Ezetimibe and Liver Function Monitoring

Safety Profile and Management

The American College of Cardiology/American Heart Association guidelines recommend monitoring transaminase levels when ezetimibe is coadministered with a statin and discontinuing ezetimibe if persistent ALT elevations greater than 3 times ULN occur 1
The American College of Cardiology recommends continuing ezetimibe with close monitoring of liver function tests every 2-4 weeks in patients with mild transaminitis (< 3× ULN) 1
The American College of Cardiology recommends discontinuing ezetimibe if elevations are persistent in patients with moderate transaminitis (3-5× ULN) 1
The American College of Cardiology recommends immediately discontinuing ezetimibe in patients with severe transaminitis (> 5× ULN) 1
Ezetimibe is not recommended for use in patients with moderate to severe hepatic impairment, according to clinical guidelines 2
The American College of Cardiology recommends considering alternative agents such as bile acid sequestrants for patients requiring lipid-lowering therapy who develop transaminitis on ezetimibe 1

The American College of Cardiology/American Heart Association guidelines recommend obtaining baseline hepatic transaminases before initiation of ezetimibe 1
The American College of Cardiology recommends monitoring transaminase levels as clinically indicated when ezetimibe is coadministered with a statin 1