Can Zetia (ezetimibe) cause liver damage?
Yes, Zetia (ezetimibe) can cause liver damage and hepatotoxicity, although serious liver injury is very rare. Healthcare providers should monitor liver enzymes regularly for signs of drug-induced liver injury and toxic hepatitis, and consider ezetimibe discontinuation if liver damage develops. Your healthcare provider should perform baseline liver function tests just before starting ezetimibe treatment and conduct regular liver monitoring thereafter. They may consider stopping ezetimibe and/or statin medications (if taken together) if liver enzymes such as ALT or AST increase to 3 or more times the upper limit of normal (ULN) and persist.
Ezetimibe Liver Damage Case Reports
Multiple case reports document instances of serious hepatocellular drug-induced liver injury after several months of ezetimibe 10 mg daily treatment. One notable case involved a 56-year-old woman with stable medications (omeprazole and bisoprolol only) for 3 years and minimal alcohol consumption, who developed painless jaundice and pruritus after 4 months of Zetia therapy. Laboratory testing excluded other liver disease causes, and within four weeks of stopping ezetimibe, her jaundice and itching resolved completely with normalized liver function tests.
Additional published case studies detail significant ezetimibe-induced liver injury, including cholestatic liver damage, hepatocellular injury, and two cases of drug-induced autoimmune hepatitis. Three cases occurred alongside atorvastatin therapy. Patients experiencing acute toxic hepatocellular damage face an elevated risk of acute liver failure.
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Common Zetia Side Effects vs Liver Problems
Most people tolerate Zetia well, with the most frequent side effects being upper respiratory infections, diarrhea, joint pain, muscle pain, and sinus problems. Significant liver function abnormalities (≥3 times the upper limit of normal) in liver enzymes occur in approximately 1% of patients taking ezetimibe alone or 1.3% of those on combination ezetimibe-statin therapy. These liver enzyme elevations are typically asymptomatic, not associated with bile duct problems, and resolve after treatment discontinuation or may normalize with continued therapy.
References
- Castellote J, Ariza J, Rota R, Girbau A, Xiol X. Serious drug-induced liver disease secondary to ezetimibe. World J Gastroenterol. 2008;14(32):5098-5099. doi:10.3748/wjg.14.5098 https://pubmed.ncbi.nlm.nih.gov/18763297/
- Zetia. Package Insert / Prescribing Information. https://www.drugs.com/pro/zetia.html
- LiverTox: Clinical and Research Information on Drug-Induced Liver Injury [Internet]. Bethesda (MD): National Institute of Diabetes and Digestive and Kidney Diseases; 2012-. Ezetimibe. [Updated 2021 Dec 1]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK548095/
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