Lipid-lowering agents that cause drug-induced hepatotoxicity

Abstract

The effort to reduce cardiovascular risk factors, including hyperlipidemia, has led to the increased use of lipid-lowering agents. Hyperlipidemic patients often have underlying fatty liver disease, however, and thus may have elevated and fluctuating liver biochemistries. Therefore, caution should be applied before attributing elevated liver tests to lipid-lowering agents. Data indicate that patients who have chronic liver disease and compensated cirrhosis should not be precluded from receiving statins to treat hyperlipidemia. Several recent studies and expert opinion currently fully endorse statin use in patients who have nonalcoholic fatty liver disease and other chronic liver disease if clinically indicated.

Figure 1. Chemical structures of commonly prescribed lipid-lowering medications with known hepatotoxicity

Chemical structure of commonly available lipid lowering agents (Statins, Fibrates, Ezetimibe, and niacin)