Atorvastatin vs. Rosuvastatin (Lipitor vs. Crestor): Which Statin Is Better?
Atorvastatin (Lipitor) and rosuvastatin (Crestor) are the two most prescribed statins in the world. Both are high-potency statins that reduce LDL cholesterol by 40–55% at standard doses, but rosuvastatin is roughly 2x more potent mg-for-mg. The critical practical difference is cost: atorvastatin has been generic since 2011 and costs as little as $7.48/month with a GoodRx coupon. Rosuvastatin only became widely generic in 2023 and still costs $14–$20/month. For most patients, atorvastatin is the first-line choice. Rosuvastatin is preferred when maximum LDL reduction is needed or when atorvastatin causes muscle side effects.
Medically Reviewed by Dr. Sarah Chen, PharmD, BCPS
Clinical Pharmacist & Medical Reviewer
Last reviewed: July 20, 2026
Side-by-Side Comparison
| Category | Atorvastatin | Rosuvastatin |
|---|---|---|
| Potency | High-intensity: 40–80 mg reduces LDL by ≥50% | High-intensity: 20–40 mg reduces LDL by ≥50%; 2x more potent mg-for-mg |
| Cost (30-day supply) | $7.48 with GoodRx; $4 at Walmart | $14–$20 with GoodRx; not on Walmart $4 program |
| LDL Reduction (standard dose) | Atorvastatin 10 mg: ~39% | 20 mg: ~43% | 40 mg: ~50% | 80 mg: ~60% | Rosuvastatin 5 mg: ~38% | 10 mg: ~43% | 20 mg: ~50% | 40 mg: ~63% |
| Muscle Side Effects (Myopathy) | 1–5% incidence; dose-dependent; more common at 80 mg | Slightly lower incidence than atorvastatin at equivalent doses |
| Drug Interactions | Metabolized by CYP3A4 — interacts with azole antifungals, macrolides, cyclosporine | Not metabolized by CYP3A4 — fewer drug interactions; interacts with antacids (take 2h apart) |
| Kidney Safety | No dose adjustment needed for renal impairment | Max dose 10 mg/day in severe renal impairment (eGFR <30) |
| Diabetes Risk | Class-wide risk: ~10% increased risk of new-onset diabetes with high-intensity statins | Class-wide risk: ~10% increased risk of new-onset diabetes with high-intensity statins |
Bottom Line
**Atorvastatin is the first-line statin for most patients** because it is equally effective, costs 50–75% less, and has 30+ years of safety data. **Rosuvastatin is preferred** when: (1) maximum LDL reduction is needed and atorvastatin 80 mg is not tolerated, (2) the patient has drug interactions with CYP3A4 inhibitors, or (3) the patient has experienced atorvastatin-induced myopathy. For patients with CKD, atorvastatin is preferred because rosuvastatin requires dose adjustment at eGFR <30. The ACC/AHA guidelines recommend either drug for high-intensity statin therapy.
Atorvastatin Overview
Atorvastatin (Lipitor) is the world's best-selling prescription drug and the most widely prescribed statin for lowering LDL ('bad') cholesterol and reducing the risk of heart attack, stroke, and cardiovascular death. It is used for both primary prevention (in people without established heart disease but with risk factors) and secondary prevention (in people who have already had a heart attack or stroke). Generic atorvastatin is available for as little as $4–$25 per month.
Full Atorvastatin guide →Rosuvastatin Overview
Rosuvastatin is a medication in a class called "statins" that helps lower high cholesterol and other fats in your blood. It works by reducing the amount of "bad" cholesterol your body makes, which helps to prevent heart problems and slow the progression of hardening of the arteries.
Full Rosuvastatin guide →Compare prices for Atorvastatin and Rosuvastatin
Check real-time pharmacy prices before you fill — free, no account needed.
Medical Disclaimer
The information on RxGuide is intended for educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician, pharmacist, or other qualified health provider with any questions you may have regarding a medical condition or medication. Never disregard professional medical advice or delay in seeking it because of something you have read on this website.