Class Explorer · Cardiovascular
Statins
HMG-CoA reductase inhibitors: upregulate hepatic LDL receptors by throttling cholesterol synthesis.
Members
AtorvastatinA high-intensity statin that shrugs at the clock.RosuvastatinThe most potent statin per milligram, and the one that mostly stays out of CYP3A4.EzetimibeThe add-on that blocks absorption rather than synthesis.
Also in this class: Rosuvastatin (most potent, hydrophilic, 2C9) · Simvastatin (evening dosing, worst 3A4 exposure) · Pravastatin (no CYP, fewest interactions). Full pages arrive as the library grows.
Compare the members
Atorvastatin
- Max intensity
- High
- CYP route
- 3A4
- Timing
- Any time
Rosuvastatin
- Max intensity
- Highest per milligram
- CYP route
- Minimal CYP3A4 involvement
- Timing
- Any time of day
Ezetimibe
- Max intensity
- Modest, additive to a statin
- CYP route
- Not CYP-dependent
- Timing
- Any time of day
Shared across the class
- Indications
- ASCVD secondary prevention · Primary prevention by risk · Familial hypercholesterolemia
- Adverse effects
- Myalgia · Transaminase elevation · Rare rhabdomyolysis · Small diabetes excess
- Contraindications
- Active liver disease · Pregnancy
- Monitoring
- Lipid panel ~8-12 weeks after start · Muscle symptoms (CK only if significant) · Baseline ALT
What makes each agent different
- Intensity: rosuvastatin and atorvastatin reach high-intensity LDL reduction; simvastatin and pravastatin do not.
- Interactions: simvastatin/lovastatin are 3A4-fragile; pravastatin and rosuvastatin largely bypass CYP. The switch targets in interaction problems.
- Half-life decides timing: short-acting agents want the evening; atorvastatin and rosuvastatin do not care.
When clarithromycin meets simvastatin, the answer is 'pause or switch', never 'hope'.
Last reviewed 2026-08-15 · Goodman & Gilman's The Pharmacological Basis of Therapeutics, 14th ed.