Aa
Statin's and cirrhosis
OH yes one more question
Back in 199 was put on a statin and got cramps, and pain that would radiate up the right side and across a hold the bottom of the rib cage. So they took me off that statin put me on another same thing, this went on for 11 years different ones over and over again with the same thing. at the end was told to go on this new one back in 2009 the cramps did not happen but the pain up the side and along the lower rib cage continued. The Doctor said that was not caused by the new meds, it was Zetia and I was on that when I went into the hospital and for a 7 months. I asked the liver specialist if that could have caused my liver cirrhosis. Was told " oh you watch those TV ads?" I said seen them but was wondering, was told that it is as plain answer "NO WAY"
Anyone been told that thier's was caused by statins?
Back in 199 was put on a statin and got cramps, and pain that would radiate up the right side and across a hold the bottom of the rib cage. So they took me off that statin put me on another same thing, this went on for 11 years different ones over and over again with the same thing. at the end was told to go on this new one back in 2009 the cramps did not happen but the pain up the side and along the lower rib cage continued. The Doctor said that was not caused by the new meds, it was Zetia and I was on that when I went into the hospital and for a 7 months. I asked the liver specialist if that could have caused my liver cirrhosis. Was told " oh you watch those TV ads?" I said seen them but was wondering, was told that it is as plain answer "NO WAY"
Anyone been told that thier's was caused by statins?
Good Morning Hector
Thank you and the other person for the in put. The hematologist wanted a biopsy done so sent me to MPLS, when I meet with them it was stated that there was no need for one as, it is already confirmed I have cirrhosis. They said at this point it is to determine at what point I am at. That is when they did the MELD thing and they did something called a Child Plug something later learned it was a CPT rating. I have also Portal Vein Thrombosis with 100% blockage. So on blood thinners.
When I was in the Hospital back in April 2012, the Doctor here said I had between 3 to 12 months and then went on to tell me how I would die. Very poor bedside.
When I asked my primary doctor why she had missed this as she was running blood work every 3 months she said all the test where not that elevated, she said in regards to what had caused it they would run more tests and refer me to other doctors which they did and I kept asking and all I heard is more tests.. Wasn't until I ended up at Hematology that the doctor said they need to know what caused it to treat the blood clot. They are the ones that arranged for me to go to Minneapolis for testing since there is not a liver specialist in North Dakota.
Down there they told me to sit down and I would have to get it in my head that there would be no transplant due to my other medical problems ( 2 stents in the heart, and Plural Effusion with PFT of 46.8 )
So no answers just more questions.
Sorry Hector for getting long winded this morning. How are you doing to day?
My prayers and hopes that you get that transplant, and that they find a cure for all who have this.
Thank you and the other person for the in put. The hematologist wanted a biopsy done so sent me to MPLS, when I meet with them it was stated that there was no need for one as, it is already confirmed I have cirrhosis. They said at this point it is to determine at what point I am at. That is when they did the MELD thing and they did something called a Child Plug something later learned it was a CPT rating. I have also Portal Vein Thrombosis with 100% blockage. So on blood thinners.
When I was in the Hospital back in April 2012, the Doctor here said I had between 3 to 12 months and then went on to tell me how I would die. Very poor bedside.
When I asked my primary doctor why she had missed this as she was running blood work every 3 months she said all the test where not that elevated, she said in regards to what had caused it they would run more tests and refer me to other doctors which they did and I kept asking and all I heard is more tests.. Wasn't until I ended up at Hematology that the doctor said they need to know what caused it to treat the blood clot. They are the ones that arranged for me to go to Minneapolis for testing since there is not a liver specialist in North Dakota.
Down there they told me to sit down and I would have to get it in my head that there would be no transplant due to my other medical problems ( 2 stents in the heart, and Plural Effusion with PFT of 46.8 )
So no answers just more questions.
Sorry Hector for getting long winded this morning. How are you doing to day?
My prayers and hopes that you get that transplant, and that they find a cure for all who have this.
Review Article: Prescribing Medications in Patients With Cirrhosis
A Practical Guide
"....Statins. There continues to be a controversy over the use of HMG Co-A reductase inhibitors (statins) in patients with CLD and cirrhosis, mostly due to a concern of causing acute-on-chronic liver injury.[12] Although the US FDA currently considers serious statin-related liver injury to be a rare and unpredictable event,[75] it nevertheless remains an important consideration among physicians and patients alike. The FDA has reviewed postmarketing data, cases from US registries of DILI as well as ALF, and other sources of information on statin-related hepatotoxicity, and has concluded that the risk of serious liver injury from all currently marketed statins is 'very low' (including a risk of less than or equal to just 2 per 1 million patient-years in the Adverse Event Reporting System database).[75] However, the risk of adverse hepatic events from statins receives renewed (but often undeserved) emphasis with each new case series that appears in the literature.[12] Indeed, the proportion of patients, including those with cirrhosis, who are not being prescribed statins because of the potential for adverse hepatic events, but who might otherwise benefit from their cardioprotective effects, is substantial.[7]
Several recent retrospective and two prospective trials all suggest that patients with compensated liver disease are not at significantly increased risk of statin-induced hepatotoxicity.[12, 76–78] In a large randomised, prospective, placebo-controlled trial with high-dose pravastatin (which, in particular, does not undergo P450 metabolism) in hypercholesterolaemic patients with compensated liver disease due to mostly non-alcoholic steatohepatitis or HCV, the cumulative risk of doubling an elevated baseline ALT value over 36 weeks was in fact lower in the pravastatin-treated group compared with untreated controls (7.5% vs. 12.5%).[76] In a post hoc analysis of the prospective, randomised GREACE trial, statins were found to be cardioprotective in 123 of those patients with moderately abnormal liver tests (mostly from non-alcoholic fatty liver disease).[78] Cardiovascular events occurred in just 10% of the subjects with abnormal LFTs who received statins, compared to 30% of those with abnormal liver tests not receiving a statin (68% relative risk reduction). Moreover, de novo elevations in ALT values were seen infrequently in the study, and those receiving atorvastatin had 'substantial' improvement in abnormal baseline LFTs compared with those not treated with the statin.[78]
Thus, the use of statins appears safe in CLD[12] and may in fact have a beneficial effect on fatty liver and viral hepatitis.[12, 76, 78–84] Indeed, in both animal and human models, statins significantly lowered portal hypertension pressure and did not cause any untoward hemodynamic effects, thus improving hepatic perfusion. Moreover, when combined with nonselective beta blockers, the effects of statins were additive.[85, 86] The role of statins in preventing angiogenesis and inducing apoptosis has also been studied recently, perhaps presenting an opportunity for reducing the development of hepatocellular carcinoma.[87–91]
While patients with normal liver tests without underlying liver disease no longer require routine liver test monitoring with statins,[12, 75] it is still considered prudent to monitor ALT when statins are to be started in the setting of advanced fibrosis or cirrhosis.[12] Whether one statin is safer than another in cirrhosis has not been formally studied – although pravastatin, in contrast to the others, does not undergo metabolism by the CYP-450 mixed function oxidase system,[92] which may be impaired in severe hepatic disease.
Regardless of their apparent safety, statins remain largely underprescribed in cirrhotic patients. Franz et al. reported that fewer than 10% of their cohort of 400 patients were being treated with statin therapy,[59] but of those cirrhotics taking a statin, none suffered an ADR....."
http://www.medscape.com/viewarticle/805023_3
A Practical Guide
"....Statins. There continues to be a controversy over the use of HMG Co-A reductase inhibitors (statins) in patients with CLD and cirrhosis, mostly due to a concern of causing acute-on-chronic liver injury.[12] Although the US FDA currently considers serious statin-related liver injury to be a rare and unpredictable event,[75] it nevertheless remains an important consideration among physicians and patients alike. The FDA has reviewed postmarketing data, cases from US registries of DILI as well as ALF, and other sources of information on statin-related hepatotoxicity, and has concluded that the risk of serious liver injury from all currently marketed statins is 'very low' (including a risk of less than or equal to just 2 per 1 million patient-years in the Adverse Event Reporting System database).[75] However, the risk of adverse hepatic events from statins receives renewed (but often undeserved) emphasis with each new case series that appears in the literature.[12] Indeed, the proportion of patients, including those with cirrhosis, who are not being prescribed statins because of the potential for adverse hepatic events, but who might otherwise benefit from their cardioprotective effects, is substantial.[7]
Several recent retrospective and two prospective trials all suggest that patients with compensated liver disease are not at significantly increased risk of statin-induced hepatotoxicity.[12, 76–78] In a large randomised, prospective, placebo-controlled trial with high-dose pravastatin (which, in particular, does not undergo P450 metabolism) in hypercholesterolaemic patients with compensated liver disease due to mostly non-alcoholic steatohepatitis or HCV, the cumulative risk of doubling an elevated baseline ALT value over 36 weeks was in fact lower in the pravastatin-treated group compared with untreated controls (7.5% vs. 12.5%).[76] In a post hoc analysis of the prospective, randomised GREACE trial, statins were found to be cardioprotective in 123 of those patients with moderately abnormal liver tests (mostly from non-alcoholic fatty liver disease).[78] Cardiovascular events occurred in just 10% of the subjects with abnormal LFTs who received statins, compared to 30% of those with abnormal liver tests not receiving a statin (68% relative risk reduction). Moreover, de novo elevations in ALT values were seen infrequently in the study, and those receiving atorvastatin had 'substantial' improvement in abnormal baseline LFTs compared with those not treated with the statin.[78]
Thus, the use of statins appears safe in CLD[12] and may in fact have a beneficial effect on fatty liver and viral hepatitis.[12, 76, 78–84] Indeed, in both animal and human models, statins significantly lowered portal hypertension pressure and did not cause any untoward hemodynamic effects, thus improving hepatic perfusion. Moreover, when combined with nonselective beta blockers, the effects of statins were additive.[85, 86] The role of statins in preventing angiogenesis and inducing apoptosis has also been studied recently, perhaps presenting an opportunity for reducing the development of hepatocellular carcinoma.[87–91]
While patients with normal liver tests without underlying liver disease no longer require routine liver test monitoring with statins,[12, 75] it is still considered prudent to monitor ALT when statins are to be started in the setting of advanced fibrosis or cirrhosis.[12] Whether one statin is safer than another in cirrhosis has not been formally studied – although pravastatin, in contrast to the others, does not undergo metabolism by the CYP-450 mixed function oxidase system,[92] which may be impaired in severe hepatic disease.
Regardless of their apparent safety, statins remain largely underprescribed in cirrhotic patients. Franz et al. reported that fewer than 10% of their cohort of 400 patients were being treated with statin therapy,[59] but of those cirrhotics taking a statin, none suffered an ADR....."
http://www.medscape.com/viewarticle/805023_3
COMMUNITY LEADER
"I think my arm bleeding from a needle prick was a sign of liver damage"
What was your diagnosis?
A liver biopsy can tell the cause of the liver disease so you don't have to guess what caused your cirrhosis. Of course you are in the age group of people that are most prone to being infected by hepatitis C. Was hepatitis ruled out?
-----------------------------------------------------------------------------------------
May 06, 2012
FDA Adds New Warning Labels to Statin Drugs
Following an internal meeting between the FDA's Office of Surveillance and Epidemiology and Office of New Drugs, the Agency announced it would be requiring additional warning labels for statin drugs. Among them are warnings that statins may increase the risk of:
Liver damage
Memory loss and confusion
Type 2 diabetes
Muscle weakness (for certain statins)
FDA Removes One Important Safety Warning
Due to statins' potential to increase liver enzymes and cause liver damage, patients must be monitored for normal liver function. At least, that's what the label used to say. Now the FDA has removed this long-standing warning and ruled that patients taking statins no longer need routine monitoring of liver enzymes, but instead can have liver enzymes tested before starting the drugs, and then only as clinically needed. It's unclear what prompted the FDA to remove the warning, but many physicians have told the press they plan to continue monitoring their patients' liver enzymes anyway.
ABC News reported:
"I disagree with the notion that you can stop checking for liver function test abnormalities," said Dr. Andrew Carroll, a physician at the Renaissance Medical Group in Phoenix. Carroll said he saw high liver enzymes in about 5 percent of the patients to whom he prescribed statins, prompting him to recommend they stop taking the medication."
It makes no sense that the FDA would remove this cautionary warning, as statins are linked to severe liver injury. Of all the adverse drug reactions (ADRs) suspected to be due to statins received by the Swedish Adverse Drug Reactions Advisory Committee from 1988-2010, the most common was drug-induced liver injury.ii Such cases accounted for 57 percent of all the statin-related ADRs and included potentially severe, and in some cases deadly, consequences, including:
Deaths from acute liver failure
Liver transplantation
Jaundice
The link to liver damage was quite strong, and in several cases after patients recovered from the initial liver damage and then started taking statins again, a similar pattern of liver injury occurred. If someone you love is currently taking a statin, please do alert them to this potential danger, as it can occur quickly. Most patients experienced liver injury just three to four months after the start of therapy.
Further, in 2010 data from more than 2 million 30- to 84-year-old statin users from England and Wales identified increased risks of moderate or serious liver dysfunction as well, among other serious effects, including acute kidney failure, moderate or serious myopathy (muscle disease), and cataract.
----------------------------------------------------------------------------------------------
Hector
What was your diagnosis?
A liver biopsy can tell the cause of the liver disease so you don't have to guess what caused your cirrhosis. Of course you are in the age group of people that are most prone to being infected by hepatitis C. Was hepatitis ruled out?
-----------------------------------------------------------------------------------------
May 06, 2012
FDA Adds New Warning Labels to Statin Drugs
Following an internal meeting between the FDA's Office of Surveillance and Epidemiology and Office of New Drugs, the Agency announced it would be requiring additional warning labels for statin drugs. Among them are warnings that statins may increase the risk of:
Liver damage
Memory loss and confusion
Type 2 diabetes
Muscle weakness (for certain statins)
FDA Removes One Important Safety Warning
Due to statins' potential to increase liver enzymes and cause liver damage, patients must be monitored for normal liver function. At least, that's what the label used to say. Now the FDA has removed this long-standing warning and ruled that patients taking statins no longer need routine monitoring of liver enzymes, but instead can have liver enzymes tested before starting the drugs, and then only as clinically needed. It's unclear what prompted the FDA to remove the warning, but many physicians have told the press they plan to continue monitoring their patients' liver enzymes anyway.
ABC News reported:
"I disagree with the notion that you can stop checking for liver function test abnormalities," said Dr. Andrew Carroll, a physician at the Renaissance Medical Group in Phoenix. Carroll said he saw high liver enzymes in about 5 percent of the patients to whom he prescribed statins, prompting him to recommend they stop taking the medication."
It makes no sense that the FDA would remove this cautionary warning, as statins are linked to severe liver injury. Of all the adverse drug reactions (ADRs) suspected to be due to statins received by the Swedish Adverse Drug Reactions Advisory Committee from 1988-2010, the most common was drug-induced liver injury.ii Such cases accounted for 57 percent of all the statin-related ADRs and included potentially severe, and in some cases deadly, consequences, including:
Deaths from acute liver failure
Liver transplantation
Jaundice
The link to liver damage was quite strong, and in several cases after patients recovered from the initial liver damage and then started taking statins again, a similar pattern of liver injury occurred. If someone you love is currently taking a statin, please do alert them to this potential danger, as it can occur quickly. Most patients experienced liver injury just three to four months after the start of therapy.
Further, in 2010 data from more than 2 million 30- to 84-year-old statin users from England and Wales identified increased risks of moderate or serious liver dysfunction as well, among other serious effects, including acute kidney failure, moderate or serious myopathy (muscle disease), and cataract.
----------------------------------------------------------------------------------------------
Hector
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