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Doctors' Answers to "Frequently Asked Questions" - Liver

These comments are made for the purpose of discussion and should NOT be used as recommendations for or against therapies or other treatments. An individual patient is always advised to consult their own physician.

[posted 08/12/1999]
Question: I have been treated with 67 mg of Tricor three times/day for approximately one year for high triglyceride levels (before treatment my levels were 3-400's.) After one year, my triglyceride,and other lipid levels are excellent. However, for the first time my ALT and AST levels are elevated (60 and 87 respectively). How large a concern should this level be to me? I know the liver cannot regenerate itself when damaged. Since the levels took one year to develop, could they be caused by an allergy medicine (ZYrtec) I took for about the past six months? What would you recommend I do? Thank you very much.

Answer: LIver functions are one of the things we regularly monitor. However, at this dosage, toxicity would be unusual. The usual thing to do is stop the drug for 4-6 weeks and recheck the liver enzymes. If they are back to normal, restart the drug and recheck in 6 weeks or so. Usually, these elevations after being on the drug for awhile are due to some other influence on the liver. The liver is affected by many drugs and infections and nearly all of my patient's elevated LFTs on lipid lowering drugs have cleared and not returned after rechallenge.

Liver and Medication Reactions [posted 10/1/98]
I was diagnosed with ADD, Depression and Anxiety/Panic Disorder after breaking down under too much stress at work in November 1996. As a result, during a 20 month period between 10/96 and 7/98, I was given BusPar, Paxil, Xanax, Wellbutrin, and Adderall, among others, in the doctor's (psychiatrist) attempt to find the right combination. On July 13, I cold-turkeyed off everything. I was also diagnosed with Hepatitis C in Nov 1996 however, I had just had foot surgery Sept 96, plus was in ER after an overdose of medication in Oct 96 and my enzymes were normal and NO HepC was diagnosed in either of those two different hospitals. I have been getting monthly blood work and see my gastroenterologist regularly. I also had 7 bleeding ulcers May 20, and rectal bleeding June 28 followed by colonoscopy July 8 removed 2 pre-cancerous polyps and 1 internal hemm. I am otherwise a very healthy 43 yr old female. Could all the medications have caused all this? Life Stressors play a role, to be sure, and I am currently trying herbal, vitamin and other natural relief methods, which are working out very well. My enzyme levels have been normal since June. Have you any information about liver problems and/or Hepatitis C in connection with these medications?

Answer: No obvious relationship, although several would be metabolized by the liver and could affect the level of liver enzymes.

Liver Damage
Question: My mom is 47 years old. She has hcv and cirrhosis. She is trying to get on a transplant list, but is having a hard time because she is on a methadone program. My question is about her brain and liver. She has been talking out of her head for about a week now. She knows who everybody is, but she is always confused and talking about something that makes no sense at all. Will this stop? Or is this how she will stay until she gets a transplant or dies? Why is her brain being affected?

Answer: Assuming that she doesn't have any other medical problems than hcv it probably represents end stage liver disease. After extensive damage the liver can no longer detoxify all the body waste that it is supposed to handle. This leads to build up of blood ammonia levels and to subsequent confusion. This can initially be handled with drugs such as laculose(an oral medication to induce diarrhea) so, I'd ensure that her doctor is aware of the problem. In later stages, it is not reversible unless the liver begins to function (transplant basically).

Liver enzymes
Question: My husband just received a call from our family physician's office saying that his liver enzymes were elevated. The blood work was done after my husband had complained about falling asleep during the day at work and here at home. This started about six months ago. What would cause the fatigue? He is on Prozac for depression with OCD tendencies, Propanonyl for MVP, and Pepcid for heartburn. Could any of these medications cause the elevated enzyme levels? I really hate to see him go off the Prozac. He seems to dwell on little details, and he gets the idea that he is the only one that can accomplish tasks in a satisfactory manner. In other words, he is almost unbearable without it.

Answer: So many different things can cause elevated liver enzymes that it staggers the mind. In general, the total elevation and symptoms are the best predictors of whether this elevation means anything(in relation to him) or is just a false clue. Usually , I stop the medications and recheck the enzymes in 4-6 weeks. Another alternative is to stop any non-essential drugs(pepcid for sure, possibly propanalol depending on his symptoms off the beta blocker). The usual reason for elevated enzymes is not found, and they resolve on their own. Prozac can cause this problem, but it is not a common problem. Actually, none of these drugs cause liver toxicity as a common side effect.

Elevated Liver Enzymes due to Isoniazid
Question: My wife had a positive TB reading, and the local Health Department prescribed Isoniazid and Pyridoxine as a preventative measure even though a negative X-ray was taken. They checked her liver enzymes in the first two months then said she didn't need any tests until 6 months, witch showed them to be extremely high (AST-sgot 355 and ALT-sgpt 715 and Bilirubin 0.6). They immediately took her off the medication In November 1996 after 6 months. In late January 1997 the results were still in the 65 and 85 range, and this past week they were up again in the 80 and 100 range. She was diagnosed in May of 1987 with MS. Now she needs a Hysterectomy and they will not proceed until the liver enzymes are back to normal levels. My wife does not drink alcohol of any kind. What could the contributing factors be in the erratic liver enzyme readings? And does any over the counter pain relievers such as Aleve contribute to the readings? Does her MS have any bearing on this?

Answer: Isoniazid is the standard treatment for skin converters for TB. Usual treatment is 6-12 months although some favor three months. The major toxicity of Isoniazid is hepatic and is very common in patients over the age of thirty. 80% or so over the age of thirty will develop elevated liver enzymes at some time during treatment. This usually resolves with cessation of the drug unless it is allowed to progress to symptomatic disease. I have difficulty believing that they never checked her liver enzymes. Most physicians would recommend much closer observation of liver enzymes during treatment. There are several potential causes of elevated liver enzymes. Non-steroidal antiinflammatories (like Aleve) can do this in some patients. She should have a liver/spleen scan to ensure there is nothing going on in her liver. MS should have no effect on liver enzymes.

Liver Function Tests
Question: Can you explain what SGPT and GGT are? Both of these tests came back elevated and my doctor wants to do more tests. I had surgery in the fall and at that time had very elevated liver enzymes(over 1,000 times normal) and the surgery was even canceled. Now the doctors are trying to adjust my hormones and are being very cautious because of my liver. I tried a hormone patch which worked beautifully and bypassed the liver, but I developed a severe allergy to the adhesives. When I was pregnant 13 and 15 years ago I had coleostasis of pregnancy. Could this have caused any liver damage? When the surgeon did a hysterectomy in 11-96 he said he did notice my liver was slightly smaller than normal and that there were some white patches on it. Now I don't know what these SGPT and GGT levels mean.

Answer: SGPT(serum alanine aminotransferase - also referred to as ALT) and GGT(gamma glutamyl transpeptidase) are abbreviations for enzymes found in the liver(and nowhere else). These enzymes are involved in the formation of oxaloacetic acid and pyruvic acid. High levels in the blood reflect leakage(usually due to damage to the cell) of these enzymes out of liver cells into the blood stream. In normal conditions, this does not occur. Elevated levels usually reflect inflammation or damage to the cells of the liver. There is a huge list of possible causes. It sounds like they are working on the cause. If you are not seeing a GI specialist, you should be.

Elevated Liver Enzymes
Question:My Father, Older Brother and I all suffer from elavated liver enzyme levels, more specifically the GGT and SGPT. Our cholesterol levels consequently are normally 250-270. I would just like to know what this actually indicates and if there is anything that can be done to lower these levels. WE have all suffered from fatigue, dizzyness and a basic cloudy feeling when these levels are high. I also want to know what exactly these elevated levles indicate other than alcoholism because I don't drink and neither does my father, but that is all that I have been able to find information about.

Answer: There are about fifty different reasons for liver enzymes to be elevated. In your case, it probably is a familial problem-unrelated to any individual problem. It would he necessary to see an internist or Gl specialist for further diagnosis-possibly including a liver biopsy. Once the diagnosis is known treatment(if any) and prognosis will be clear.

Liver Enzymes
Question: I have a liver enzyme level of "106" and "58"...My doctor says that these levels are slightly high. Does this mean that I have Hepatitus B? I had the blood test since I have had hives for the past 6 months.

Answer: An elevation of liver enzymes is a frequent problem seen on screening bloodtests. In the absence of symptoms of jaundice, fatigue, fevers, this is usually not infectious hepatitis. There are numerous causes for elevated enzymes - particularly if they are only slightly elevated. Once the enzymes are three to four times normal, pathologic causes increase in frequency. I see this problem about three to four times a month in my patients - usually after detection in an insurance physical or while giving blood at the Red Cross. Usually, they resolve after three or four months with no sequelae. I suspect that your hives may be related and that they will return to normal. Blood tests are availible for Hepatitis A, B, C and D. However, I would not pursue this unless they persist in elevation.

Liver Elevated AST, ALT
Question: I've had problems with a stiff neck for 2 years now. My doctor prescribed Ibuprofen and Flexeril which was switched to Norflex, all are taken as needed. I am 39, just had a physical and one of the tests showed ALT = 71,( he said normal is 5-40) and AST = 52, with normal being up to 35. He's instructed me to stop alcohol and ibuprofen unless it's necessary. In 3 months, I'm to be retested. What are AST and ALT? Would anything else have contributed to the higher numbers? For instance, Caffeine or Aspertaime. How serious is something like this?

Answer: AST and ALT are enzymes produced by the liver in its function. An elevation of liver enzymes is a frequent problem seen on screening blood tests. The liver is exceptionally sensitive and minor elevations such as these are commonly seen. There are numerous causes for elevated enzymes - particularly if they are only slightly elevated. Once the enzymes are three to four times normal, pathologic causes increase in frequency. I see this problem three to four times a month in my patients - usually after detection in an insurance physical or while giving blood at the Red Cross. Usually, they resolve after three to four months with no sequelae. I wouldn't be concerned at this point unless they don't improve or if any symptoms arise.

Elevated Enzymes
Question:On a recent Dr's visit, they did some blood work on me. The nurse called yesterday and the one thing that concerned me was, she asked if I drank which I don't, or if I am on any medication which I'm not, because my liver enzymes are elevated. What does this mean? I don't know very much about my liver. They told me to not take any medications, or vitamins for two weeks then they are going to run the test again. Is there anything I can do to promote liver health?

Answer: "Liver enzymes" usually refer to about four or five tests on a "panel" which is directed towards different liver functions. One's liver is extremely sensitive to different environmental factors. Different infections, toxins, medications, and a host of other causes can cause elevation of liver enzymes. In my practice, I see about 5-10% of patients with elevated liver enzymes and absolutely no symptoms related to any liver dysfunction. Most of the time rechecking several weeks later will find normal enzymes. This usually indicates that a virus or some transient factor has inflammed the liver and no further evaluation is necessary. Also, the lab tests define "normal" in order to encompass 95% of patients. This means that 5% will always be "abnormal", however, there may be absolutely nothing wrong with their livers.

Fatty Liver
Question:I have been diagnosed with a fatty liver. I am interested in the long term effects of this condition. What is the prognosis for my condition if I take no corrective action?

Answer: Fatty liver is a fairly common problem. It appears to run in families and is often seen as a precursor to diabetes mellitus, etc. Indeed, many people say that the cause is insulin resistance etc. The long term course is fairly benign. I would recommend that you lose weight to minimize the risk of long term diabetes mellitus. Also, check your cholesterol-many with fatty liver will need treatment for elevated cholesterol.

Liver Disorder
Question: I have a friend who has a liver disorder(unidentified). He was told that he has spots on his liver, fatty deposits, and high lipids/triglycerides. I don't know if it relates, but he has had a rash on the palms of his hands. The liver is not swollen. If you have any ideas as to a condition with these indications, please respond.

Answer: Almost any inflammatory or degredative process of the liver will produce these symptoms. The red palms are a classic physical finding for liver dysfunction-whether from alcohol, cirrhosis, infection etc.

Liver Enzyme Level
Question: My liver enzymes are at twice what they should be and I have a cough that won't go away. What could this be? I have been to four different Drs. and they can't figure it out. Please help this has been going on for two years!

Answer: I'll need a little more information like your other tests, diagnostic tests performed by the physicians that you have seen, a more complete history etc.

Lipitol & Side Effects
Question: How does the knew statin, lipitol, compare side effects wise with the others in its class, specifically effects on liver functions?

Answer: Although liver dysfunction is listed as one of the potential side effects, I rarely see this in patients until the dosage is really pushed. Lipitor is relatively new and so far doesn't seem to have appreciably different side effects from other HMG CoA Reductase drugs.

Question: Could voltaren be the cause of having elevated liver results that are 2 to 3 times higher than normal. I drink 2-4 drinks per day on the average, I take tylenol #3 tablets once a day. If I quite taking the voltaren should I notice a decrease in my liver studies. I had stopped drinking for 3 weeks and it barely reduced these results.

Answer: Almost any drug can cause liver inflammation. Stop all your drugs including alcohol for at least 6 weeks before you decide which is the culprit. Probably a combination of all 3 or a condition called "fatty liver". Back to Drug InfoNet Home Page.

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