Standard Starting Doses
Lipitor (atorvastatin) typically starts at 10-20 mg once daily for most patients with high cholesterol or cardiovascular risk. Pravastatin starts lower, at 40 mg once daily in adults.[1]
Dose Ranges for Common Conditions
- High cholesterol (primary hyperlipidemia): Lipitor ranges from 10-80 mg daily; pravastatin from 10-80 mg daily, though 40 mg is most common.
- High triglycerides or mixed dyslipidemia: Lipitor 10-80 mg; pravastatin 10-40 mg.
- Prevention of heart events: Lipitor often 10-40 mg; pravastatin 40 mg (as in major trials like CARE and LIPID).
Doses are taken orally once daily, any time, with or without food. Lipitor's wider high-end range (up to 80 mg) allows more titration for aggressive LDL lowering.[1][2]
Adjustments for Age, Kidney Issues, or Other Factors
Both drugs require lower starting doses in specific groups:
- Elderly (65+): Lipitor starts at 10 mg; pravastatin at 40 mg but monitor closely.
- Kidney impairment: Pravastatin starts at 10 mg (less dependent on kidney metabolism); Lipitor no routine adjustment but caution at higher doses.
- Asian patients: Lipitor starts at 10 mg due to higher blood levels.
Pravastatin maxes at 80 mg but rarely exceeds 40 mg; Lipitor routinely goes to 80 mg.[1][3]
How Potency Affects Dosing Choices
Lipitor is roughly 2-4 times more potent per mg than pravastatin for LDL reduction (e.g., 20 mg Lipitor ≈ 40-80 mg pravastatin). Doctors often pick Lipitor for patients needing >40% LDL drop, using lower doses; pravastatin suits milder cases or kidney concerns since it's hydrophilic and renally safer.[2][4]
Switching Between Them
Switching requires dose adjustment: e.g., pravastatin 40 mg ≈ Lipitor 20 mg. Total cholesterol response guides final dose, not direct mg-for-mg swap.[1][3]
[1]: Lipitor Prescribing Information (FDA)
[2]: Pravastatin Prescribing Information (FDA)
[3]: UpToDate: "Lipid-lowering therapy: Use of statins"
[4]: Drugs.com: Atorvastatin vs Pravastatin Comparison