Simvastatin vs. Crestor comparison
Zocor (simvastatin) and Crestor (rosuvastatin) are both members of the family
of cholesterol-lowering drugs called statins, which revolutionized the
management of cardiovascular diseases, many of which are caused by cholesterol
plaque deposits in the arteries.
Crestor is the more potent cholesterol-lowering drug, and it’s also newer
Aside from being better at lowering so-called “bad” cholesterol levels in the
bloodstream, another advantage to rosuvastatin is that it has far fewer negative
interactions with other medications than simvastatin, or most other statins, for
What are simvastatin and Crestor?
Simvastatin (Zocor) and Crestor (rosuvastatin) are both in the statin family
of cholesterol-reducing drugs. They both work to lower “bad” cholesterol in the
bloodstream, which comes in the form of low-density lipoprotein or LDL.
Cholesterol is vital for the body to function. It’s used to provide cell
structure, insulate nerve cells, enable digestion, and a host of other benefits.
The body can make all the cholesterol it needs in the liver, but food also
contains cholesterol that ends up in the bloodstream. There, it sticks to artery
walls as a solid plaque, constricting blood flow. This can lead to debilitating
or fatal heart attacks or strokes.
Statins like Zocor and Crestor lower LDL by hindering liver cells’ ability to
make cholesterol. The liver manufactures cholesterol from simpler molecules. The
liver has to turn these molecules into a compound called
HMG-CoA reductase, which turns into cholesterol after a few more steps. Statins
(also called HMG-CoA reductase inhibitors) bind with HMG-CoA reductase to stop it from turning into cholesterol.
Because the body’s natural impulse is to
maintain a balanced level of cholesterol, the liver cells start to suck
cholesterol out of the bloodstream, meaning it’s no longer floating around to
add to arterial plaque deposits.
Statins also raise levels of HDL, the so-called “good” cholesterol. HDL
molecules act as scavenger molecules in the bloodstream, binding with LDL and
taking to the liver for processing. Research isn’t as clear on the mechanism by
which statins raise HDL levels as it is on how the drugs lower LDL levels.
How are simvastatin and Crestor different?
Statins typically are very similar to one another, but rosuvastatin is a bit
of an outlier. Rosuvastatin, aside from Lipitor (atorvastatin), is the most
potent statin for lowering LDL. It’s different than simvastatin and many other statins
in several important ways.
First, simvastatin is a prodrug, meaning that the chemical sold in the pill
won’t lower cholesterol by itself; the body needs to break it down in the gut
into a different form before it can do its job. Rosuvastatin is ready to go out
of the package.
Second, simvastatin and most other statins can have bad interactions with a
bunch of different drugs, whereas Crestor has relatively few.
Why? A specific system of enzymes found mostly in specialized liver cells
break down simvastatin and other statins. This system is responsible for
breaking down (metabolizing) all sorts of different foreign compounds, toxins, and
toxic waste produced internally by our own cells. The enzyme system – created
by a group of genes called CYP450 – is responsible for processing 70% to 80% of
all drugs on the market.
Because different, more obscure enzymes break down rosuvastatin – enzymes
only minimally involved with the powerhouse CYP450 system – Crestor doesn’t
interfere as much with other drugs.
Finally, because Crestor is has a tendency to
dissolve or combine with water (it’s “hydrophilic”), it has fewer muscle and nervous system
side effects than simvastatin. Zocor is more likely to dissolve or
combine with fats (it’s “lipophilic”), meaning it can more easily enter nerve and muscle cells
to cause problems.
What are the uses for simvastatin and Crestor?
- Simvastatin and rosuvastatin are used for reducing total cholesterol,
LDL cholesterol, and
triglycerides, and for increasing HDL cholesterol.
peripheral vascular disease, or
stroke or other
Zocor and Crestor are prescribed
for reducing the risk of mortality by reducing death from coronary heart
disease, reducing nonfatal
myocardial infarction (heart attack) and
reducing the need for coronary and noncoronary revascularization procedures.
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What are the side effects of simvastatin and Crestor?
The potential side effects of both Zocor and Crestor are nearly identical and
are similar to those seen in other statins. The most common side effects include
headache, nausea, vomiting, diarrhea, and muscle pain. Rarely, forgetfulness and
memory loss can happen with both these medications.
Doctors’ chief worries when prescribing patients simvastatin and rosuvastatin
are potential liver damage and muscle breakdown. Though serious liver damage is
rare, doctors prescribing either Crestor or Zocor will closely monitor important
chemical markers that show up in liver tests to make sure the levels are in the
acceptable range. Abnormal liver tests usually return to normal after shortly
after dosing starts, but if chemical markers remain three times higher than the
normal accepted highest levels, your doctor will discontinue administering the
Muscle breakdown is also a serious problem. If statins cause the muscle
protein myoglobin to leech into the bloodstream, it can shut down the kidneys,
which aren’t equipped to filter out that protein. That condition is called
rhabdomyolysis, and can be potentially fatal.
This isn’t a full list of side effects. Consult your doctor for more
information if you’re taking either of these drugs.
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How should simvastatin and Crestor be taken (dosage)?
- The recommended dose range of simvastatin is 10 mg to 40 mg,
and it is administered once daily in the evening with or without food. Therapy
usually is initiated with 10 or 20 mg daily, but individuals who have a high
risk of heart disease can be started on 40 mg daily.
- Simvastatin 80 mg is
restricted to patients who have been taking simvastatin 80 mg chronically (for
example, for 12 months or more) without evidence of muscle toxicity because the
80 mg dose is associated with increased risk of muscle toxicity, including
rhabdomyolysis. Patients who are currently tolerating the 80 mg dose of
simvastatin who need to start an interacting drug that should not be taken with
simvastatin or is associated with a dose cap for simvastatin should be switched
to an alternative statin or statin-based regimen with less potential for the
- Patients that require more than the 40 mg dose should be
switched to an alternative drug.
- The starting dose for most adults is 5 mg once daily.
- The maximum dose is 40 mg daily, and this dose should be reserved for patients who do not adequately respond to a 20 mg dose.
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Which drugs interact with simvastatin and Crestor?
As mentioned earlier, rosuvastatin has far fewer harmful drug interactions
that Zocor and other statins. Still, Crestor is not without dangers.
Cyclosporine can exponentially increase rosuvastatin levels in the blood,
increasing the chances of side effects. Also, you shouldn’t take the blood
thinner warfarin (Coumadin) with Crestor, nor should you combine it with drugs
that could damage the liver, like nicotinic acid or gemfibrozil (Lopid).
Antacids reduce the body’s ability to absorb Crestor, so don’t take them
within two hours of a dose of rosuvastatin.
Zocor, on the other hand, is similar to other statins in that is has a high
number of adverse interactions with other drugs.
A number of drugs make it more difficult for the body to break down and get
rid of Zocor, which can make simvastatin more toxic to muscle tissue. Some of
these drugs include:
- erythromycin (E-Mycin),
- ketoconazole (Nizoral),
- itraconazole (Sporanox),
- clarithromycin (Biaxin),
- telithromycin (Ketek),
- cyclosporine (Sandimmune),
- nefazodone (Serzone),
- boceprevir (Victrelis),
- telaprevir (incivek),
- voriconazole (Vfend),
- posaconazole (Noxafil), and
- HIV protease inhibitors such as:
Other drugs that you shouldn’t take with simvastatin include:
- Amiodarone (Cordarone),
- verapamil (Calan Verelan, Isoptin),
- amlodipine (Norvasc),
- danazol (Danocrine),
- ranolazine (Ranexa),
- niacin (Niacor, Niaspan,
- gemfibrozil (Lopid) and
- fenofibrate (Tricor).
This isn’t a full list of drugs that interact with simvastatin and
rosuvastatin, so make sure you tell your doctor about all the medications you’re
taking if they prescribe you either of these drugs.
Are simvastatin and Crestor safe to take during pregnancy or while breastfeeding?
Neither Crestor nor Simvastatin should be taken during pregnancy or breastfeeding. Cholesterol is absolutely vital for the developing fetus and growing infant, so cholesterol reducing medications like Crestor and Zocor. Furthermore, statins are passed on in breastmilk, so either don’t take them while nursing or feed your baby formula.