Statin and liver

Q: Severe Hepatic injury due to statin intake, if it occurs, usually happens in the first two weeks of initiation of drug therapy.

A) True

B) False

Answer: B

There is little chance of severe liver injury from statin therapy. It is considered almost as near as to the general population. The most common effect is aminotransferase elevation.

If a hepatic failure occurs, it usually occurs three to four months after initiation. Although the range is extremely wide—between one month and 10 years—the occurrence within two weeks of initiation should prompt a clinician to look for other causes.

The FDA recommends liver function testing only before initiating statin therapy and repeating such testing only with clinical indications afterwards.

Standard clinical practice is to change medications or lower statin dose if ALT level is more than three times the upper limit of normal, which is confirmed on repeat lab tests.

#pharmacology

#hepatology

References:

Russo MW, Hoofnagle JH, Gu J, et al. Spectrum of statin hepatotoxicity: experience of the drug-induced liver injury network. Hepatology 2014; 60:679.

Cohen DE, Anania FA, Chalasani N, National Lipid Association Statin Safety Task Force Liver Expert Panel. An assessment of statin safety by hepatologists. Am J Cardiol 2006; 97:77C.

Charles EC, Olson KL, Sandhoff BG, et al. Evaluation of cases of severe statin-related transaminitis within a large health maintenance organization. Am J Med 2005; 118:618.

US Food and Drug Administration. FDA Drug Safety Communication: Important safety label changes to cholesterol-lowering statin drugs. February 28, 2012. Available at: http://www.fda.gov/Drugs/DrugSafety/ucm293101.htm (Accessed on September 8, 2024).