Statins & Zetia effect on liver enzymes

[Ruthiejb]

Our doctor switched my 57-year old husband from 20 mg Zocor to 10 mg Lipitor in Dec. 2011 due to elevated LDL particles.  He also takes Dutroprol 100/12.5 and 40 mg Benicar for BP, 81 mg Aspirin, and 2000 mg Metformin for Insulin Resistance.  He currently weights 260 lbs. at 6' tall, down from 275, and he's continuing to lose weight by following a lower carb diet and exercising.  Seven months after starting Lipitor, his GGTP tested high at 87.   It came down to 56 within 6 months, but 7 months after that in August 2013 it tested even higher at 167 and his ALT tested high at 50.  At that point, our doctor added 10 mg Zetia to his regimen because of elevated LDL particles.  Also, my husband stopped all alcohol (he was a social drinker, around 2-3 glasses of wine per week) and NSAID's.  A month later most of his LFT's were elevated, ALT 79, GGTP 178, ALP 113 & AST on upper end of normal at 40.  The doctor said to stop the Lipitor...but stay on the Zetia...... and retest in 1-1/2 weeks which he did this past Sept. 30th.  His ALP came down to normal at 91, his ALT stayed the same at 79, his AST stayed relatively the same at 42, but his GGTP went quite high at 240.  The doctor's office called and told him to come in next week.  It's seems to me that the Zetia added to the statin caused his LFT's to go even higher, even the ALP which was always normal (and came back to normal after stopping the Lipitor).  Would you tend to agree? Is 1-1/2 weeks long enough for his other enzymes to come down after stopping the Lipitor?  Do you feel he should stop the Zetia as well?  What could be possible reasons why the GGTP went up so high? And lastly, do you feel he should have an ultrasound or CT scan at this point?  I thank you for your time.

[Ruthiejb]

I'm sorry, I just reread your response and see that I had originally misunderstood the last part of your response.  After rereading, it's clear to me to me what you were saying.  Thank you again.

[Ruthiejb]

Yes, thank you.  Your response leads me to feel that you believe the elevation in his liver enzymes is not totally due to his drug therapy as you say, "I suspect they may not be completely normal."  Can you explain why you say that?  Thank you again.

[CCFHeartMD19]

Hello,

Statins are known to have the adverse effect of liver enzyme elevation, which is generally asymptomatic. Severe liver damage as a result of statin is virtually unknown. The current clinical practice is to discontinue statin when the liver enzymes have increased to more than three times the upper limit of normal. Although zetia on its own does not generally cause liver enzyme abnormalities, it might potentiate the enzyme abnormalities, when coadministered with a statin.
Generally, when that happens, physicians would generally withdraw the statin or both medications, depending on the extent of enzyme elevation.
At this point in time, I would recommend watchful waiting. Enzyme elevations might take up to three months to completely normalize. Getting the enzymes checked in 1-2 weeks will tell you the direction in which they are moving: so it is a good idea, but I suspect that they may not be completely normal.

HOpe that helps
CCFHeartMD19