Crestor vs. Pravachol

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

Key Takeaways

  • Crestor is a high-intensity statin that can lower LDL cholesterol by up to 63%, while Pravachol is a lower-intensity option with more modest reductions.

  • Crestor is approved to cut heart attack and stroke risk based on elevated CRP alone, while Pravachol has separate FDA approvals for use before and after a coronary heart disease diagnosis.

  • Both are once-daily oral tablets, but Crestor's dose range runs 5 mg to 40 mg while Pravachol's runs 10 mg to 80 mg, so pill strengths are not interchangeable.

Crestor vs. Pravachol Drug Summary

Crestor

Crestor (rosuvastatin) is a high-intensity statin that blocks the liver enzyme used to make cholesterol. It's approved to lower LDL cholesterol and triglycerides in adults and certain children, and to cut the risk of heart attack, stroke, and artery procedures in adults at high cardiovascular risk. It's taken as one tablet by mouth once a day, with or without food.

Pravachol

Pravachol (pravastatin) is a statin that also blocks the liver's cholesterol-making enzyme, though it's generally less potent at lowering LDL than Crestor at similar doses. It's approved to treat high cholesterol in adults and certain children, and to lower heart attack risk both before and after a coronary heart disease diagnosis. Like Crestor, it's taken as one tablet by mouth once a day.

Crestor vs. Pravachol 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%)

Pravachol

Most common
Musculoskeletal pain (up to 24.9%)
Upper respiratory infection (up to 21.2%)
Nausea/vomiting (up to 10.5%)
Diarrhea (up to 6%)

Crestor vs. Pravachol Dosage

Crestor

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

Pravachol

Dosage
Dosage Table
STAGE DOSE WHEN
Starting dose 40 mg once daily At the start
Maximum dose 80 mg once daily If needed
Dose changes 1 increase As tolerated

Crestor vs. Pravachol Indications

Crestor

Crestor lowers LDL cholesterol, triglycerides, and other harmful lipids in adults and in children as young as 7 with certain inherited high-cholesterol disorders. In adults at increased cardiovascular risk but without diagnosed heart disease, it's also approved to lower the chance of a first heart attack, stroke, or artery procedure, and to slow plaque buildup in artery walls.

  • Lowers LDL-C, non-HDL-C, and triglycerides in adults

  • Treats homozygous and heterozygous familial hypercholesterolemia, including in children

  • Reduces risk of heart attack, stroke, and artery procedures in at-risk adults without heart disease

  • Slows the progression of plaque buildup in artery walls

Pravachol

Pravachol lowers LDL cholesterol and triglycerides as an add-on to diet in adults and children 8 and older with high cholesterol. It's also approved for two distinct heart-protection uses: preventing a first heart attack in people with high cholesterol but no known heart disease, and reducing further heart attacks, strokes, and procedures in people who already have coronary heart disease.

  • Lowers LDL-C and triglycerides in adults and children 8 and up

  • Reduces risk of a first heart attack in people without known heart disease

  • Reduces risk of repeat heart attack, stroke, and procedures in people with heart disease

  • Slows progression of coronary atherosclerosis in people with heart disease

Crestor vs. Pravachol Pros and Cons

Crestor

Crestor sits at the high-intensity end of the statin spectrum, so it can push LDL cholesterol down further than Pravachol at typical doses. It also carries a broader set of FDA-approved uses, including an indication based on inflammation markers rather than cholesterol level alone.

Pros

  • Higher LDL-lowering potency than Pravachol at comparable doses

  • Also approved to slow atherosclerosis progression on imaging

  • Approved for primary CV prevention based on CRP levels, not cholesterol alone

Cons

  • Lacks Pravachol's decades of dedicated secondary-prevention outcome trials

  • Requires dose limits or avoidance with several antiviral and immunosuppressant drugs

  • People of Asian ancestry and others must start at a lower 5 mg dose

Pravachol

Pravachol's clinical profile is built on some of the longest-running statin outcome trials, giving it a specific secondary-prevention approval for people who already have coronary heart disease. It's a milder statin overall, so it may not get patients with very high LDL to goal as easily as Crestor.

Pros

  • Long-running outcome trials (WOS, CARE, LIPID) support a dedicated secondary-prevention indication

  • Fewer known interactions with HIV and hepatitis antiviral combinations than Crestor

  • Well-established safety record from more than three decades of use

Cons

  • Even its highest dose lowers LDL-C less than Crestor's mid-range doses

  • Not approved for homozygous familial hypercholesterolemia

  • No indication for primary prevention based on inflammation markers alone

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