When is Lipitor^® really better than generic lovastatin?

Both atorvastatin (Lipitor®) and lovastatin lower LDL cholesterol, the primary goal of drug therapy for patients with high cholesterol. Lovastatin is much less expensive than atorvastatin, but does not reduce LDL cholesterol as much. The maximum recommended dose of lovastatin (80 mg daily) lowers LDL cholesterol by an average of 42%. Atorvastatin 40 mg and 80 mg lower LDL cholesterol by an average of 50% and 60%, respectively. Thus, drug choice depends on how much the LDL-cholesterol level should be reduced. It’s easy to calculate the percent reduction needed:Both atorvastatin (Lipitor®) and lovastatin lower LDL cholesterol, the primary goal of drug therapy for patients with high cholesterol. Lovastatin is much less expensive than atorvastatin, but does not reduce LDL cholesterol as much. The maximum recommended dose of lovastatin (80 mg daily) lowers LDL cholesterol by an average of 42%. Atorvastatin 40 mg and 80 mg lower LDL cholesterol by an average of 50% and 60%, respectively. Thus, drug choice depends on how much the LDL-cholesterol level should be reduced. It’s easy to calculate the percent reduction needed:

If a greater than 40% reduction in LDL-C is needed, a more potent statin such as atorvastatin, or the addition of a second agent such as ezetimibe (Zetia®), will probably be necessary.Other differences between atorvastatin and lovastatin may be important in some patients. Both statins are metabolized by cytochrome P450 3A4. Inhibitors of this isoenzyme may increase statin serum concentrations and the risk of myopathy and rhabdomyolysis (a potentially fatal syndrome involving skeletal muscle destruction). Atorvastatin is less affected by 3A4 inhibitors than lovastatin. However, statins which are not primarily metabolized by 3A4 (pravastatin, fluvastatin, rosuvastatin) are safer options in patients taking potent 3A4 inhibitors.

Atorvastatin and lovastatin also differ somewhat in their effects on HDL (“good”) cholesterol levels. Lovastatin 80 mg daily increases HDL cholesterol by an average of 8%, compared to a 5% increase with atorvastatin 80 mg daily.