STATIN DOSING









Atorvastatin (Lipitor®)

Dosage forms

Tablet
  • 10 mg
  • 20 mg
  • 40 mg
  • 80 mg

Dosing - Adults

High cholesterol
  • Starting: 10 - 20 mg once daily
  • Maintenance: 10 - 80 mg once daily
  • Max: 80 mg once daily
  • May take without regard to food

Dosing - Pediatric

Heterozygous familial hypercholesterolemia (10 - 17 years old)
  • Starting: 10 mg once daily
  • Maintenance: 10 - 20 mg once daily
  • May take without regard to food
  • Individualize dose according to goals of therapy
  • Increase dose at intervals of ≥ 4 weeks

Generic / Price

- YES/$

Fluvastatin | Lescol® | Lescol XL®

Dosage forms

Capsule (Lescol®)
  • 20 mg
  • 40 mg
Tablet, extended-release (Lescol XL®)
  • 80 mg

Dosing - Lescol®

High cholesterol (Adults)
  • Starting: 40 mg once daily in evening
  • Maintenance: 20 - 80 mg/day
  • Max: 80 mg/day
  • For 80 mg/day dosing, give 40 mg twice a day
  • For patients requiring LDL reduction of < 25%, a 20 mg starting dose may be used
  • Do not open capsules
  • May take without regard to food
Heterozygous Familial Hypercholesterolemia (10 - 16 years old)
  • Starting: 20 mg once daily in evening
  • Maintenance: 20 - 80 mg/day
  • Max: 80 mg/day
  • For 80 mg dosing, give 40 mg capsule twice a day or one Lescol XL 80 mg tablet once daily
  • Do not open capsules. Do not crush, cut, or chew tablet.
  • May take without regard to food

Dosing - Lescol XL®

High cholesterol
  • Starting: 80 mg once daily
  • Maintenance: 80 mg once daily
  • Max: 80 mg once daily
  • May take without regard to food
  • Do not crush, cut, or chew tablet

Generic / Price

  • Lescol capsule - YES/$
  • Lescol XL tablet - YES/$$

Lovastatin | Mevacor® | Altoprev®

Dosage forms

Tablet (Mevacor®)
  • 10 mg
  • 20 mg
  • 40 mg
Tablet, extended-release (Altoprev®)
  • 20 mg
  • 40 mg
  • 60 mg

Dosing - Mevacor®

High cholesterol (Adults)
  • Starting: 20 mg once daily with evening meal
  • Maintenance: 10 - 80 mg/day
  • Max: 80 mg/day
  • May be given once daily or in two divided doses
  • Take with meals
Heterozygous Familial Hypercholesterolemia (10 - 17 years old)
  • Dosing: 10 - 40 mg/day
  • Max: 40 mg/day
  • For reductions in LDL of ≥ 20%, starting dose should be 20 mg/day. A starting dose of 10 mg/day may be considered for patients requiring smaller reductions.
  • May be given once daily or in two divided doses
  • Take with meals

Dosing - Altoprev®

High cholesterol (Adults)
  • Dosing: 20 - 60 mg once daily at bedtime
  • Elderly: starting dose should be 20 mg
  • Max: 60 mg once daily
  • Take on an empty stomach. Food decreases absorption.
  • Do not crush, cut, or chew tablet

Generic / Price

  • Tablet (Mevacor®) - YES/$
  • Tablet, extended-release (Altoprev®) - NO/$$$$

Pitavastatin | Livalo® | Zypitamag®

Dosage forms

Tablet
  • 1 mg
  • 2 mg
  • 4 mg

Dosing - Livalo®

High cholesterol (Children ≥ 8 years and Adults)
  • Starting: 2 mg once daily
  • Maintenance: 1 - 4 mg once daily
  • Max: 4 mg once daily
  • May take without regard to food

Dosing - Zypitamag®

High cholesterol (Adults)
  • Starting: 2 mg once daily
  • Maintenance: 1 - 4 mg once daily
  • Max: 4 mg once daily
  • May take without regard to food

Generic / Price

  • Livalo - NO/$$$$
  • Zypitamag - NO/$$$$

Pravastatin (Pravachol®)

Dosage forms

Tablet
  • 10 mg
  • 20 mg
  • 40 mg
  • 80 mg

Dosing

High cholesterol
  • Starting: 40 mg once daily
  • Maintenance: 40 - 80 mg once daily
  • Max: 80 mg once daily
  • May take without regard to food

Generic / Price

- YES/$

Rosuvastatin | Crestor® | Ezallor™ Sprinkle

Dosage forms

Tablet (Crestor®)
  • 5 mg
  • 10 mg
  • 20 mg
  • 40 mg
Capsule (Ezallor™ Sprinkle)
  • 5 mg
  • 10 mg
  • 20 mg
  • 40 mg

Dosing - Adults

High cholesterol
  • Starting: 10 - 20 mg once daily
  • Maintenance: 5 - 40 mg once daily
  • Max: 40 mg once daily
  • Asian patients: Consider starting dose of 5 mg. Limit dose to 20 mg. See statins in Asian patients for more.
  • In patients with homozygous familial hypercholesterolemia, starting dose of 20 mg is recommended
  • May take without regard to food

Dosing - Pediatric

Heterozygous familial hypercholesterolemia
  • 8 - 9 years: 5 - 10 mg once daily
  • 10 - 17 years: 5 - 20 mg once daily
  • May take without regard to food
Homozygous familial hypercholesterolemia
  • 7 - 17 years: 20 mg once daily
  • May take without regard to food

Generic / Price

  • Tablet - YES/$
  • Capsule - NO/$$

Other

Ezallor™ Sprinkle
  • Capsules should be swallowed whole. Do not crush or chew.
  • Capsules may be opened and granules sprinkled on a teaspoon of soft food such as applesauce or chocolate/vanilla flavored pudding. Swallow whole without chewing within 60 minutes of combining.
  • May be given via NG tube. See Ezallor PI for instructions.

Simvastatin | Zocor® | Flolipid®

Dosage forms

Tablet (Zocor®)
  • 5 mg
  • 10 mg
  • 20 mg
  • 40 mg
  • 80 mg
Suspension (Flolipid®)
  • 20 mg/5 ml
  • 40 mg/5 ml
  • Comes in 150 ml bottle
  • Store at room temperature
  • Use within 30 days of opening

Dosing - Adults

High cholesterol
  • Starting: 10 - 20 mg once daily in the evening
  • Maintenance: 5 - 40 mg once daily
  • Max: 40 mg once daily
  • Asian patients: simvastatin may increase risk of myopathy. See statins in Asian patients for more.
  • 80 mg dose should be limited to patients who have been taking it for ≥ 12 months without muscle toxicity
  • The tablet may be taken without regard to food. The suspension should be taken in the evening on an empty stomach.

Dosing - Pediatric

Heterozygous Familial Hypercholesterolemia (10 - 17 years old)
  • Starting: 10 mg once daily in the evening
  • Maintenance: 10 - 40 mg once daily
  • Max: 40 mg once daily
  • The tablet may be taken without regard to food. The suspension should be taken in the evening on an empty stomach.

Generic / Price

  • Zocor - YES/$
  • Flolipid - NO/$$$$

Roszet® (rosuvastatin + ezetimibe)

Dosage forms

Tablet
  • Rosuvastatin - Ezetimibe
    • 5 mg - 10 mg
    • 10 mg - 10 mg
    • 20 mg - 10 mg
    • 40 mg - 10 mg

Dosing

High cholesterol
  • Dosing: 5/10 mg - 40/10 mg once daily
  • Asian patients: starting dose should be 5/10 mg once daily. Consider risks/benefits of doses > 20/10 mg. Exposure to rosuvastatin is higher in Asian patients (see statins in Asian patients for more).
  • Kidney disease:
    • CrCl ≥ 30 ml/min: no dose adjustment necessary
    • CrCl < 30 ml/min: recommended starting dose is 5/10 mg once daily. Do not exceed 10/10 mg once daily.
  • May take without regard to food
  • Do not crush, dissolve, or chew tablets

Generic / Price

- NO/$$$$

Vytorin® (simvastatin + ezetimibe)

Dosage forms

Tablet
  • Ezetimibe - Simvastatin
    • 10 mg - 10 mg
    • 10 mg - 20 mg
    • 10 mg - 40 mg
    • 10 mg - 80 mg

Dosing

High cholesterol
  • Starting: 10/10 - 10/20 mg once daily in the evening
  • Maintenance: 10/10 - 10/40 mg once daily in the evening
  • Max: 10/40 mg once daily
  • May take without regard to food
  • For patients requiring > 55% LDL reduction, recommended starting dose is 10/40 mg/day
  • Due to increased risk of myopathy, the 10/80 mg dose should be restricted to patients who have been taking 10/80 mg chronically (> 12 months) without evidence of muscle toxicity

Generic / Price

- YES/$$-$$$

Caduet® (amlodipine + atorvastatin)

Dosage forms

Tablet
  • Amlodipine - Atorvastatin
  • 2.5 mg - 10 mg
  • 2.5 mg - 20 mg
  • 2.5 mg - 40 mg
  • 5 mg - 10 mg
  • 5 mg - 20 mg
  • 5 mg - 40 mg
  • 5 mg - 80 mg
  • 10 mg - 10 mg
  • 10 mg - 20 mg
  • 10 mg - 40 mg
  • 10 mg - 80 mg

Dosing

Hypertension / Hyperlipidemia
  • Starting: 2.5/10 mg once daily
  • Maintenance: 2.5/10 - 10/80 mg once daily
  • Max: 10/80 mg once daily
  • May take without regard to food

Generic / Price

- YES/$$



Kidney disease dosing recommendations
Creatinine clearance / GFR
Drug < 30 ml/min 30 - 59 ml/min ≥ 60 ml/min
Atorvastatin No change No change No change
Fluvastatin Has not been studied No change No change
Lovastatin For doses > 20 mg/d, use caution No change No change
Pitavastatin Start 1 mg/d | Max 2 mg/d Start 1 mg/d | Max 2 mg/d No change
Pravastatin Start 10 mg/d, use caution No change No change
Rosuvastatin Start 5 mg/d | Max 10 mg/d No change No change
Simvastatin Start 5 mg/d, monitor closely No change No change




High-intensity statin therapy
(lowers cholesterol by ≥50%)
Moderate-intensity statin therapy
(lowers cholesterol by 30 - 50%)
Low-intensity statin therapy
(lowers cholesterol by < 30%)
  • Atorvastatin (Lipitor®) 40 - 80 mg/day
  • Rosuvastatin (Crestor®) 20 - 40 mg/day
  • Atorvastatin (Lipitor®) 10 - 20 mg/day
  • Rosuvastatin (Crestor®) 5 - 10 mg/day
  • Simvastatin (Zocor®) 20 - 40 mg/day
  • Pravastatin (Pravachol®) 40 - 80 mg/day
  • Lovastatin (Mevacor®) 40 mg/day
  • Fluvastatin XL (Lescol XL®) 80 mg/day
  • Fluvastatin (Lescol®) 40 mg twice/day
  • Pitavastatin (Livalo®) 2 - 4 mg/day
  • Simvastatin (Zocor®) 10 mg/day
  • Pravastatin (Pravachol®) 10 - 20 mg/day
  • Lovastatin (Mevacor®) 20 mg/day
  • Fluvastatin (Lescol®) 20 - 40 mg/day
  • Pitavastatin (Livalo®) 1 mg/day



  • Reference: [Manufacturer's PI, CYP and transporter pages, 6 ]
  • OATP - Organic anion transporting polypeptide
Statin metabolism and clearance
Drug CYP3A4 CYP2C8 CYP2C9 P-glycoprotein OATP1B1 OATP1B3
Atorvastatin Substrate - - Substrate and inhibitor Substrate Substrate
Fluvastatin Minor substrate Minor substrate Major substrate and weak inhibitor Substrate and inhibitor - Substrate
Lovastatin Sensitive substrate - - Substrate and inhibitor Substrate -
Pitavastatin - Minor substrate Substrate Substrate Substrate -
Pravastatin - - - Substrate Substrate Substrate
Rosuvastatin - - Minor substrate - Substrate Substrate
Simvastatin Substrate Substrate and inhibitor - Substrate and inhibitor Substrate -



Pricing legend
  • $ = 0 - $50
  • $$ = $51 - $100
  • $$$ = $101 - $150
  • $$$$ = > $151
  • Pricing based on one month of therapy at standard dosing in an adult
  • Pricing based on information from GoodRX.com®
  • Pricing may vary by region and availability