Periodic Liver Tests Not Necessary with Statins

the MPR take:

Do the cholesterol-lowering medications known as statins really require routine liver monitoring?  In 2012 the FDA updated the prescribing information for all statins removing the need for routine periodic monitoring of liver enzymes and requiring that tests only be performed before starting therapy and when clinically indicated thereafter. The FDA stated that periodic monitoring of liver enzymes did not appear to be effective in detecting or preventing serious liver injury.  A new study published in the journal Hepatology concurs with statements made by the FDA, stating that serious liver injury related to statin use is rare and unpredictable in individual patients. In this study, which analyzed 1,188 cases of drug-induced liver injury, 22 cases were found to be related to statin use. All commonly used statins, including atorvastatin, fluvastatin, lovastatin, pravastatin, rosuvastatin, and simvastatin, were implicated.  Hepatic injury was not severe in most cases and was reversed upon discontinuing the statin. One patient did die in the study, but it is believed the cause was due to alcoholic liver disease more so than statin-related complications.  The results of the study further enforce that routine blood testing, which most often includes liver function tests, should be enough to monitor most patients taking statins.

The HMG-CoA reductase inhibitors (statins) are widely prescribed for patients with hyperlipidemia and are generally well tolerated. Mild elevations in serum aminotransferases arise in up to 3% of treated patients, but clinically apparent drug-induced liver injury is rare. The aim of this study is to report the presenting features and outcomes of 22 patients with clinically apparent liver injury due to statins.

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