Crestor vs. Praluent

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

Key Takeaways

  • Crestor is a once-daily pill, while Praluent is a self-injected shot given every two weeks or once a month.

  • Crestor has decades of safety data and low-cost generics, while Praluent has no generic and a much higher monthly cost.

  • Praluent is usually added on top of a statin like Crestor rather than used in its place, since the two drugs lower LDL through different pathways.

Crestor vs. Praluent Drug Summary

Crestor

Crestor (rosuvastatin) is a statin, or HMG-CoA reductase inhibitor, that lowers LDL cholesterol by blocking a liver enzyme involved in cholesterol production. It treats high cholesterol and related lipid disorders, slows plaque buildup in arteries, and lowers cardiovascular risk in certain patients. It comes as a once-daily oral tablet, typically starting at 10 mg.

Praluent

Praluent (alirocumab) is a PCSK9 inhibitor, a lab-made antibody that helps the liver clear more LDL cholesterol from the blood. It's approved as an add-on to statin therapy for high cholesterol, for inherited high cholesterol (HeFH), and to lower cardiovascular risk in adults with heart disease. It's self-injected under the skin every two weeks or, at a higher dose, once a month.

Crestor vs. Praluent Side Effects

Crestor

Most common
Headache (up to 6.1%)
Myalgia (up to 4.4%)
Nausea (up to 3.4%)
Asthenia (up to 2.7%)

Praluent

Most common
Nasopharyngitis (up to 11.3%)
Injection site reactions (up to 7.2%)
Influenza (up to 5.7%)
Urinary tract infection (up to 4.8%)

Crestor vs. Praluent Dosage

Crestor

Dosage
Dosage Table
STAGE DOSE WHEN
Starting dose 5-20 mg once daily At the start
Maximum dose Up to 40 mg once daily If needed
Dose changes 2 increases As tolerated

Praluent

Dosage
Dosage Table
STAGE DOSE WHEN
Starting dose 75 mg every 2 weeks At the start
Maximum dose 300 mg every 4 weeks If needed
Dose changes 2 increases As tolerated

Crestor vs. Praluent Indications

Crestor

Crestor is FDA-approved to lower LDL cholesterol and triglycerides in adults with high cholesterol, and to treat inherited forms of high cholesterol in adults and children. It's also approved to slow the buildup of plaque in arteries and to reduce the risk of heart attack, stroke, and certain heart procedures in adults with elevated cardiovascular risk.

  • Lower LDL cholesterol and triglycerides in high cholesterol

  • Treat heterozygous familial hypercholesterolemia in kids 8+

  • Treat homozygous familial hypercholesterolemia in kids 7+

  • Slow progression of atherosclerosis

Praluent

Praluent is FDA-approved as an add-on to diet and maximally tolerated statin therapy to further lower LDL cholesterol in adults with high cholesterol. It also treats inherited high cholesterol (HeFH) starting at age 8, and lowers the risk of heart attack, stroke, and hospitalization for unstable angina in adults with existing heart disease.

  • Lower LDL cholesterol as add-on to statin therapy

  • Treat heterozygous familial hypercholesterolemia in kids 8+

  • Reduce heart attack, stroke, and unstable angina risk

  • Not approved for homozygous familial hypercholesterolemia

Crestor vs. Praluent Pros and Cons

Crestor

Crestor has been used for over two decades, giving it an extensive real-world safety record, and it's now widely available as a low-cost generic. As a daily pill, it's simple to take but works best alongside diet changes and, for some patients, an add-on therapy for further LDL lowering.

Pros

  • Generic rosuvastatin costs as little as $4 to $30 per month

  • Once-daily pill, no injections or needles required

  • Over 20 years of long-term safety data

  • Approved for children as young as 7 with genetic cholesterol conditions

Cons

  • Must be taken every day without missing doses

  • Can cause muscle aches typical of statin drugs

  • Interacts with several medications, requiring dose limits

  • May not be enough alone for patients needing large LDL drops

Praluent

Praluent works through a different pathway than statins, making it useful for patients who can't reach their LDL goals on a statin alone or who can't tolerate one. It requires self-injection rather than a pill, and as a newer biologic with no generic version, it carries a much higher price than a statin.

Pros

  • Only self-injected PCSK9 inhibitor with a monthly dosing option

  • Proven to cut major cardiovascular events after acute coronary syndrome

  • Option for patients who cannot tolerate statins

  • Not affected by the drug interactions common to statins

Cons

  • Costs roughly $500 to $640 per month with no generic available

  • Requires self-injection every 2 or 4 weeks

  • Can cause injection site reactions

  • Rare risk of serious hypersensitivity reactions

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