Liver injury associated with ezetimibe monotherapy

Abstract Statin intolerance, primarily myalgia, is not uncommon in patients treated for elevated low-density lipoprotein (LDL) cholesterol. Nonstatin drugs, such as ezetimibe, can spare patients from statin exposure, while still reducing LDL cholesterol. Ezetimibe is generally very well tolerated, although gastrointestinal and musculoskeletal symptoms have been occasionally reported. We describe an extremely rare case of an ezetimibe-associated liver injury who required protracted treatment with prednisone and azathioprine. Ezetimibe-associated liver injury should be suspected with development of hepatic abnormalities concurrent with the timing of ezetimibe treatment and in the absence of other possible precipitating factors.