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atorvastatin (Lipitor) vs. simvastatin (Zocor): Dosage & Side Effects

Atorvastatin vs. simvastatin comparison

Atorvastatin (Lipitor) and simvastatin (Zocor) are parts of a group of drugs
called statins
that revolutionized cholesterol management and heart disease prevention.

Atorvastatin and simvastatin both target the same chemical in the body to
reduce drastically the bloodstream levels of LDL (low-density lipoprotein, or
“bad cholesterol”), which lowers the risk it will clog up arteries, a central
cause of cardiovascular problems.

These drugs also modestly raise levels of “good cholesterol” (HDL or
high-density lipoprotein).

Both Lipitor and Zocor are good for lowering LDL, but Zocor is better at
increasing HDL and tends to have fewer gastrointestinal side effects, according
to one study.

Both atorvastatin and simvastatin share some possible side effects,

Lipitor and Zocor differ on a number of other less serious side effects.

A large number of drugs interact with both atorvastatin and simvastatin, so
be sure to tell your doctor about all your other medications if they prescribe
either of these cholesterol drugs.

What are atorvastatin and simvastatin?

Atorvastatin and simvastatin are both chemicals that interfere with liver
cells’ cholesterol production. They are in a family of statins
which also includes:

The molecules of the medications target an enzyme called HMG-CoA
reductase, one step in the chemical process cells use to fabricate
cholesterol from simpler types of molecules. Because of this, statins are called
“HMG-CoA reductase inhibitors.”

Cholesterol is essential for many body functions, including hormone
production, cell structure, lining of nerve cells, digestion, and more. The body
can make all the cholesterol it needs, but foods also contain cholesterol
the body can use.

A healthy liver can balance cholesterol levels, but
too much cholesterol in the bloodstream in LDL form leads to a host of
cardiovascular diseases. The excess LDL forms plaques on artery walls, narrowing
blood vessels to cause clots and blockages that can lead to coronary heart
disease, stroke, heart
attack, and other debilitating or fatal problems.

Lipitor and Zocor, as well as other statins, stop the cholesterol-making
process in the liver cells by grabbing onto and binding up HMG-CoA reductase
before it becomes cholesterol, sabotaging the cell’s cholesterol factory.

When the liver cells can’t make enough of their own cholesterol anymore
because of the statin treatment, the body’s cholesterol balancing impulse kicks
into action, causing liver cells to suck up more LDL from the bloodstream. The
cells break down the LDL into cholesterol to make up for the shortfall in
production. As a consequence, less LDL is floating around in the bloodstream to
add to arterial plaque deposits, thus substantially reducing cardiovascular disease

Statins like atorvastatin and simvastatin also modestly increase HDL
(high-density lipoproteins) in the bloodstream, which is the so-called “good
cholesterol.” Good levels of HDL molecules are healthy because they act as
scavenger molecules, grabbing LDL from the bloodstream and taking it to the
liver for processing and removal.

Researchers don’t yet understand exactly how statins increase HDL.

What are the uses for atorvastatin and simvastatin?

Lipitor and Zocor are used for the treatment of
elevated total cholesterol, LDL, and
triglycerides and to elevate
HDL cholesterol.
Both atorvastatin and simvastatin can help prevent:

Lipitor and Zocor reduce the risk of heart attack,
stroke, angina and revascularization procedures in adults with multiple risk factors for
coronary artery disease.
Atorvastatin and simvastatin also prevent
heart attacks and
strokes in patients with
type 2 diabetes with multiple risk factors for
coronary artery disease.

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What are the side effects of atorvastatin and simvastatin?

Side effects common to both Lipitor and Zocor include:

Common side effects unique to atorvastatin include constipation, fatigue,
gas, heartburn, common cold, urinary tract infection and joint pain.

Simvastatin, on the other hand, can cause nausea, vomiting, gas, and allergic

The most serious possible side effect of both Lipitor and Zocor is liver
damage. Statins will usually affect the results of liver tests soon after
treatment starts, but then return to normal. Doctors should stop administering
atorvastatin or simvastatin if liver tests for certain chemical markers remain
three times normal concentrations for an extended period.

Muscle inflammation caused by Lipitor and Zocor can cause serious damage if
muscle protein (myoglobin) leeches into the bloodstream. This can cause
rhabdomyolysis, a potentially fatal condition that can cause kidney failure because those
organs cannot filter myoglobin.

Anonther concern with both atorvastatin and simvastatin is they can raise
blood sugar and HbA1c levels, mimicking conditions seen in diabetes.


In the U.S., 1 in every 4 deaths is caused by heart disease.
See Answer

How should atorvastatin and simvastatin be taken (dosage)?

atorvastatin (Lipitor)

  • Lipitor is prescribed once daily. The usual starting dose for adults is 10-20 mg per day, and the maximum dose is 80 mg per day. Adults who need more than a 45% reduction in
    LDL cholesterol may be started at 40 mg daily.
  • Pediatric patients should receive 10 mg once daily up to a maximum dose of 20 mg daily.
    Lipitor may be taken with or without food and at any time of day.

simvastatin (Zocor)

  • 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. People
    usually start with 10 or 20 mg daily, but those with high
    heart disease
    risk can start with 40 mg daily.
  • Simvastatin 80 mg is restricted to patients who have been taking
    simvastatin 40 mg long-term (for example, for a year or more) without evidence of muscle toxicity.
    80 mg dose is associated with increased risk of muscle toxicity, including
    rhabdomyolysis. Patients who are currently tolerating the
    40 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
    drug-drug interaction.
  • Patients that require more than the 80 mg dose should be
    switched to an alternative drug.

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Which drugs interact with atorvastatin and simvastatin?

A number of drugs reduce the body’s ability to get rid of both Lipitor and Zocor. They include, but aren’t limited to:

Large quantities of grape fruit juice (more than 1.2 liters daily) also will
increase blood levels of atorvastatin and simvastatin, so drink it sparingly.

The following drugs also may increase the risk of muscle toxicity when combined
with Lipitor or Zocor.

A number of other drugs have reactions with Liptor and Zocor. This is
not a complete list of drugs dangerous to combine with these statins, so make
sure to tell your doctor about all the medications you are taking if they
prescribe you atorvastatin or simvastatin.

Are atorvastatin and simvastatin safe to take during pregnancy or while breastfeeding?

Because cholesterol is vital to the formation of the fetus and the growth of infants, pregnant and nursing mothers should never take atorvastatin, simvastatin, or any other statin. The risk is so great, doctors won’t prescribe statins to women of childbearing age unless they are unlikely to become pregnant.

Lipitor and Zocor are passed on in breast milk, so either feed your infant
with formula
or don’t take any statins.


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