Can lithium (lithium carbonate) or statins (HMG-CoA reductase inhibitors) increase liver function, specifically leading to hypertransaminasemia or elevated liver enzymes?

From the Guidelines

Lithium and statins can potentially cause elevations in liver enzymes, but they do not increase or improve liver function, and their use should be carefully considered in patients with pre-existing liver disease. The risk of liver damage from statins is rare, with studies demonstrating they are safe in patients with pre-existing abnormal liver enzymes 1. In fact, statins have not been shown to worsen the outcome in persons with chronic transaminase elevations due to hepatitis B or C, and treatment of hyperlipidemia may actually improve transaminase elevations in individuals with fatty liver 1.

Some key points to consider when evaluating the potential impact of lithium and statins on liver function include:

• Lithium therapy can occasionally cause mild elevations in liver enzymes, indicating some stress on the liver, but these elevations are typically not clinically significant for most patients 1.
• Statins can lead to drug-induced liver injury, but this is very rare, and the risk of serious liver injury while receiving moderate-dose statin therapy is extremely rare 1.
• The FDA recommends measuring transaminases if there are signs or symptoms suggesting hepatotoxicity, but routine monitoring of transaminases is not recommended for patients taking statins 1.
• An asymptomatic increase in transaminases (>3 times upper limit of normal) is an infrequent statin-associated side effect that often resolves with dose reduction or rechallenge with alternative statins 1.

Overall, the benefits of statin therapy are shown to outweigh the risks of new-onset diabetes mellitus and liver damage, and the possibility of incident diabetes mellitus or liver damage should not be a contraindication to statin therapy or indication for statin discontinuation 1. If you're concerned about liver health while taking lithium or statins, regular monitoring of liver enzymes through blood tests is recommended, especially during the initial treatment period, and always consult with your healthcare provider before making any changes to medication regimens or if you have concerns about medication effects on your liver.

From the FDA Drug Label

An encephalopathic syndrome (characterized by weakness, lethargy, fever, tremulousness and confusion, extrapyramidal symptoms, leucocytosis, elevated serum enzymes, BUN and FBS) followed by irreversible brain damage has occurred in a few patients treated with lithium plus haloperidol

Lithium may increase liver function, specifically leading to hypertransaminasemia or elevated liver enzymes, as evidenced by the encephalopathic syndrome characterized by elevated serum enzymes. However, this is in the context of combined use with haloperidol, and a causal relationship has not been established.

• Lithium may be associated with elevated liver enzymes, but only in combination with other medications.
• There is no direct information about statins (HMG-CoA reductase inhibitors) in the provided drug label. 2

From the Research

Liver Function and Lithium or Statins

• There is no direct evidence in the provided studies that lithium (lithium carbonate) or statins (HMG-CoA reductase inhibitors) increase liver function, specifically leading to hypertransaminasemia or elevated liver enzymes 3, 4, 5, 6.
• However, one study mentions that serum lithium levels of 1.5-2.0 mM may have mild and reversible toxic effects on the liver 4.
• Another study discusses the treatment and prevention of drug-induced liver injury (DILI), but it does not specifically mention lithium or statins. It suggests that ursodeoxycholic acid (UDCA) may have some benefits in the treatment and prevention of DILI, but more research is needed to confirm its efficacy 7.
• The provided studies focus on the effects of lithium on the brain, blood, and other organs, as well as its potential use in treating dementia and other conditions 3, 4, 5, 6.
• There is no mention of statins in the provided studies.

Potential Liver-Related Side Effects of Lithium

• Mild and reversible toxic effects on the liver at serum lithium levels of 1.5-2.0 mM 4.
• No other liver-related side effects of lithium are mentioned in the provided studies.

Statins and Liver Function

• There is no information available in the provided studies about the effects of statins on liver function or their potential to cause hypertransaminasemia or elevated liver enzymes.