In patients found to have elevated transaminase levels on routine screening, the appropriate response will depend on the level of increase, the patient's symptoms and the need for lipid statin therapy. The first step in the evaluation of transaminase elevation is to repeat the test. The level of abnormality dictates how soon levels should be re-evaluated. Mild elevations could be rechecked in 3 months while larger elevations should be rechecked within the week. About half of the time, these abnormalities will resolve with repeat testing done within one week without stopping the medication. Transient increases are common and not clinically important.
If the elevation remains and the level of increase is less than 3 times the upper limit of normal, there is no need to interrupt therapy, although more frequent monitoring might be justified. Patients with persistent elevations should be questioned about symptoms, risks of underlying hepatic disease should be assessed and further evaluation for viral, alcoholic or other liver disease should be pursued as indicated.[6,38]
For persistent elevations greater than 3 times the upper limit of normal, a decrease in dose or discontinuation of therapy is warranted. Transaminase elevations due to statin therapy will almost always resolve within 6 weeks of discontinuation. The decision to reinstitute therapy should be based on an individualized risk versus benefit analysis. Signs and symptoms of hepatic failure should prompt immediate discontinuation of therapy and referral to a specialist.
South Med J. 2006;99(3):250-254. © 2006 Lippincott Williams & Wilkins
Cite this: Primary Evaluation and Management of Statin Therapy Complications - Medscape - Mar 01, 2006.