Rosuvastatin vs Pravastatin
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Rosuvastatin (Crestor) and pravastatin (Pravachol) represent opposite ends of the statin potency spectrum. Rosuvastatin is the most potent statin available, while pravastatin is among the least potent but has a particularly favorable safety and tolerability profile.
Both are hydrophilic (water-soluble) statins, which distinguishes them from lipophilic statins like atorvastatin and simvastatin. However, they differ substantially in how much they lower LDL cholesterol and in their metabolic pathways.
The choice between them often comes down to balancing the degree of LDL lowering needed against concerns about tolerability and drug interactions.
Rosuvastatin vs Pravastatin: Side-by-side comparison
| Category | Rosuvastatin | Pravastatin |
|---|---|---|
| Drug Class | Statin | Statin |
| Brand Name | Crestor | Pravachol |
| Max LDL-C Reduction | ~55-63% (40 mg) | ~34% (80 mg) |
| Solubility | Hydrophilic | Hydrophilic |
| CYP450 Metabolism | Minimal (CYP2C9) | None significant |
| Dosing Time | Any time of day | Bedtime recommended |
| Generic Since | 2016 | 2006 |
Efficacy: How well does each drug work?
Rosuvastatin is far more potent than pravastatin. Rosuvastatin 5 mg (the lowest available dose) achieves approximately 38-40% LDL-C reduction, which exceeds the maximum effect of pravastatin 80 mg (~34%). At its maximum dose of 40 mg, rosuvastatin reduces LDL-C by approximately 55-63%.
The STELLAR trial confirmed rosuvastatin's superior LDL-lowering across all dose comparisons. For patients who need LDL reductions greater than 35%, rosuvastatin is clearly the more effective choice.
Pravastatin has strong clinical outcomes evidence from the WOSCOPS and CARE trials, demonstrating meaningful cardiovascular risk reduction despite its more modest LDL lowering. For patients who only need moderate LDL reduction, pravastatin remains a proven option.
Side effects comparison
Both rosuvastatin and pravastatin are hydrophilic statins, which may contribute to a lower incidence of muscle-related side effects compared to lipophilic statins. Pravastatin in particular has one of the lowest rates of myalgia among all statins and is often chosen for statin-rechallenge in patients who experienced muscle problems.
Pravastatin is unique among statins in that it is not significantly metabolized by the CYP450 enzyme system, giving it the fewest drug interactions of any statin. Rosuvastatin is minimally metabolized by CYP2C9 and also has relatively few interactions, though it does interact with certain drugs like cyclosporine and gemfibrozil.
Both drugs can cause elevated liver enzymes and should be monitored with periodic liver function tests, as with all statins.
Cost comparison
Pravastatin has been generic since 2006 and rosuvastatin since 2016. Both are affordable, with 30-day supplies typically costing $4-$20. Pravastatin may be marginally cheaper at some pharmacies, but both are widely available through discount generic programs.
Neither drug has a significant cost advantage that would typically influence prescribing decisions.
Convenience and dosing
Both are taken once daily. Pravastatin is typically recommended at bedtime, while rosuvastatin can be taken at any time of day due to its long half-life (~19 hours). Neither requires administration with food.
Rosuvastatin's dosing flexibility is a minor convenience advantage. Both drugs are available in multiple tablet strengths, allowing dose titration.
Which is right for you?
Rosuvastatin is preferred when aggressive LDL lowering is the primary goal. It can achieve at its lowest dose what pravastatin achieves at its maximum, making it the clear choice for patients who need substantial cholesterol reduction.
Pravastatin is preferred when tolerability is the primary concern — particularly for patients who have experienced muscle pain with other statins, or patients on complex medication regimens where minimizing drug interactions is important. Its established safety record makes it a reasonable first statin for patients at lower cardiovascular risk.
Consult your healthcare provider to determine which statin best matches your cardiovascular risk profile and treatment goals.
Frequently asked questions
References
- [Regulatory] Crestor (rosuvastatin calcium) prescribing information. AstraZeneca. https://www.accessdata.fda.gov/drugsatfda_docs/label/2010/021366s016lbl.pdf Accessed 2026-02-28.
- [Regulatory] Pravachol (pravastatin sodium) prescribing information. Bristol-Myers Squibb. https://www.accessdata.fda.gov/drugsatfda_docs/label/2012/019898s065lbl.pdf Accessed 2026-02-28.
- [Clinical] Jones PH, et al. STELLAR Trial. Am J Cardiol. 2003;92(2):152-160. https://pubmed.ncbi.nlm.nih.gov/12860216/ Accessed 2026-02-28.
- [Clinical] Shepherd J, et al. Pravastatin in elderly individuals at risk of vascular disease (PROSPER). Lancet. 2002;360(9346):1623-1630. https://pubmed.ncbi.nlm.nih.gov/12457784/ Accessed 2026-02-28.
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