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
Praluent
Crestor vs. Praluent Dosage
Crestor
Praluent
| 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 |
| 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
| 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
| 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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