To the Editor: Hydroxymethylglutaryl coenzyme-A (HMG Co-A) reductase inhibitors (or statins) are widely prescribed, and any class-specific side effect has the potential to affect many thousands of patients. The statin drugs are well recognised as a cause of mild and usually transient hepatitis.1-3 Cholestatic liver injury has been reported with simvastatin4 and atorvastatin,5 but pravastatin has only been implicated as a cause in one report.6
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- 1. Boccuzzi SJ, Bocanegra TS, Walker JF, et al. Long-term safety and efficacy profile of simvastatin. Am J Cardiol 1991; 68: 1127-1131.
- 2. Nakad A, Bataille L, Hamoir V, et al. Atorvastatin-induced acute hepatitis with absence of cross-toxicity with simvastatin. Lancet 1999; 353: 1763-1764.
- 3. Walker JF. Worldwide experience with simvastatin/lovastatin. Eur Heart J 1992; 13: Suppl B: 21-22.
- 4. Ballare M, Campanini M, Catania E, et al. Acute cholestatic hepatitis during simvastatin administration. Recenti Prog Med 1991; 82: 233-235.
- 5. Jiminez-Alonso J, Osorio JM, Gutierrez-Cabello F, et al. Atorvastatin-induced cholestatic hepatitis in a young woman with systemic lupus erythematosus. Grupo Lupus Virgen de las Nieves. Arch Intern Med 1999; 159: 1811-1812.
- 6. Hartleb M, Rymarczyk G, Januszewski K. Acute cholestatic hepatitis associated with pravastatin. Am J Gastroenterol 1999; 94: 1388-1390.