Kickas.org Forums Ankylosing Spondylitis General Discussion #1 AS Web Support Group Elevated Liver - Questions about blood work...

When I saw my Rhuemy on Wednesday last week they took a bunch of blood work. The nurse called me back today with my results. She said my liver numbers were elevated that they were at 64 and they should be below 40. She told me that I am to stop taking tylenol or anything with tylenol in it.

I let her know that I had only been taking tylenol with my fever and prior to the blood test I had only taken about 6 tylenol from Monday to Wednesday morning when I saw the dr. Then I asked her what about the vicodin and she said she'd have to talk with my Rhuemy and call me back.

She called me back and told me that he wants me to reduce my vicodin from 1 tab 4x a day to 1 tab 3x a day. That they think possible the tylenol is my vicodin / and what I took last week for my sky high fever is what is making my liver elevated. (I have no clue on how I'm going to manage on 3 pain pills a day, I can't manage as it is with 4 a day. My pain is still constant)

I then asked her if any of my other medications could be causing my liver to be elevated, like the methotrexate or the humira. She said it's possible that one of them may be causing this problem. But that we will start by taking me off one medication at a time to see which is causing it!

Truthfully I'm woundering if it's not the Humira. I've been on methotrexate for going on three years and have never had a problem. This is the first time they've checked my blood work since I've been on Humira as well.

My vitamin d was also really low it was at 13 so they are having me take 50000 mgs of vitamin d 2x a week.

Ugh... To make matters worce I called hubby to let him know that they want me to reduce my pain meds. When I called him I was quite upset because I can't imagine having to deal with more pain, it's already playing havic with my blood pressure, I was sick to my stumack last night, running to the bathroom from the pain. Hubby's first responce was well you just need to quit your part time job. I enjoy working the little I do work, which is anyware from 0-12 hrs a week depending on how I'm feeling. It gives me a chance to earn a little extra spending money.

Has anyone ever had their liver numbers elevated from either their pain medication or from Humira?

Kim

I would suspect the methotrexate first before the vicodin. It has a much larger impact on your liver function. Luckily I was taking Humira at the same time and did not lose all relief when stopped. Your liver levels should drop down to normal within a couple of weeks. I have never had any issues with Humira or pain medication. Get in and see your Rheumatologist and go over it with him. He should order another liver test within 2 weeks of making changes.

Tim

i don't take any of these drugs so i don't want to say 100% (check up on what i say), but i'm pretty sure by memory and a quick google now, that a common side effect of methotrexate is liver toxicity. but if you've been on it for 3 years, then maybe it is a different med or the combination?

i know when i start a medication, i look up the potential side effects, talk to both my doctor and the pharmacist of what to watch out for, etc.

i do take a muscle relaxant that can also cause unexpected liver failure so i had blood work done at 1, 3, 6, and 12 months, and now yearly. if it was going to cause a problem, it probably would right away is my guess, but we do it yearly still, just to make sure. been on it for about 8 years and i take the lowest dose i can for several reasons, but partially to protect my liver. i also don't take tylenol much or drink alcohol figuring the healthier i can keep my liver, the less effect this drug will have on it.

why did the doctor order the liver function test? which drug is he monitoring this way? or is it to monitor the drugs?

i know for my muscle relaxant, i was glad i had a specialist prescribe it so they knew to do the liver function panel as i described. now, my GP prescribes all my maintenance drugs that i've been on for a while, but i'm the one who has to remind him that i need the liver panel test or it would never get done.

are there any pain meds that don't get processed by the liver that you could take instead? that's something i would ask a doctor. or is there one that is least likely to cause liver damage? i'd ask that as well. of course its important to pay attention to liver numbers, but we are a whole person and the entire thing must be managed, both the pain / symptoms and the other stuff like the liver. hopefully your doctor can help you manage both.

sue

About a year ago I had an episode of acute hepatitis. My ALT was over 1600 and I got the comforting diagnosis of liver failure. The culprit? Ibuprofen. Luckily after I stopped taking the Ibuprofen my ALT level slowly began to come down and I got to keep my own liver (always a good thing!) I get LFTs checked about every other month now and although they are never normal, they have been staying below 100 most of the time. I figure if my hepatologist isn't worried I shouldn't be either.
There is always the possibility that your elevated LFTs are due to your recent illness. You say you had a fever, any other symptoms? Nausea, vomiting, loss of appetite, weight loss? In addition to all the hepatitis viruses (A-E) there are a number of other viral & bacterial pathogens that can cause a transient hepatitis. I would also find out which number was higher. The AST:ALT ratio is useful in determining the cause of the increase. Also find out if your alkaline phosphatase was elevated.
Since one of the problems with Vicodin is the possibility of acetaminophen liver toxicity you could ask about switching to Vicoprofen which does not carry this risk.
Hope this all works out for you!
~trish

Hi Kim

I too have had trouble with liver toxicity. Drug induced hepatitis, mine was attributed to Imuran. I have taken Methotrexate, tylenol, Humira along with a mirad of others! Many people cannot take Tylenol at all! I cannot begin to tell you how many people I've seen come into the Lab with elevated liver enzymes due to tylenol (acetaminophen). As Trish said there are other liver enzymes such as Alk Phos. if others are elevated then there is a good chance there is something else going on, other wise if it is just AST or ALT it is usually drug related.

Personally, I have to watch that I don't take any Tylenol. If I do my numbers go sky high. (One of my Lab Tech's was being treated for Hep. C and my numbers were 4 times as high as his! He was wondering what the heck was wrong with me! ) Methotrexate can be hard on your liver especially if you aren't supplementing with Folic Acid, as it depleates it. I wouldn't worry about the Humira. Personally I would stay off of ANY Tylenol and keep checking your numbers then monitor the Methotrexate.

I totally understand where you stand with working part time! I did that for 9 years. My husband was just like yours, I quite working the end of the year and hubby was retiring. I must say I do miss it! I will be doing some type of volunteer work or something!! Possible per diem work, will see?!

Good luck and Take care. God Bless
Trae~

hi kim:

i had a high liver test once about 20 years ago and doctor immediately changed me to another anti-inflammatory medication. that seemed to help and the numbers dropped back to normal. so far every annual blood test after that has come up normal.

i've been on methotrexate and remicade, combined over several years and liver tests are normal. at night i take one tylenol 3 with codeine to help me sleep. it depends on how your body reacts. the good news is the liver gets better once you stop the offending drug.

i hope the doctors can figure out what will help the pain and at the same time not attack your liver.

sending you healing wishes from hawaii.

leslie


http://islandtails.honadvblogs.com/

Hi Kim,

I would also suspect the methotrexate first, this med is hard on the liver. I took sulfasalazine for 6 years and it eventually caught up with my liver.

You may want to also look into the amount of Vitamin A you are getting in your diet or if supplementing. This can be toxic to liver as well as this is where excess is stored. I ran into that issue when I ate a lot of carrots many years ago while on the med as well... once I cut down, my enzymes came down.

Tim

Just my own experience....

Humira has never caused my liver enzymes to elevate. I take Vicodin regularly, as well as OTC Tylenol - again no issues.

Methotrexate on the other hand caused my liver enzymes to triple. I took it for almost a year with no problems, then in a real short time span they tripled. We stopped it & the enzymes returned to normal. We started it again. Again they elevated, and I had more side effects.

I switched rheumatologists & she wanted to try the methotrexate herself. We started out at a very low dose & before she even tried to increase it she had me have bloodwork done & they were already elevated. And I had very severe side effects from it that time.

It is best to eliminate one med at a time to see what's causing it, but I would be inclined to agree with Tim that the Mtx may be an issue.

Hey Kim,

I went through something odd recently and may be similar to what you've described?

It was my psychiatrist who noticed that my GGT and ALT (liver enzymes) were elevated. He assumed this was evidence of a drinking problem and didn't believe me when I told him I don't drink at all anymore. I'd rather spend my money on other things like bills and groceries...lol
This situation started quite the flurry of questions and not so many answers.
I thought it might have been Tylenol as well but learned that Tylenol will only register in liver enzyme tests if something close to an overdose had been taken - like well beyond the normal daily limit for adults. Also, it wasn't considered to be indicative of liver malfunction since all four of the tests would have to be significantly elevated.
They said Humira could do it but I hadn't begun that drug at that point.
Perhaps ninjas snuck into my home at night and slipped a mickey into my OJ?
One thing that was interesting is that the psychiatrist considered the numbers to be a startling jump while my GP and my rheumy both blew it off as "just one of those things".

If I read your post correctly, this is coming from your nurse? I'm sure you'll get some more info when you talk with your doc.

Take care,

Chris

Hi, sorry you are going through this! Why not have them re-do the liver lab when you are not taking tylenol and you don't have any kind of virus. Are you sure the vicodin does not have any tylenol (the generic form of it) in it? And regarding your job, your husband probably just wanted to find a solution, "fix" it however he can, by supporting you, but see how it goes. My liver enzymes were elevated once and I was not sure why, but I was ok. You may feel better once you get the Vitamin D going up, so I hope you will feel better soon!