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Mar 27, 2023



Atorvastatin vs Pitavastatin

  • Atorvastatin is a more potent statin than pitavastatin. At moderate-intensity, both statins have similar effects at lowering LDL-C.
  • Pitavastatin is a good choice for those who have not responded well to other statins due to the reduced risk of drug interactions and muscle pain. Atorvastatin is recommended for those who need to reduce their LDL-C significantly.
  • Both statins are metabolized in the liver but they use different enzymes. Due to the difference in their metabolism pitavastatin has a reduced risk of drug interactions.
  • Grapefruit and grapefruit products: pitvastatin is safe with grapefruit. Atorvastatin is not.

Atorvastatin (Lipitor) and pitavastatin (Livalo, Zypitamag) are both used to lower cholesterol levels and reduce the risk of cardiovascular disease. Since both statins belong to the same drug class, HMG-CoA reductase inhibitors, they work in similar ways to lower cholesterol and share similar side effects. However, there are some differences in the dosage, strength, and how they are processed in the body.


Atorvastatin came to the U.S. market in 1996 under the brand name Lipitor. Currently over 100 million atorvastatin prescriptions are filled annually, making it the most prescribed statin in America. Atorvastatin is approved for use in children as young as 10 years old as well as adults.

Atorvastatin doses

Atorvastatin can be taken with or without food and is available in a tablet form in the following dosages:

  • High-intensity: 20–40 mg daily
    Can reduce LDL by at least 50%
  • Moderate-intensity: 5–10 mg daily
    Can reduce LDL by approximately 30%–49%

Within 2–4 weeks following atorvastatin's start-up and/or adjustment, your lipid levels should be assessed, and the dosage should be changed as necessary.

Your therapy goal and responsiveness to treatment should be taken into consideration when determining the atorvastatin initiating dosage as well as your maintenance dosage.


Pitavastatin is a newer statin and available in two brand names Livalo and Zypitamag. There are no generic options at the time of writing. Livalo and Zypitamag became available in the U.S. in 2009 and 2017 respectively.

Livalo vs Zypitamag

Zypitamag is an FDA-approved drug substitute for Livalo. The two brands are a little different because they use different types of salt. (Salt is used in medication to improve drug’s solubility and stability.) Livalo includes calcium while Zypitamag includes magnesium. Zypitamag and Livalo are considered to be bioequivalent by the FDA (Food and Drug Administration), meaning they have the same active component and function in the same way.

Cost might be a deciding factor for many people when choosing a pitavastatin. The cash-price for Zypitamag is $34.50/month compared to over $300/month with a coupon for Livalo.

Pitavastatin is a good choice for those who have not previously responded well to other statins and who’re looking for a statin with less muscular discomfort. Additionally, pitavastatin (Livalo) is used in adolescents as young as 8 years as well as adults.

Pitavastatin doses

Pitavastatin is available in tablet form and can be taken with or without food. Pitavastatin is available in the following dosages

  • Moderate-intensity: 2–4 mg daily
    Can reduce LDL by approximately 30%–49%

Note that the dosage prescribed to you is determined by your age, medical history, treatment response, and any additional drugs you may be taking.

Metabolism and interactions

Although both atorvastatin and pitavastatin are metabolized in the liver, they are processed by different enzymes, which may affect their potential for drug interactions.

After the medications you ingest are absorbed in the bloodstream they get excreted from your body. Your liver prepares (metabolizes) medications for elimination by using enzymes. The group of enzymes called CYP450 is responsible for metabolizing 70–80 % of all drugs on the market. Atorvatatin is primarily processed by CYP450. Since so many other drugs are processed by the same enzyme group, atorvastatin may cause extensive drug-drug interactions with popular medications.

Pitavastatin, on the other hand, is processed by a different enzyme called UGT (uridine 5'-diphosphate glucuronosyltransferase), a much less frequently used enzyme for drug metabolism. Because pitavastatin bypasses CYP450, it has a lower risk of drug interactions, especially for those who take multiple medications.

Drug interaction is why it's important to inform your doctor of any additional medications you are taking because some of them might significantly raise your chance of developing serious adverse effects.

Tell your doctor or pharmacist of all prescription and over-the-counter (OTC) medications you may be taking, including:

Drugs that can interact with
Atorvastatin Pitavastatin
HIV or hepatitis C mediations, including atazanavir and ritonavir
Grapefruit juice and grapefruit products
St. John’s Wort
Red yeast rice

It’s also recommended to avoid taking pitavastatin if you are taking cyclosporine or have liver problems, especially if you have abnormal liver enzyme testing.

How about grapefruit?

Grapefruit contains a chemical that can interfere with your body's ability to break down or metabolize certain statin medications. Grapefruit and grapefruit products should be avoided while you're taking a statin, including atorvastatin, to avoid undesirable adverse effects.

However, unlike most statins, pitavastatin does not interact with grapefruit juice or grapefruit products.

Which statin is better at lowering cholesterol?

Atorvastatin can reduce LDL-C (bad cholesterol) by 50% or more at the highest dose (80 mg). Because of its high efficacy, atorvastatin is frequently prescribed as the first-line medication for patients who need to significantly lower their cholesterol levels.

At lower doses (moderate intensity) both statins have similar efficacy at reducing LDL-C. Clinical studies show pitavastatin 4 mg reduced LDL cholesterol similarly to atorvastatin 20 mg, and pitavastatin 2 mg similarly to atorvastatin 10 mg.

Pitavastatin is preferred for those who have not responded well to other statins and need medication with less muscular discomfort as a side effect. Pitavastatin also has fewer drug interactions than other statins, making it a better alternative for individuals who take numerous drugs.

The statin that is best for you will depend on a variety of things, including your cholesterol levels, any drugs you are taking, and any other health issues you may have.

How statins work

Because both pitavastatin and atorvastatin are part of the same drug class, they work in very similar ways to lower cholesterol.

What is cholesterol?

Cholesterol is a waxy substance your body, specifically your liver, makes. Cholesterol isn’t inherently bad. Your body needs it to make cells, vitamins and hormones. But too much of bad cholesterol (LDL-C) can cause cardiovascular disease. Cholesterol circulates in your blood. If you have too much LDL-C, it can stick to the artery walls and form plaque, a buildup of fats, cholesterol and other substances. If the plaque ruptures, it can lead to conditions like a heart attack or stroke.

Learn more about Cholesterol

The enzyme called HMG-GoA reductase converts mevalonate (a naturally occurring chemical) to cholesterol in your liver. Statins reduce cholesterol synthesis by blocking this enzyme. Additionally, statins increase your liver's ability to take in and break down cholesterol from your blood.

With proper diet and exercise, statins are used to reduce your “bad” cholesterol (LDL), decreasing triglycerides (a type of fat in your blood), and increasing your “good” cholesterol (HDL), overall lowering your risk of having a heart attack or stroke.

The conditions pitavastatin and atorvastatin are used for:

  • Dyslipidemia—an abnormal balance between good and bad cholesterol levels
  • Hypercholesterolemia—high cholesterol levels in your blood
  • Heterozygous Familial Hypercholesterolemia (HeFH)
    —an inherited medical condition that causes high levels of LDL
    —pitavastatin is used in adolescents as young as 8 years to decrease total cholesterol and LDL cholesterol
  • Homozygous Familial Hypercholesterolemia (HoFH)
    —HoFH is a medical condition that develops when your body has trouble eliminating LDL from your blood, resulting in an increased risk of developing a heart attack at a young age.
  • Primary and secondary Atherosclerotic Cardiovascular Disease (ASCVD)—a condition caused by the development of cholesterol plaque (build-up) in your arteries.

Essentially, these medications can help delay the onset of cardiovascular disease by lowering your cholesterol levels. Pitavastatin and atorvastatin may even decrease your likelihood of experiencing a heart attack and/or stroke. In comparison to those who did not take statins, those who took statins were found to have nearly a 25% lower risk of suffering a heart attack or stroke, according to a study of more than 135,000 individuals who were at risk for having one.

Side effects

Since pitavastatin and atorvastatin are in the same drug class of medications, they share similar adverse effects, including the following:

  • Myopathy (skeletal muscle disorder causing muscle spasms, muscle stiffness and muscle weakness)
  • Myalgias (muscle pain and/or soreness)
  • Arthralgia (joint pain)
  • Cognitive impairment
  • Headache
  • Cold-like symptoms, including sore throat, stuffy nose, and/or sneezing
  • Insomnia
  • Nausea
  • Heartburn
  • Abdominal pain
  • Indigestion
  • Constipation
  • Weakness

Do not abruptly discontinue taking your statin if you believe you are encountering any negative side effects. Consult your doctor to determine whether a dose adjustment or switching to a different drug could be beneficial in your case.

Serious side effects
  • Difficulty raising your arms and/or difficulty rising or standing
  • Muscle aches in your hips, shoulders, neck, and back
  • Hepatic (liver) issues, such as upper abdominal pain, weakness, fatigue, decreased appetite, dark urine, and jaundice (yellowing of the skin or eyes)
  • Kidney issues, such as little to no urination, ankle or foot swelling, fatigue, or shortness of breath
  • Confusion and/or memory problems

If you’re experiencing any of the serious side effects listed above, immediately call your doctor and stop taking this medication.


Individuals taking statins may experience blood in their urine, also called hematuria, or protein in their urine commonly referred to as proteinuria.

Learn more about Statin Intolerance

What if I’m pregnant or breastfeeding?

Inform your doctor if you are pregnant or could be pregnant while taking a statin. Your doctor will advise you on whether you should discontinue your statin during pregnancy and if you should temporarily stop using it while nursing or breastfeeding.

Following giving birth, women who need statins and are at high risk of heart attack or stroke should not breastfeed; instead, they should utilize alternatives such as baby formula.

Kidney failure may result from muscle tissue degradation brought on by pitavastatin. If you experience inexplicable muscular pain, soreness, or stiffness while taking pitavastatin, consult your physician immediately, particularly if you're also experiencing fever, unusual fatigue, or dark urine.

Missed dose

If you forget to take a dose of your statin, take it as soon as you remember. However, if your missed dose was more than 12 hours ago, it's best to skip it. You can take your next dose again on your regular schedule.

Consult your physician or pharmacist if you're unsure about taking a missed dose or skipping it.

To make up for a missed dosage, do not take another pill. This might increase your likelihood of experiencing negative adverse effects.

Consider utilizing a medicine reminder to ensure that you don't forget to take a dosage. This may entail using a timer or setting an alarm. On your phone, you might also download a reminder app.

Speak with your doctor

Both medications are considered safe and effective when taken appropriately (as prescribed by your doctor). Talk to your doctor today about using pitavastatin and Atorvastatin and send your prescription to Marley Drug. Save up to 95% compared to your local pharmacy by using Marley Drug.

Marley Drug provides free nationwide shipping, allowing you to receive your medication at no additional cost straight to your door.

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