Lipitor vs Crestor
Lipitor (atorvastatin) and Crestor (rosuvastatin) are the two most commonly prescribed statins in the world. Both belong to the same drug class (HMG-CoA reductase inhibitors) and work the same way, but Crestor is more potent per milligram and has different metabolic pathways. Understanding the differences helps patients and doctors choose the right statin for their specific situation.
What Is Lipitor?
Lipitor (atorvastatin) is a statin manufactured by Pfizer. It was FDA-approved in 1996 and became the best-selling drug in history before going generic. Atorvastatin is metabolized by the CYP3A4 liver enzyme, which means it interacts with grapefruit juice and certain other medications. Lipitor is available as a generic (atorvastatin), making it inexpensive.
What Is Crestor?
Crestor (rosuvastatin) is a statin manufactured by AstraZeneca. It was FDA-approved in 2003 and is the most potent statin per milligram. Unlike Lipitor, rosuvastatin is not significantly metabolized by CYP3A4, meaning fewer drug interactions. Crestor became available as a generic (rosuvastatin) in 2016.
Direct Comparison
| Feature | Lipitor | Crestor |
|---|---|---|
| Drug class | HMG-CoA reductase inhibitor (statin) | HMG-CoA reductase inhibitor (statin) |
| Generic name | Atorvastatin | Rosuvastatin |
| Manufacturer | Pfizer (brand) / various (generic) | AstraZeneca (brand) / various (generic) |
| Relative potency | High | Highest (most potent per mg) |
| Equivalent doses | Lipitor 40mg ≈ Crestor 20mg | Crestor 20mg ≈ Lipitor 40mg |
| Metabolism | CYP3A4 (interacts with grapefruit) | Minimal CYP3A4 (fewer interactions) |
| Grapefruit interaction | Yes — significant interaction | No significant interaction |
| Half-life | ~14 hours | ~19 hours |
| FDA approvals | High cholesterol, cardiovascular prevention | High cholesterol, cardiovascular prevention, pediatric |
| Generic available | Yes (atorvastatin) since 2011 | Yes (rosuvastatin) since 2016 |
| Cost per month | $4–$15 (generic) | $4–$30 (generic) |
What Is Actually Different?
Crestor is more potent per milligram than Lipitor. Roughly, Crestor 20mg achieves similar LDL reduction as Lipitor 40mg. This means patients needing aggressive cholesterol lowering may achieve their target with a lower dose of Crestor. The metabolism difference is clinically significant: Lipitor is processed by CYP3A4, which means grapefruit juice and certain medications (like certain antibiotics and antifungals) can increase Lipitor levels in the blood. Crestor has minimal CYP3A4 metabolism, so grapefruit and most CYP3A4 drug interactions are not a concern. See our Lipitor and grapefruit page for details. Both are available as generics, making cost relatively similar. Lipitor's generic has been available longer, so it may be slightly cheaper at some pharmacies. The SATURN trial directly compared high-intensity Lipitor (80mg) vs Crestor (40mg) and found Crestor achieved slightly greater plaque regression.
Frequently Asked Questions
Is Crestor stronger than Lipitor?
Yes, per milligram. Crestor is the most potent statin available. Roughly, Crestor 20mg ≈ Lipitor 40mg in LDL reduction. This means you may need a lower dose of Crestor to achieve the same cholesterol reduction.
Which has fewer drug interactions?
Crestor. Because Crestor is not significantly metabolized by CYP3A4, it has fewer interactions with grapefruit juice and other medications compared to Lipitor.
Are both available as generics?
Yes. Atorvastatin (Lipitor) has been generic since 2011, and rosuvastatin (Crestor) since 2016. Both are inexpensive.
Which is better for high cholesterol?
Both are highly effective high-intensity statins. The choice depends on your specific cholesterol levels, drug interactions, and side effect tolerance. Your doctor will determine which is best for you.
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