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Statins in hepatic impairment — GPhC CRA MCQ

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ModerateHepatic Dose AdjustmentStatins in hepatic impairmentGPhC CRA

A 63-year-old woman with hepatic impairment (Child-Pugh B) presents with a prescription for atorvastatin 40 mg daily for primary prevention of cardiovascular disease. She asks about monitoring. What is the most appropriate advice?

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Correct answer: A — Liver function tests should be checked before starting and periodically during treatment, as statins can worsen hepatic impairment

Statins should be used with caution in patients with hepatic impairment. The BNF advises checking liver function tests before treatment and repeating within three months of starting, then at 12 months, or if clinically indicated. Statins are contraindicated in active liver disease or unexplained persistent elevations of serum transaminases, but not in all liver disease. In compensated cirrhosis (Child-Pugh B), careful use with monitoring may be appropriate.

Reference: BNF; NICE CKS Lipid Modification