======= previously today, CJ quoted WebMed article =============

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Liver damage and statins  (two articles, second is more comprehensive -
Cactus Jammies)

Question:
Please could you tell me what are the symptoms of liver damage due to taking
statins to reduce cholesterol? What other adverse affects can occur if
Pravastatin is not stopped immediately after liver function tests show
abnormalities? Thank you.

Answer:
It is very unusual for a patient to have symptoms of liver damage due to
taking statins because if liver function tests are taken occasionally to
check the liver enzymes, the problem is never allowed to develop to the
stage where symptoms occur.  Muscle aches and pains are sometimes
experienced by people who do not tolerate statins, but this is due to a
direct effect on the muscles and not liver damage.

Pravastatin (and other statins) are not always stopped immediately when
liver function tests show abnormalities. Two liver enzymes in particular
(alanine aminotransferase or ALT, and aspartate aminotransferase or AST) may
be mildly elevated, but it is safe to continue treatment unless they rise by
three times the upper limit of normal.

In this case the statin should be stopped. The damage is not permanent, and
when statins are stopped the liver tests return to normal. Special care is
needed if there is any pre-existing history of liver disease or high alcohol
intake.  Statins can also interact with other drugs used for lowering blood
fats levels, particularly a group of drugs called fibrates. So I don't think
there is cause for alarm here. As long as your doctor keeps an eye on the
liver function tests no long-term damage will be done. Of course, if the
pravastatin is causing other side effects like headache, diarrhoea
or fatigue then there is a case for stoppng them anyway and trying something
else. Sometimes another type of statin will be better tolerated.

Yours sincerely
Dr Keith Barnard, GP
Last updated 7.6.2001
NetDoctor.co.uk:
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from:
http://health.discovery.com/centers/articles/articles.html?

chrome=c14&article=LC_79&center=p05  article July 01, published

July 10

What Do I Need to Know About Statins? By Bobbie Hasselbring [ 7/01 ]

Statins are also called HMG-CoA reductase inhibitors. They are the medicines
of choice for lowering cholesterol.

When Are Statins Prescribed?
Your doctor is likely to prescribe a statin to help lower your cholesterol
if any of the following apply to you.
You have high LDL - known as the bad cholesterol. You have severe high
cholesterol or coronary heart disease, called CHD. You are middle-aged or
older and have multiple risk factors for heart disease. You have diabetes.
You have certain types of inherited high cholesterol or high cholesterol
caused by the kidney disease called nephrotic syndrome. If your doctor has
prescribed a statin for you, be sure to take it as directed.

Common Names of Statins
The following table shows some of the most common brand and generic names
for this type of medicine.

brand generic
Lescol fluvastatin Na, Lipitor atorvastatin Ca, Mevacor lovastatin,
Pravachol pravastatin Na, Zocor simvastatin

How to Take It
Statins are usually taken by tablet or capsule once a day, usually in the
evening.

How Statins Work
Statins work by blocking a substance that your liver needs in order to make
cholesterol. That means less cholesterol is released into your circulating
blood. Statins are very effective in lowering LDL - the bad
cholesterol - by 18% to 55%. They may also raise HDL - the good
cholesterol - by 5% to 15%. In addition, they may decrease triglycerides by
7% to 30%.

Precautions and Possible Side Effects With Statins:

Precautions to take when you are on statins:
Remind your doctor of your age. Unless the cholesterol is very high, statins
are not usually the first medicine of choice for young adults who don't have
CHD.  Keep all your follow-up visits with your doctor - especially when you
first start taking a statin and any time your dose is changed. Your doctor
will check your liver enzymes 6 to 12 weeks after you first start taking a
statin with a blood test to make sure that liver damage is not occurring.
You will then need a blood test to check your liver about every 4 to 6
months once you are on a set dose of your statin. If your liver enzymes or
creatine kinase values rise to more than three times the normal limit, you
should stop taking statins. Tell your doctor if you are pregnant or if you
have active or chronic liver disease. People with these conditions should
not take statins. Taking these actions will help ensure that you take your
statins safely.

Most Common Side Effects. The most common side effect of statins is
gastrointestinal upset. This may include:
constipation . cramping . diarrhea . gas . heartburn . indigestion . nausea
. stomach pain .

Less Common Side Effects. You may also have these less common side effects:
blurred vision, dizziness, headache, liver damage, which sometimes causes
yellowing of eyes and skin rash.

Severe Side Effects. Less often, statins may cause severe side effects.
Report any muscle pain or brownish or rust-colored urine to your doctor
immediately. Some people have muscle pain when taking statins. In rare
cases, people taking statins develop a condition that causes muscle weakness
and wasting of muscle tissue called myopathy.  Severe myopathy is more
frequent in people who take high doses of some statins along with
cyclosporine, gemfibrozil, or nicotinic acid. Taking erythromycin or
itraconazole along with some statins may increase your risk for muscle
inflammation.  Tell your doctor immediately if you develop muscle aching,
weakness, or dark urine. If any of these things occurs, your doctor may
order a blood test to measure a muscle enzyme in the blood called creatine
kinase.

In rare cases, statin medicines have been linked with liver inflammation,
called hepatitis. To be on the lookout for that, your doctor will monitor
your liver function.

Possible Drug Interactions With Statins

Make sure your doctor is aware of all the medicines that you are taking
before you start any new medicines. Also, ask your pharmacist for a complete
list of possible interactions with the statin medicine your doctor
prescribes. Statins may interact with the following:

alcohol, antacids, the cholesterol medicines bile acid resins, gemfibrozil,
and nicotinic acid, cyclosporine, which suppresses the immune system, the
antibiotics erythromycin and rifampin, the ulcer medicines cimetidine,
ranitidine, and omeprazole, propranolol, used for blood pressure or heart
conditions, oral contraceptives, digoxin, a heart  edicine, warfarin, a
blood thinner, the antifungal medicines fluconazole, itraconazole, and
ketoconazole.  If you take atorvastatin, your skin may be more sensitive to
sunlight.  So take care not to get sunburned.

If you take lovastatin, avoid taking it with grapefruit juice. It may
interact dangerously with your medicine, causing higher levels of lovastatin
in your blood. The potential increase is unpredictable and may worsen side
effects.

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