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Mar 7, 2023



Pitavastatin vs Simvastatin: Which one is better?

Key points
  • Pitavastatin is a moderate-intensity statin. Simvastatin is a moderate- to low-intensity statin. Both medications are used to treat high cholesterol.
  • Pitavastatin is more effective than simvastatin for people with primary hypercholesterolemia or mixed dyslipidemia
  • Pitavastatin is safe with grapefruit and grapefruit products. Simvastatin may interact with grapefruit and grapefruit products.
  • Pitavastatin is available in tablet form only and simvastatin is available in tablet and oral suspension.

Pitavastatin and simvastatin belong to a group of drugs called statins and are used to treat high cholesterol. Statins work by blocking the enzyme called HMG-CoA reductase that is needed to make cholesterol in your liver.

Pitavastatin is a moderate-intensity statin and simvastatin a moderate- to low-intensity statin. Since they belong to the same drug class, HMG-CoA reductase inhibitors, they work in similar manners and share many of the side effects. The differences are in the dosage and administration—how and when to take it. Pitavastatin comes in tablet form only and can be taken any time of the day whereas simvastatin is available in tablet and suspension form and recommended to be taken at bed time or with the evening meal.

Which medication is better?

Although both medications are well-tolerated, according to a study that compared the efficacy and safety of both medications, pitavastatin was shown to be an effective therapeutic option for individuals with primary hypercholesterolemia or mixed dyslipidemia when compared to simvastatin.

Notably, pitavastatin has shown to be more effective than simvastatin at a lower dose (pitavastatin: 2 mg vs simvastatin: 20 mg) and has similar effects at a higher dose (pitavastatin: 4 mg vs simvastatin: 40 mg).

Keep in mind that 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.

Read more about Compare Statins

Pitavastatin (Livalo, Zypitamag)

Pitavastatin is a newest statin that came into the U.S. market in 2009 under the brand name Livalo. In 2017 another brand pitavastatin, Zypitamag, 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. Although their prices differ Livalo and Zypitamag have the same active component and function in the same way.

Because pitavastatin has been shown to have a reduced risk of muscle pain, it is recommended for people who have not previously responded well with other statins.

Pitavastatin is available in tablet form and can be taken with or without food. The available doses are:

  • Moderate-intensity: 1 mg, 2 mg, 4 mg daily
    Can reduce LDL by approximately 30%–49%

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

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

Simvastatin (Zocor)

Simvastatin is one of the oldest statins and considered a first-line treatment for high cholesterol. It came into the U.S. market in 1991 under the brand name Zocor and now available in both brand and generic. It can be taken with or without food at bedtime or with an evening meal.

Simvastatin is available in suspension and tablet form in dosages ranging from 5 mg to 80 mg, including the following:

  • Moderate-intensity: 20–40 mg daily
    Can reduce LDL by approximately 30%–49%
  • Low-intensity: 10 mg daily
    Can reduce LDL by no more than 30%

Simvastatin oral suspension is generally taken once daily in the evening on an empty stomach and should be shaken for approximately 20 seconds before each use.

Your physician could prescribe you a low dose of simvastatin to begin and then progressively increase it up to once every 4 weeks. Simvastatin should still be taken even if you're feeling better. Without consulting your physician, do not discontinue taking simvastatin.

Additionally, this medication is approved for adults and children older than 10 years.

The similarities

Because both pitavastatin and simvastatin 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-CoA 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.

Pitavastatin and simvastatin are commonly used to treat the following medical conditions:

  • Hyperlipidemia, commonly described as having high levels of lipids or fats, including cholesterol and triglycerides
  • Heterozygous Familial Hypercholesterolemia (HeFH)
    —an inherited medical condition that causes high levels of LDL
  • 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.

Side effects

Pitavastatin and simvastatin are in the same drug class and share similar adverse effects:

  • 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 pitavastatin 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 is statin intolerance?

You may develop a statin intolerance when you acquire an allergy to one or have side effects that outweigh the medication's benefits. Although statins are commonly used to lower cholesterol levels, some people become intolerant to them and are unable to take them.

In the event that your physician advises using a statin to lower your cholesterol, be aware of any abnormalities you may discover.

Signs and symptoms that are generally affiliated with statin intolerance include the following:

  • Muscle aches
  • Muscle pain
  • Weakness
  • Cramps
  • You may have muscle inflammation and an increased level of creatine kinase, a serious indication of muscle damage.


Your physician must be aware of any additional medications you are taking because some of them might significantly raise your chance of developing serious muscle issues.

Inform your physician of all prescription and over-the-counter (OTC) medications, including:

  • Atazanavir
  • Amiodarone
  • Fluconazole
  • Fenofibrate
  • Cyclosporine
  • Gemfibrozil
  • Retrovir
  • Colchicine
  • Erythromycin
  • Niacin
  • Red yeast rice
  • Medications used to treat HIV/AIDs, including atazanavir or indinavir

Although grapefruit and grapefruit juice should not be used with simvastatin since there may be an interaction that results in undesirable side effects, pitavastatin has not been shown to interact with grapefruit products.

Can I take these medications if I’m pregnant?

When taking a statin, including Pitavastatin and Simvastatin, you should inform your doctor if you get 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 simvastatin 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.

Missed dose

Although both medications can be taken at any time of the day, they should be taken at roughly the same time every day so you don’t forget to take them.

However, if you do forget to take a dose, take it as soon as you remember unless it's almost time for your next dose. In this case, skip the forgotten dose and take the next one at the usual time. Do not take 2 doses together to make up for a missed dose.

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 simvastatin 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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