Crestor vs. Livalo

See how Crestor and Livalo compare on approved uses, dosing, side effects, and cost.

Key Takeaways

  • Both are once-daily statins that lower LDL cholesterol, but only Crestor is FDA-approved to reduce heart attack and stroke risk in at-risk adults.

  • Crestor has a generic version that often costs far less per month, while Livalo is brand-only and typically runs $315 to $410 a month.

  • Livalo has minimal CYP3A4 metabolism and fewer drug interactions, while Crestor needs dose limits with cyclosporine, gemfibrozil, and some HIV medications.

Crestor vs. Livalo Drug Summary

Crestor

Crestor (rosuvastatin) is a statin, or HMG-CoA reductase inhibitor, taken as a once-daily tablet to lower LDL cholesterol and triglycerides. It treats high cholesterol and familial hypercholesterolemia, and is also FDA-approved to reduce the risk of heart attack and stroke in adults at increased cardiovascular risk.

Livalo

Livalo (pitavastatin) is also a statin, or HMG-CoA reductase inhibitor, taken as a once-daily tablet to lower LDL cholesterol and triglycerides. It treats high cholesterol and familial hypercholesterolemia, though using it to help prevent a first heart attack or stroke is an off-label use.

Crestor vs. Livalo Side Effects

Crestor

Most common
headache (up to 5.5%)
nausea (up to 3.4%)
myalgia (up to 2.8%)
asthenia (up to 2.7%)

Livalo

Most common
myalgia (1.9% to 3.1%)
constipation (1.5% to 3.6%)
diarrhea (1.5% to 2.6%)
back pain (1.4% to 3.9%)

Crestor vs. Livalo Dosage

Crestor

Dosage
Dosage Table
STAGE DOSE WHEN
Starting dose 5-20 mg once daily At the start
Maximum dose 40 mg once daily If needed
Dose changes 3 increases As tolerated

Livalo

Dosage
Dosage Table
STAGE DOSE WHEN
Starting dose 1 mg once daily At the start
Maximum dose 4 mg once daily If needed
Dose changes 2 increases As tolerated

Crestor vs. Livalo Indications

Crestor

Crestor is FDA-approved as an add-on to diet to lower LDL cholesterol, total cholesterol, and triglycerides in adults with high cholesterol. It also treats familial hypercholesterolemia starting at age 7 or 8, and is approved to cut the risk of heart attack, stroke, and other cardiovascular events in adults at increased risk.

  • High cholesterol and mixed dyslipidemia (adjunct to diet)

  • Heterozygous familial hypercholesterolemia (age 8+)

  • Homozygous familial hypercholesterolemia (age 7+)

  • Reducing risk of heart attack, stroke, and CV events

Livalo

Livalo is FDA-approved as an add-on to diet to lower LDL cholesterol, total cholesterol, apolipoprotein B, and triglycerides in adults with high cholesterol. It also treats heterozygous familial hypercholesterolemia starting at age 8, though using it to help prevent a first heart attack or stroke is an off-label use.

  • High cholesterol and mixed dyslipidemia (adjunct to diet)

  • Heterozygous familial hypercholesterolemia (age 8+)

  • Off-label: primary prevention of cardiovascular disease

  • Not approved for homozygous familial hypercholesterolemia

Crestor vs. Livalo Pros and Cons

Crestor

Crestor carries the broadest label of any commonly prescribed statin, covering cardiovascular risk reduction and both forms of familial hypercholesterolemia, and its generic form is widely covered by insurance. It does interact with several transporter-dependent drugs, so doses need to be capped in some situations.

Pros

  • Only drug here FDA-approved to lower heart attack and stroke risk

  • Approved for homozygous familial hypercholesterolemia; Livalo is not

  • Generic available, roughly $10 to $30 a month without insurance

Cons

  • Requires dose caps with cyclosporine, gemfibrozil, and some HIV drugs

  • Diabetes and HbA1c increases reported more often in trials

  • Muscle-related side effects rise at the highest 40 mg dose

  • Lower starting dose recommended for patients of Asian descent

Livalo

Livalo's minimal reliance on the CYP3A4 enzyme means it interacts with fewer medications than many other statins, making it a common choice for patients on multiple prescriptions. It has a narrower FDA label than Crestor and remains a brand-only medication with no generic on the market.

Pros

  • Fewer drug interactions due to minimal CYP3A4 metabolism

  • Simple three-dose lineup with no interaction-based dose caps

  • No boxed warning history tied to high-dose muscle risk

Cons

  • No FDA approval for reducing heart attack or stroke risk

  • No generic version; brand pricing runs $315 to $410 a month

  • Not approved for homozygous familial hypercholesterolemia

  • Contraindicated entirely with cyclosporine, not just dose-capped

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