Pravastatin vs Atorvastatin: Which Statin Is Right for You?

When it comes to lowering cholesterol, pravastatin and atorvastatin are two of the most commonly prescribed lipid-lowering drugs known as statins. Both reduce LDL (bad) cholesterol and help prevent heart attacks and strokes, but they’re not the same. pravastatin is milder, processed mainly by the liver without heavy enzyme involvement, making it a go-to for people with liver concerns or those taking other meds that interact with CYP3A4. atorvastatin, on the other hand, is stronger, longer-lasting, and more effective at lowering cholesterol at lower doses—which is why doctors often choose it for patients with high baseline numbers or existing heart disease.

Here’s the thing: atorvastatin cuts LDL by 35–60% at standard doses, while pravastatin typically drops it by 20–30%. That difference matters if your cholesterol is way above target. But strength isn’t everything. Pravastatin has fewer drug interactions, so it’s safer if you’re also on blood thinners, antidepressants, or antibiotics like erythromycin. Atorvastatin can clash with those, raising the risk of muscle pain or even rare but serious damage. Also, pravastatin is less likely to cause muscle aches—something nearly 1 in 10 people report with stronger statins. If you’ve had side effects with other statins, pravastatin might be your best bet. But if you need big results fast, atorvastatin delivers.

Both are generics now, so cost isn’t a big divider. But dosing is: pravastatin is usually taken once daily, often at night, while atorvastatin works just as well any time of day. Neither needs strict fasting before blood tests. Neither causes weight gain or diabetes outright, though all statins slightly raise blood sugar risk. What you really need to know is this: if you’re healthy with moderate cholesterol, pravastatin gives you solid protection with fewer risks. If you’ve had a heart event or have familial hypercholesterolemia, atorvastatin’s power may be worth the extra monitoring.

Below, you’ll find real-world breakdowns of how these two statins stack up against each other—and against other meds like rosuvastatin and simvastatin. You’ll see what studies actually show about side effects, how kidney or liver function changes the game, and why some people switch from one to the other. No fluff. Just clear comparisons based on what doctors see and patients experience.