Review of atorvastatin alternatives

7 Best Atorvastatin alternative Drugs

Patients may seek atorvastatin alternative drugs for various reasons. Some may find treatment with atorvastatin not suitable due to possible side effects. Recently atorvastatin has been in and out of stock which spiked the interest in alternative drugs for the treatment of high cholesterol.

What is atorvastatin?

Atorvastatin alternative drugs - review

Atorvastatin is a medication that belongs to the class of drugs known as statins. It is commonly prescribed to lower cholesterol levels and reduce the risk of cardiovascular diseases, such as heart attacks and strokes. Atorvastatin works by inhibiting an enzyme called HMG-CoA reductase, which is responsible for cholesterol production in the liver. By blocking this enzyme, atorvastatin reduces the amount of cholesterol synthesized in the body, leading to lower levels of LDL (low-density lipoprotein) cholesterol, often referred to as “bad” cholesterol.

Why lowering cholesterol is important?

Lowering LDL cholesterol is important because high levels of LDL can contribute to the formation of plaque in the arteries, narrowing them (atherosclerosis) and increasing the risk of cardiovascular problems. Atorvastatin also has modest effects on raising HDL (high-density lipoprotein) cholesterol, commonly known as “good” cholesterol, which helps remove LDL cholesterol from the bloodstream.

Atherosclerosis can be caused by by cholesterol levels in the body.
Cholesterol plays a significant role in the development of atherosclerosis

Atorvastatin is available in tablet form and is typically taken orally once daily. The dosage prescribed depends on various factors such as the patient’s cholesterol levels, medical history, and response to the medication. It is essential to follow the prescribed dosage and consult a healthcare professional for personalized advice.

Apart from its primary use in managing cholesterol levels, atorvastatin has also shown potential benefits in reducing inflammation, improving endothelial function (the lining of blood vessels), and reducing the risk of certain cardiovascular events.

Atorvastatin: common side effects

As with any medication, atorvastatin may have side effects, although they are generally well-tolerated. Common side effects include muscle pain or weakness, headache, digestive issues, and an increased risk of developing type 2 diabetes. In rare cases, more severe side effects such as liver damage and muscle breakdown (rhabdomyolysis) may occur, but these are extremely uncommon.

Atorvastatin alternative drugs

Atorvastatin, is a widely prescribed medication. Atorvastatin is the main drug recommended by NICE for the reduction of cholesterol. However, like any medication, atorvastatin may not be suitable for everyone. Atorvastatin alternative drugs may be also considered during atorvastatin shortage.

1. Simvastatin as an atorvastatin alternative

Simvastatin is another statin medication which could possibly be prescribed as an alternative to atorvastatin. It works by reducing the production of cholesterol in the liver, thus aiding in managing cholesterol levels. Similar to atorvastatin, simvastatin effectively lowers LDL (low-density lipoprotein) cholesterol while modestly raising HDL (high-density lipoprotein) cholesterol.

Simvastatin is usually taken once daily, typically at night, as it inhibits cholesterol synthesis, which is more active during the nighttime. The requirement to take medication at night does not apply to atorvastatin.

Although simvastatin is an atorvastatin alternative, in recent years its demand decreased hugely in favour of atorvastatin prescribing.

2. Rosuvastatin

Rosuvastatin, another statin drug, which is frequently recommended as an alternative to atorvastatin. Like atorvastatin, it functions by blocking the enzyme responsible for cholesterol synthesis. Rosuvastatin demonstrates potent cholesterol-lowering capabilities, often requiring lower doses compared to atorvastatin. While both medications have similar efficacy, the choice between them depends on individual patient needs, tolerability, and potential drug interactions.

3. Fluvastatin

Atorvastatin and fluvastatin share the same overall mechanism of action by inhibiting the enzyme HMG-CoA reductase, there are some differences between the two. Atorvastatin is commonly prescribed and has a broader range of dosages, including high-intensity options, which makes it suitable for a wider range of patients. Fluvastatin, on the other hand, is available in immediate-release and extended-release formulations, providing different dosing options. The choice between atorvastatin and fluvastatin depends on individual patient factors, such as cholesterol levels, cardiovascular risk, medication tolerability, and response to treatment.

4. Pravastatin

Pravastatin is another statin medication used to lower cholesterol levels and reduce the risk of cardiovascular diseases. While both atorvastatin and pravastatin belong to the same class of drugs, there are some differences between the two. Atorvastatin is generally considered a high-intensity statin and is often prescribed at higher doses compared to pravastatin, which is typically classified as a moderate-intensity statin. Atorvastatin has a broader range of dosage options and is known for its potent cholesterol-lowering effects. Pravastatin, on the other hand, is often recommended for individuals who may have a higher risk of developing side effects or drug interactions due to its lower potency.

5. Ezetimibe

Ezetimibe is a non-statin medication that complements the cholesterol-lowering effects of statins. It works by blocking cholesterol absorption in the intestines, resulting in reduced LDL cholesterol levels. Unlike atorvastatin, which primarily targets cholesterol synthesis, ezetimibe primarily inhibits cholesterol absorption. Combination therapy of ezetimibe with a statin can provide additional LDL-lowering benefits for patients who do not achieve their target cholesterol levels with statin monotherapy.

6. Changing atorvastatin dosage

During the first wave of the atorvastatin shortage, the lower strength of this drug, 10mg tablets were less affected than most commonly prescribed atorvastatin 20mg. Many patients were switched from 20mg to 10mg tablets with the dose adjustments. It is a common practice for patients to get lower/higher strengths of the same medication prescribed when medication goes of stock and it is available in different strengths.

7. Atorvastatin alternative: lifestyle modifications

NICE guidelines on the management of high cholesterol emphasize the importance of lifestyle changes as the first step in managing high cholesterol. These lifestyle modifications include:

  • Dietary changes: Adopting a healthy, balanced diet low in saturated fats, trans fats, and cholesterol while incorporating high-fiber foods, fruits, vegetables, and whole grains.
  • Regular physical activity: Engaging in moderate-intensity aerobic exercise for at least 150 minutes per week, along with muscle-strengthening activities at least twice a week.
  • Weight management: Achieving and maintaining a healthy body weight, particularly by reducing excess weight and abdominal obesity.
  • Smoking cessation: Encouraging smoking cessation and providing support for individuals who smoke.


I am a qualified pharmacist working in an independent pharmacy in the UK.
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