A 65-year-old man on atorvastatin 60 mg with fatigue, dark urine, scleral icterus after starting high-dose B-complex vitamin. What is the next step?

A 65-year-old man on atorvastatin 60 mg with fatigue, dark urine, scleral icterus after starting high-dose B-complex vitamin. What is the next step?

• A. Discontinue Lipitor and order LFTs
• B. Increase Lipitor dose
• C. Start acetaminophen
• D. Ignore symptoms and monitor

Answer: (A)

Recognize that the symptoms (fatigue, dark urine, scleral icterus) after starting a new medication point to acute drug-induced liver injury. The safest immediate step is to stop the suspected hepatotoxic medication and check liver enzymes to assess injury and guide further care. Discontinuing the atorvastatin is warranted because statins, especially at high doses, can cause hepatotoxicity. Ordering liver function tests helps confirm injury, gauge severity, and decide on the need for ongoing monitoring or hospitalization. While a high-dose B-complex vitamin could also contribute (niacin-containing supplements can affect the liver), the priority remains to remove a potential hepatotoxin and evaluate with labs. Increasing the statin dose would worsen potential injury. Starting acetaminophen is not appropriate in the context of possible liver injury, and ignoring symptoms is unsafe.

Recognize that the symptoms (fatigue, dark urine, scleral icterus) after starting a new medication point to acute drug-induced liver injury. The safest immediate step is to stop the suspected hepatotoxic medication and check liver enzymes to assess injury and guide further care.

Discontinuing the atorvastatin is warranted because statins, especially at high doses, can cause hepatotoxicity. Ordering liver function tests helps confirm injury, gauge severity, and decide on the need for ongoing monitoring or hospitalization. While a high-dose B-complex vitamin could also contribute (niacin-containing supplements can affect the liver), the priority remains to remove a potential hepatotoxin and evaluate with labs.

Increasing the statin dose would worsen potential injury. Starting acetaminophen is not appropriate in the context of possible liver injury, and ignoring symptoms is unsafe.