What you should know about: Generic vs. brand-name statins

September 28, 2013|Harvard Health Letter

Statins are among the most widely prescribed medications in the world, and their cholesterol-lowering properties are reducing heart disease risk for millions of people. Like many other drugs, most statins are available in generic and brand-name versions. The cost differences can be significant, with some generics costing about $12 a month, compared with brand-name statins that can run $500 a month.

But taking the right statin isn't simply a matter of money. There are seven different types of statins approved for use in the United States, and each one works in the body a little differently. Patients report different responses to various statins, as well as to generic and brand-name versions of the same statin type.

The basics

Among the most potent types of statin is atorvastatin, which is available as a generic and in a brand-name form (Lipitor). Slightly less potent is simvastatin (Zocor). Lovastatin (Mevacor) and pravastatin (Pravachol) are most often prescribed when a smaller percentage of cholesterol needs to be lowered.

Two other statin types, fluvastatin (Lescol) and pitavastatin (Livalo), are not as widely used in the United States. One commonly prescribed statin, rosuvastatin (Crestor), has no generic version available. It is as potent as atorvastatin, but also expensive. The patent on Crestor is set to expire in 2016, which may lead to the availability of generic versions.

Which is better?

Your response to a statin is impossible to predict, though most versions, including available generics, are well-tolerated and effective. However, a report published earlier this year in JAMA Internal Medicine found that while there is little evidence to suggest that brand-name statins are more effective or safer than their generic counterparts, many physicians still tend to prescribe the brand names. That's not true for cardiologist Dr. Thomas Lee, co-editor in chief of the Harvard Heart Letter. "I basically never prescribe brand-name statins except on those pretty rare occasions when I cannot get a high-risk patient [e.g., someone with coronary artery disease or diabetes] to his or her target on generic atorvastatin or simvastatin. In those pretty unusual cases, I will use Crestor. But otherwise I use generics, and almost always start with simvastatin," he says.

Asking about a generic alternative is always a good idea. If you experience muscle aches, the most common side effect of statins, your doctor may prescribe a lower dose or simply try a different type of statin.