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Feb 23, 2023



Pitavastatin vs Rosuvastatin: Which is better at lowring cholesterol?

Key points
  • Rosuvastatin is a high- to moderate-intensity statin. Pitavastatin is a moderate-intensity statin.
  • Rosuvastatin is more potent in lowerering cholesterol. Pitavastatin has reduced potential for certain drug interactions and is better tolerated by people who are on multiple medications.
  • Grapefruite and grapefruit products are safe with both statins.

Pitavastatin and rosuvastatin are among the most commonly prescribed statins to treat high cholesterol. They work similarly to lower cholesterol and share similar side effects. However, there are some notable differences you may want to know in order to choose the right one.

Rosuvastatin (Crestor)

The FDA initially authorized the rosuvastatin tablet formulation in 2003 under the trade name Crestor. Ezallor Sprinkle was authorized in 2018. It was approved in adults who find it difficult to swallow tablets or capsules. Its advantage is that you can open the capsule it comes in and empty the contents onto soft food and consume them to make it easier to swallow.

Only Crestor tablets have received approval for use in adolescents. Because the manufacturer of Crestor tablets presently holds the exclusive marketing rights for use of rosuvastatin in this age range, generic tablets and capsules are not authorized for use in young children.

Rosuvastatin doses

Rosuvastatin is a high- to moderate-intensity statin and available 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 LDL by approximately 30%–49%

Pitavastatin (Zypitamag, Livalo)

Pitavastatin was approved in the United States in 2009 under the brand name Livalo. In 2017, Zypitamag, another brand became available at a more affordable price. Livalo currently costs over $1000 for a 90-day supply. Zypitamag on the other hand is available through our pharmacy for just $34.50/month.

Livalo and Zypitamag are a little different because they use different types of salt; Livalo includes calcium while Zypitamag includes magnesium. However, Zypitamag and Livalo are still considered to be bioequivalent by the FDA (Food and Drug Administration), meaning they have the same active component and function in the same way.

Pitavastatin doses

Pitavastatin is a moderate-intensity statin and comes only in tablet form. Availabe doses are:

  • Moderate-intensity: 1 mg, 2 mg, ;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. Zypitamag is only available in the 2 mg and 4 mg format.

Additionally, pitavastatin is used in adults and adolescents as young as 8 years to decrease total cholesterol as well as LDL cholesterol.

Metabolism and interactions

Although both rosuvastatin 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 drugs on the market. Since so many drugs are processed by CYP450, this enzyme may cause extensive drug-drug interactions with popular medications.

Rosuvastatin is mainly metabolized by CYP2C9 (part of CYP450 family) whereas pitavastatin is primarily metabolized by a different liver enzyme called UGT (uridine 5'-diphosphate glucuronosyltransferase). Because pitavastatin bypasses CYP450, it has a lower risk of drug interactions, especially for those who take multiple medications.

Drugs that can interact with
Rosuvastatin Pitavastatin
Regorafenib (for rectum and colon cancer)
Protease inhibitors, including Atazanavir (for HIV or hepatitis C)
Anti-fungal medications, including Fluconazole
Daralutamide (for prostate cancer)
Colchicine (for gout)
Red yeast rice

Be sure 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.

Which medication is best suited for me?

Rosuvastatin is more potent and considered to be one of the most effective statins at reducing LDL levels by more than 50%. It also comes with a greater likelihood of causing unwanted side effects, including muscle pain. These rates vary between clinical trials and were as high as 12.7%.

Pitavastatin has been shown to have a lower rate of muscle pain (3.1% at the highest dose) and has a reduced risk for dug interactions compared to other statins. Therefore, pitavastatin may be beneficial to patients who need a statin with less muscular discomfort and/or take multiple medications.

Additionally, pitavastatin may be the more appropriate statin for individuals with HIV who take antiretroviral therapies (ARTs) such as Atazanavir.

The similarities

Since both pitavastatin and rosuvastatin are part of the same drug class, they work in very similar ways.

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 rosuvastatin 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.

To lower cholesterol and promote heart health, pitavastatin is taken in conjunction with a balanced diet and other lifestyle modifications.

It's safe to drink grapefruit juice with pitavastatin or rosuvastatin

Unlike other statins, pitavastatin and rosuvastatin do not interact with grapefruit juice or grapefruit products. You can continue to enjoy grapefruit juice.

Side effects

Since pitavastatin and rosuvastatin 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 experiencing 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

Can I take pitavastatin or rosuvastatin if I’m pregnant or breastfeeding?

When taking pitavastatin or rosuvastatin, you should inform your doctor if you become pregnant or think you could be pregnant.

Your doctor will advise you on whether you should discontinue this medication during pregnancy and if you should temporarily stop using pitavastatin 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.

There is no evidence to support rosuvastatin's safety in expectant mothers, and there is no advantage to using it. Statins, which block the HMG-CoA reductase enzyme, may harm an unborn fetus because they reduce the production of cholesterol and possibly other biologically active compounds derived from cholesterol.

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.

Additionally, studies on nursing mothers have shown negative effects on infants. Breastfeeding while taking pitavastatin is not recommended. Your doctor should prescribe an alternative.

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 rosuvastatin 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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