Ezetimibe's Impact on Liver Function

Hepatic Effects and Monitoring Requirements

The American College of Cardiology recommends that ezetimibe can cause persistent elevations in hepatic transaminases, particularly when combined with statins, and requires monitoring of liver function tests before and during treatment 1, 2, 3
Persistent transaminase elevations may occur with concomitant statin therapy, necessitating monitoring based on statin therapy recommendations 1, 2, 3
Baseline hepatic transaminases should be obtained before initiating ezetimibe, and it is reasonable to monitor transaminase levels as clinically indicated when ezetimibe is coadministered with a statin 4
Discontinue ezetimibe if persistent ALT elevations ≥3 times upper limit of normal occur 4

The American College of Cardiology states that ezetimibe is not recommended in patients with moderate to severe hepatic impairment (Child-Pugh B or C) due to unknown effects of increased drug exposure 1, 2, 3

Obtain baseline hepatic transaminases before initiating ezetimibe 4
Assess for moderate to severe hepatic impairment (contraindication) before initiating ezetimibe 1, 2, 3
Monitor hepatic transaminases as clinically indicated, especially when combined with statins 4
Discontinue ezetimibe if persistent ALT elevations ≥3 times ULN occur 4