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
Livalo
Crestor vs. Livalo Dosage
Crestor
Livalo
| 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 |
| 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
| 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
| 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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