When Using Statins, How Frequently Should Liver Enzymes Be Checked?

Liver function (transaminases) should be measured within 3 months of starting treatment and at 12 months, but not again unless clinically indicated. Chronic liver disease is not a contraindication to statin use, so a single baseline liver test is recommended before starting on a statin. Periodic checks might be continued in people at high risk.

The ideal period after normalization of liver enzyme levels when the rechallenge can be done is not clearly stated. In Europe, it is recommended to check liver enzyme levels again after stopping the statin for 4 to 6 weeks. In Japan, testing is recommended before titration and 3 months after, periodically for the first year. For atorvastatin, the SPC is recommended.

Liver function tests should be performed before the initiation of therapy and at 6 and 12 weeks after initiation or elevation in dose, and periodically. It may be reasonable to start statin treatment with monitoring at intervals (e.g., 3 and 6 months) but with continued treatment if transaminases remain stable. Current guidance (NICE CG67) recommends that ALT should be monitored before starting therapy, at 3 months, and again at 12 months.

When to repeat LFTs after starting statin?

The ATP III guidelines for monitoring statin therapy include checking lipid panels at baseline, 6-8 weeks after starting or adjusting the medication/dose, and every 4-6 months. LFTs should be checked at baseline, approximately 12 weeks after starting therapy, then annually or more frequently if indicated. Creatine kinase (CK) should be checked at baseline and if the patient reports muscle soreness, tenderness, or pain. A Liver Expert Panel evaluated the liver-associated risks of statins, reporting that routine monitoring could potentially identify patients with isolated increased transaminase levels, potentially leading to unnecessary discontinuation of statin therapy.

In 2006, the National Lipid Association (NLA) Statin Safety Taskforce published recommendations stating that LFTs should be monitored before initiation of treatment and when clinically indicated. The ATP III and NLA consider a critical elevation to be an ALT or AST greater than three times the ULN and both recommend rechecking to confirm the elevation. Once confirmed, the NLA recommends clinical judgment to decide whether to continue, reduce the dose, or discontinue treatment.

In 2012, the FDA released updated recommendations for the monitoring of LFTs, resulting in revisions of all statin labels. The FDA concluded that serious liver injury with statins is rare and unpredictable in individual patients, and routine periodic monitoring of liver enzymes does not appear to be effective in detecting or preventing serious liver injury.

How often should I check liver enzymes on statins?

Before starting to take statins, you should have a blood test to check how well your liver and kidneys are working. You should also have a routine blood test to check the health of your liver 3 months after treatment begins, and again after 12 months.

Pregnancy and breastfeeding. Statins should not be taken by anyone who is pregnant or breastfeeding, as there’s no firm evidence on whether it’s safe to do so.

Contact a GP for advice if you become pregnant while taking statins.

How much do statins raise liver enzymes?

About 10% of patients see liver enzymes rise after starting a statin, which can exceed the threshold of three times the upper limit of normal for 1%, but these eventually return to normal even when continuing the same statin, Bader noted.

His group reported a small pilot study in 2007 that actually suggested a liver function boost on statin treatment for patients with chronic hepatitis C infection.

Yet reluctance to start statins in patients with out-of-range alanine aminotransferase (ALT) levels, and discontinuation of statins for ALT increases, might keep statins from 10% to 30% of those who need them, he estimated.

How often should elevated liver enzymes be checked?

3. Results in liver function tests. The patient’s blood will be sent to a laboratory for analysis according to the doctor’s orders for evaluation of liver function tests. Normal blood test results for typical liver function tests include: ALT: 7 to 55 units per liter of blood (U/L) AST: 8 to 48 U/L ALP: 40 to 129 U /L Albumin: 3. 5 to 5. 0 grams per deciliter of blood (g/dL) Total protein: 6. 3 to 7. 9 g/dL Bilirubin: 0. 1 to 1. 2 milligrams per deciliter (mg/ dL) GGT: 8 to 61 U/L LDH: 122 to 222 U/L PT Time: 9. 4 to 12. 5 s These results are typical for adult males. Normal results vary between laboratories and may be slightly different for women and children. Your doctor will use these results, in combination with your clinical signs and risk factors for liver disease, to help diagnose your liver condition and determine treatment if needed. Then, the time to re-examine will depend on the progression of the disease, after 2 weeks or 4-6 weeks or 3-6 months. If the patient has acute liver injury or complications of liver disease, hospitalization may be required for monitoring.

Bác sĩ sẽ kết hợp kết quả xét nghiệm và khám lâm sàng để chẩn đoán tình trạng gan của người bệnh.

On the contrary, if the examination and the test results are completely normal, how often should the liver examination be incorporated into the annual general health examination, in order to facilitate monitoring. Castle. Periodic examination every 6-12 months or when there are signs such as liver pain, weight loss, fatigue, jaundice, fever. In short, because the liver is an essential organ to digest food and remove toxins from the body. Any damage to the liver can eventually lead to liver failure, a life-threatening condition. This is why liver exams are part of routine health care. At the same time, how often to have a liver exam will depend on each individual’s condition, the doctor will decide this helps to monitor liver function more complete and closely.

How often should I have a blood test when on statins?

You will need to have regular blood tests whilst taking a statin to monitor your cholesterol level and also your liver, as occasionally statins can cause the enzymes in your liver to change. Your will need blood tests every three months when you start on a statin but less frequently (every six to twelve months) once you have been taking the tablets for some time.

When you start taking your statin you might notice side effects for a short time such as:

• Headaches
• Sleeping problems
• A rash
• Pains in your chest
• Unexplained loss of hair

How often do you check liver enzymes on statins?

Before starting to take statins, you should have a blood test to check how well your liver and kidneys are working. You should also have a routine blood test to check the health of your liver 3 months after treatment begins, and again after 12 months.

Pregnancy and breastfeeding. Statins should not be taken by anyone who is pregnant or breastfeeding, as there’s no firm evidence on whether it’s safe to do so.

Contact a GP for advice if you become pregnant while taking statins.

Why do I need a repeat liver function test in 3 months?

Slightly abnormal. Generally, if liver blood tests are less than twice the upper limit of normal (ULN), repeat the tests and consider seeking further advice.

Refer to secondary care or a liver specialist if no cause can be identified and liver blood tests continue to be abnormal.

If the cause is alcohol-related, ask the patient to abstain, and repeat their liver blood tests after a month.

Significantly abnormal. Any level greater than 2 to 3 times the ULN requires further investigation. This may include further blood tests, imaging or referral to secondary care or a liver specialist for investigation and follow up.

When to stop statin elevated liver enzymes?

The mild ALT elevations associated with atorvastatin therapy are usually self-limited and do not require dose modification. Atorvastatin should be stopped if ALT levels rise above 10-fold normal, or persist in being above 5-fold elevated or are associated with symptoms of liver injury.

Abbreviations used: ANA, antinuclear antibody; HDL, high density lipoprotein; LDL, low density lipoprotein; OD, odds ratio.

Zimmerman HJ. Drugs used in the treatment of hypercholesterolemia and hyperlipidemia. In, Zimmerman HJ. Hepatotoxicity: the adverse effects of drugs and other chemicals on the liver. 2nd ed. Philadelphia: Lippincott, 1999, pp. 660-2.

(Expert review of hepatotoxicity published in 1999; the statins have dose related hepatic effects in guinea pigs and rabbits and transient elevations in aminotransferases occur in 1-5% of humans treated; several cases of clinically apparent liver injury from lovastatin and simvastatin have been published).

When to recheck labs after starting statins?

If you start taking a statin or another cholesterol medicine, your provider may order a lipid panel 1 to 3 months later to see whether the drug is working.

Undiagnosed or untreated high blood cholesterol can lead to serious problems, such as heart attack and stroke.

High blood cholesterol can lead to a condition called atherosclerosis, in which plaque builds up in the arteries throughout your body. Over time, uncontrolled high blood cholesterol can lead to one of the following health problems:

• Carotid artery disease
• Coronary heart disease. You may feel chest pain (called angina ).
• Heart attack
• Peripheral artery disease
• Stroke

Which statin is hardest on your liver?

Statins, or hydroxymethylglutaryl-coenzyme A (HMG-CoA) reductase inhibitors, are widely used oral cholesterol lowering agents in the United States. They inhibit the rate-limiting step in cholesterol synthesis by the liver, causing a significant decrease in total and LDL cholesterol levels. Statins also have minor effects on triglyceride and HDL levels. Seven statins are available in the US: lovastatin, pravastatin, simvastatin, fluvastatin, atorvastatin, rosuvastatin, and pitavastatin. All statins have been associated with mild-to-moderate serum aminotransferase elevations during therapy, which are typically transient and asymptomatic. They have also been associated with rare instances of clinically apparent acute liver injury. The latency to onset of these statins can be more than 6 months or several years after starting. Most cases are hepatocellular, but cholestatic hepatitis is also well described for most statins. Cases with autoimmune features have been reported with atorvastatin, simvastatin, rosuvastatin, and fluvastatin, as well as with combinations of these agents with ezetimibe, an inhibitor of cholesterol absorption.

How long after stopping statins do liver enzymes return to normal?

Abstract. Atorvastatin has been associated with liver injury. We reported here two cases of aminotransferases elevation within 12 h of low-dose atorvastatin therapy. Liver functions were fully recovered to the baseline level 11 days after discontinuation of atorvastatin treatment. The possible relative risk factors included advanced age, chronic and systemic diseases, and co-administration of cytochrome P450 3A (CYP3A) enzyme-dependent metabolic drugs or its inhibitors such as clopidogrel and diltiazem. No significant transaminase elevation was observed after switching to pravastatin. Thus, pravastatin might be safer than atorvastain in patients with chronic or systemic diseases, or with co-administration of CYP3A enzyme-dependent drugs.

Keywords: atorvastatin, pravastatin, liver injury, cytochrome P450 3A enzyme.

Introduction. The 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (also known as statins) are safe to the treatment of hyperlipidemia and prevention of coronary artery diseases. Few common side effects of statins include myopathy, gastrointestinal disturbance, depression, and liver injury. According to Motola et al. , the rate of statin-associated hepatic reactions is 10. 9% in a total of 1, 254 adverse drug reaction reports from January 1990 to May 2005. Statins are among those with the highest rate of hepatic reactions, higher than antiplatelet agents and non-steroidal anti-inflammatory drugs. Various hepatotoxic side effects related to atorvastatin therapy have been reported ( 2, 3 ), raising a potential concern of atorvastatin-associated liver injury in Chinese populations. Here we report two patients who demonstrated significant elevation of serum alanine amino-transferase (ALT) levels immediately after atorvastatin therapy, but without cross-toxicity to the livers after switching to pravastatin.