From the Guidelines
Pitavastatin can affect AST and ALT blood tests, but significant elevations are rare, occurring in less than 1% of patients taking the medication. Like other statins, pitavastatin may cause elevations in liver enzymes, including aspartate aminotransferase (AST) and alanine aminotransferase (ALT) 1. These elevations are typically mild (less than three times the upper limit of normal) and often transient, occurring most commonly within the first few months of treatment. The mechanism behind these elevations involves the drug's effect on liver metabolism, as statins are processed primarily through the liver.
Key Points to Consider
- Pitavastatin is a potent inhibitor of HMG-coenzyme A reductase and reduces LDL-C effectively, with a mean reduction of 43–47% 1.
- The drug has pleiotropic effects, which may be beneficial in specific patient groups, such as those with metabolic disturbances, diabetes, or pre-diabetes 1.
- Pitavastatin does not share the propensity of other statin agents to cause a small absolute reduction of NOD, and had slight optimisation of fasting blood glucose (FBG) and HbA1c 1.
- The prevalence of pitavastatin intolerance is similar to placebo, making it a suitable option for patients with statin intolerance 1.
Monitoring and Recommendations
- If you're taking pitavastatin, your healthcare provider will likely monitor your liver function through blood tests, especially during the initial treatment period 1.
- Patients with aspartate or alanine aminotransferase levels less than 3 times the normal levels do not warrant an immediate change in dose but should continue to follow up and consider repeated testing with their health care provider 1.
- If you experience symptoms like unusual fatigue, loss of appetite, right upper abdominal discomfort, dark urine, or yellowing of the skin or eyes while taking pitavastatin, you should contact your healthcare provider promptly as these could indicate liver problems.
From the FDA Drug Label
The following laboratory abnormalities have been reported: elevated creatine phosphokinase, transaminases, alkaline phosphotology, bilirubin, and glucose Four patients (3%) treated with pitavastatin tablets had at least one ALT value exceeding 3 times but less than 5 times the ULN, none of which led to drug discontinuation
Pitavastatin can affect Aspartate Aminotransferase (AST) and Alanine Aminotransferase (ALT) blood tests, as evidenced by reports of elevated transaminases and specific instances of increased ALT values in clinical studies 2.
- Key findings:
- Elevated transaminases have been reported in patients taking pitavastatin.
- Specific ALT value increases were observed in some patients, with 3% of patients in one study experiencing ALT values exceeding 3 times but less than 5 times the upper limit of normal (ULN).
From the Research
Effects of Pitavastatin on AST and ALT Blood Tests
- Pitavastatin, like other statins, can cause mild elevations of alanine aminotransferase (ALT) or aspartate aminotransferase (AST) [<3 times the upper limit of normal (ULN)] in some patients 3.
- The incidence of mild ALT and AST elevation in patients taking statins is relatively low, around 2.3% and 2.1%, respectively 4.
- These elevations are generally not associated with significant liver toxicity over time 3 and may normalize after withdrawal of statins or lowering the dosage 4.
- The risk of elevated ALT and AST is higher in older patients (≥ 65 years) and those with chronic liver diseases 4.
- Pitavastatin's unique pharmacokinetic properties, including minimal metabolism by cytochrome P450 (CYP) 3A4, may contribute to its safety profile regarding liver enzyme elevations 5.
Comparison with Other Statins
- Pitavastatin has been compared to other statins, such as atorvastatin, in terms of its effects on liver enzymes 5, 4.
- While the available evidence suggests that pitavastatin is generally safe regarding liver enzyme elevations, the incidence of elevated ALT and AST may vary depending on the specific statin and patient population 4.