A 55-year-old male with obesity, type 2 diabetes, and newly diagnosed non-alcoholic steatohepatitis (NASH) is currently taking metformin 1000 mg BID, empagliflozin 25 mg daily, and atorvastatin 40 mg daily. His liver enzymes are ALT 150 U/L and AST 100 U/L. Which of his current medications requires careful monitoring or potential adjustment due to his liver condition?

Question: A 55-year-old male with obesity, type 2 diabetes, and newly diagnosed non-alcoholic steatohepatitis (NASH) is currently taking metformin 1000 mg BID, empagliflozin 25 mg daily, and atorvastatin 40 mg daily. His liver enzymes are ALT 150 U/L and AST 100 U/L. Which of his current medications requires careful monitoring or potential adjustment due to his liver condition?

Answer options:

• Metformin
• Empagliflozin ✅ Atorvastatin
• All medications are safe with current liver enzymes

Correct answer: Atorvastatin

Explanation: While NASH can itself elevate liver enzymes, statins like atorvastatin can also cause liver enzyme elevations. Although generally safe, the existing liver inflammation warrants close monitoring of liver function tests and consideration of dose adjustment or alternative if elevations persist or worsen significantly.