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
Pravachol
Crestor vs. Pravachol Dosage
Crestor
Pravachol
| 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 |
| 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
| 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
| 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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