatin | $119 per
90, 20 mg tablets of generic lovastatin |
$15 per 90, 20 mg tablets of generic lovastatin at Kroger | See latest prices |
| Livalo (pitavastatin) | $444 per
30, 2 mg tablets |
$46 per
30, 2 mg tablets of generic pitavastatin at CVS |
See latest prices |
| Lescol XL (fluvastatin) | $483 per
30, 80 mg tablets |
$104 per
90, 80 mg tablets of generic fluvastatin at CVS |
See latest prices |
| Zetia (ezetimibe) | $1,525 for 90, 10 mg tablets | $14 for 90, 10 mg tablets of generic ezetimibe at Kroger | See latest prices |
| Questran (cholestyramine) | $449 for 60 packets | $50 for 60 packets of generic cholestyramine at CVS | See latest prices |
| Welchol (colesevelam) | $1,092 for 180, 625 mg tablets | $43 for 180, 625 mg tablets of generic colesevelam at CVS | See latest prices |
| Lopid (gemfibrozil) | $243 for 60, 600 mg tablets | $9 for 60, 600 mg tablets of generic gemfibrozil at Walmart | See latest prices |
| Tricor (fenofibrate) | $216 for 90, 145 mg tablets | $17 for 90, 145 mg tablets of generic fenofibrate at Kroger | See latest prices |
| Repatha (evolocumab) | $793 for 2, 1 mL of 140 mg/mL syringes | $462 for 2, 1 mL of 140 mg/mL syringes of brand-name Repatha at Kroger | See latest prices |
| Praluent (alirocumab) | $711 for 2, 1 mL of 75 mg/ml pens | $512 for 2, 1 mL of 75 mg/ml pens of brand-name Praluent at Kroger | See latest prices |
| Leqvio (inclisiran) | $3,511 for 1, 1.5 mL of 284 mg/1.5 mL prefilled syringe of brand-name Leqvio at Kroger | See latest prices |
Prescription drug prices often change. These are the most accurate medication prices available at the time of publication in ZIP code 23666 as of November 16, 2025. The listed price, without insurance, refers to the price of brand-name drugs (unless otherwise specified). The listed SingleCare price references the price of generic drugs if available. Click the link under “Savings options” to see the latest drug prices.
Top 5 simvastatin alternatives
The following are some of the most common alternatives to simvastatin.
1. Crestor
If simvastatin is not controlling cholesterol levels adequately, Crestor or its generic version, rosuvastatin, is the most potent statin at reducing bad cholesterol (low-density lipoprotein or LDL). Triglycerides (fats) are another detrimental substance in the blood. These, too, are lowered by Crestor more than simvastatin. Fibrates, such as Tricor (fenofibrate) and Lopid (gemfibrozil), have a more profound effect on triglycerides than statins, but they achieve less LDL lowering, a fact that limits their use.
Crestor also avoids many of the drug interactions that can plague simvastatin. However, the higher potency of Crestor could translate to a higher risk of side effects. Besides myalgias, the potential statin side effects can include changes in bowel habits (such as constipation), elevated liver enzymes, elevated muscle enzymes, elevated blood glucose (blood sugar), and cognitive impairment (difficulty learning, remembering, or concentrating).
RELATED: Crestor side effects and how to avoid them
2. Lipitor
Lipitor and its generic form, atorvastatin, are another example of statins that outperform simvastatin in regard to LDL reduction, at the expense of potentially more adverse effects. Drug interactions are still a concern with Lipitor, but not as much as with simvastatin. Another advantage of Lipitor and Crestor is their long half-lives. You can take them at any time of day, unlike simvastatin, which should be taken at bedtime. In some cases, Lipitor and Crestor are even dosed every other day. Convenience and cholesterol-reducing power could be an appealing combo.
Save up to 80% on Lipitor with SingleCare
Different pharmacies offer different prices for the same medication. SingleCare helps find the best price for you.
RELATED: 13 things you might not know about Lipitor
3. Pravastatin
On the other hand, sacrificing potency is not always a bad thing when it comes to choosing between statin medications. Pravastatin will not lower LDL cholesterol as much as simvastatin, Crestor, or Lipitor, but it may help you avoid uncomfortable muscle symptoms. If muscle pain is a side effect of simvastatin, then pravastatin may be a good alternative to consider.
Fans of grapefruit and grapefruit juice may also benefit from pravastatin. Simvastatin interacts with grapefruit, elevating the risk of side effects. Pravastatin does not.
RELATED: Pravastatin vs. Lipitor: Differences, similarities, and which is better for you
4. Zetia
In some cases, statin therapy is ineffective as monotherapy. The cholesterol absorption inhibitor Zetia (ezetimibe) is one of the most commonly prescribed statin alternatives. Unlike statins, which inhibit the HMG-CoA reductase enzyme to lower LDL cholesterol, Zetia works by inhibiting the absorption of cholesterol. Zetia and its generic version, ezetimibe, lower cholesterol by blocking the intestinal absorption of cholesterol. By avoiding the statin mechanism, you may be able to prevent statin side effects. Unfortunately, you may not gain as much benefit either, since cholesterol reduction is commonly less with Zetia than with statins.
Inhibiting cholesterol absorption with a bile acid sequestrant, such as Welchol (colesevelam) or Questran (cholestyramine), achieves small LDL reductions in a similar manner.
The LDL-lowering achieved with cholesterol absorption blockers can be additive to that of a statin. In other words, some individuals take both Zetia and a statin like simvastatin to get their cholesterol numbers to goal.
RELATED: Lower your cholesterol with these 7 steps
5. Praluent
PCSK9 inhibitors, such as Praluent (alirocumab), can be added to statins to achieve additional benefit in cases of particularly high cholesterol levels. In other cases, when statins are ineffective or intolerable, PCSK9 inhibitors can be used to lower LDL levels on their own. They require an injection and commonly carry a hefty price tag, but their effectiveness may be alluring for those with coronary heart disease or atherosclerosis elsewhere in the body. If the price is daunting, try showing your SingleCare discount card at your local pharmacy to see if the expense is more manageable.
RELATED: Why you should monitor your cholesterol
Over-the-counter cholesterol medications
There are no over-the-counter medications that can lower cholesterol. Products marketed as cholesterol reducers make claims that haven’t been proven. However, some dietary supplements—particularly berberine, niacin, and red yeast rice—have been shown to have some proven merit for reducing LDL levels. In fact, red yeast rice has a mechanism similar to that of statins. Alternatively, omega-3 fatty acids can lower high triglyceride levels.
The label of being “natural” may make it seem that these supplements are harmless, but they are, in fact, manufactured products. Their quality and safety are not regulated. The scope of their adverse effects or drug interactions may not be fully known due to limited testing. In any case, healthcare professionals do not consider over-the-counter supplements to be an adequate substitute for statins. Consult your healthcare provider for medical advice on the effectiveness and potential risks associated with over-the-counter or natural alternatives to statins.
Natural alternatives to simvastatin
Leaving no stone unturned in the pursuit of finding the best alternative to simvastatin might bring you to consider natural alternatives to statins. The impact of a heart-healthy diet and exercise should not be underestimated. Augmenting these lifestyle changes with dietary supplements is a common practice. Other lifestyle changes that significantly affect cholesterol levels include weight loss, smoking cessation, and limiting alcohol consumption.
How to switch to a simvastatin alternative
Now that you have expanded your knowledge of simvastatin alternatives, scheduling an appointment with the prescribing healthcare professional is a good next step toward making an informed decision. The discussion should cover your concerns about simvastatin, review other options, and reference your list of over-the-counter and prescription drugs you take to prevent possible drug interactions. The final decision should be one that you both agree will help to improve your cholesterol numbers and overall health for years to come.
Choosing the right path for high cholesterol treatment
If simvastatin is not working at lower cholesterol levels, or if the side effects are intolerable, don’t give up. There are other effective treatment options:
- A different statin may be more effective at lowering cholesterol levels or may not have intolerable side effects.
- Switching to an alternative drug class may resolve issues with side effects.
- Adding an alternative drug class to statin therapy may reduce LDL and triglyceride levels even more. It may also permit a lower statin dose.
- Over-the-counter supplements can help reduce cholesterol, but should not be considered an adequate substitute for statins.
- Dietary changes, physical activity, and weight loss are powerful tools in reducing cholesterol levels, but may not be an adequate substitute for statins.
- Always get medical advice from a healthcare provider when considering alternatives or add-ons to statin therapy.
Expert takeaway
“In place of simvastatin, I bring up an alternative generic statin that is better at reducing cholesterol, such as rosuvastatin, or one that has less side effects, like pravastatin,” explains Chad Shaffer, MD, member of the SingleCare Medical Board. “When all statins are off the table, Repatha is frequently called upon for those with known cardiovascular disease and Zetia for those only needing preventive measures.”
- Statin safety and associated adverse events: a scientific statement from the American Heart Association, Arteriosclerosis, Thrombosis, and Vascular Biology (2018)
- Comparison of the efficacy and safety of rosuvastatin versus atorvastatin, simvastatin, and pravastatin across doses, American Journal of Cardiology (2003)
- Meta-analysis of the effect and safety of berberine in the treatment of type 2 diabetes mellitus, hyperlipemia and hypertension, Journal of Ethnopharmacology (2015)
- Comparative effects of lovastatin and niacin in primary hypercholesterolemia. A prospective trial, Archives of Internal Medicine (1994)
- Red yeast rice for dyslipidemia in statin-intolerant patients: a randomized trial, Annals of Internal Medicine (2009)
- Dose-response effects of omega-3 fatty acids on triglycerides, inflammation, and endothelial function in healthy persons with moderate hypertriglyceridemia, American Journal of Clinical Nutrition (2011)
- Weight loss with a low-carbohydrate, Mediterranean, or low-fat diet, New England Journal of Medicine (2008)
- The effects of exercise training on lipid metabolism and coronary heart disease, American Journal of Physiology: Heart and Circulatory Physiology (2020)