Kickas.org Forums Treatments, Drugs and Alternatives AS Pharmacy Liver Enzymes after stopping medication

Hello!

I have a question. Around 2 and a half months ago I stopped all of my major medications (omeprazole, humira-weekly, mtx-10mg/wk, and 500mg naprosyn/day). I had to stop my medication because over the course of about a year and a half there had been an upward trend in my liver enzymes. Finally with my ALT going over 70 and the graph of my alt/ast just going up every 2 months my rheumy decided I should give my body a rest. Luckily during this time my back hasn't been too bad, but it has been almost three months now and my liver enzymes appear to still be elevated.

Is this normal? I had thought that after suspending medication my enzymes would return to normal pretty quickly, unfortunately they have not. In fact my ALT looks to have increased by 6 points over my previous blood draw and my AST is also up. My gastroenterologist is concerned by this and has talked about a liver biopsy. So I'm just wondering if this is common? How long does it generally take for liver enzymes to come down after having been on medication for years?

Anyone with experience and a little more knowledge? I'd be very grateful for any info I can get.

My elevated ALT and AST (but especially ALT) has nothing to do with my meds.

I have diabetes, pretty mild compared to most, HbA1c usually 5.8-5.9, sometimes up closer to 6.5. FBG usually 100-110.

But the diabetes has raised my lipids, especially LDLs. Pravastatin helps that.

And my weight has gone up due to the metabolic syndrome.

When my weight went up close to 150, my liver enzymes went up. When I lost down to 138, they were back to normal. Gained up near 150 again, liver enzymes up. Down to only ~145 and they are still up a bit.

I have a really good GI doc and he did a bunch of blood tests to rule out various hepatitis's, ruled out an iron storage disease, ruled out a few other things, basically whatever could be ruled out by blood work.

then, instead of a liver biopsy, did an ultrasound first. The ultrasound showed "fatty infiltration" of the liver.

Put all together:

1. diabetes and NAFLD-->NASH-->cirrhosis of the liver run in my family

2. I had gained weight and weight gain in people with metabolic syndrome often have NAFLD. and the number one way to improve the disease is through weight loss.

3. the ultrasound showed fat in my liver

4. i gain weight --> liver enzymes go up

5. i lose weight --> liver enzymes go down

6. 4 and 5 are true irrespective of my medications

not saying this is what you have, but it is something to consider. before a liver biopsy, ask for a liver ultrasound, its noninvasive, whereas a liver biopsy though now laparoscopic, is still invasive.

hoping its something this simple, as NAFLD is relatively easy to turn around with weight loss.

too, have other things ruled out with blood work. make sure its not a hepatitis, etc.

lots of easy simple testing to rule things out or in.

too, if its drug / med related, there are other liver enzymes that tend to go up.

if its mostly your ALT and to a lesser extent AST, then NAFLD (or AFLD if you drink) is the most common thing to consider. especially if you have diabetes or prediabetes (or metabolic syndrome) and have gained weight.

PS i went back and read an older thread of yours and see you are not overweight, but lack of exercise, elevated triglycerides and/or LDLs, prediabetes, can all play a role.

What did your abdominal ultrasound indicate?

Hi Mike,

I would have expected your liver enzymes to have improved after a break from your meds, and although the meds do seem like the most obvious culprit to suspect, the fact things haven't improved must make you wonder if the cause might be something else.

In case this thought might help, I wonder if you have been tested to rule out the possibility of hemochromatosis? This might be considered if you are in your 40's or 50's and are of northern European heritage. There is a simple blood test to check for this really common genetic disorder. Sometimes this is missed and since it is easily treated, you might want to ask to be tested if they haven't already ruled out the possibility.

Hemochromatosis causes too much iron to be absorbed, which get deposited in the liver because the body can't rid itself of iron.

hemochromatosis.org

Anyway, just tossing this thought out there, in case it's something you want to ask your doctor about.

Hope things improve for you soon!

yes, that's one of the blood tests I had that I mentioned in my post.

blood work is so super simple and non-invasive, can rule out tons of stuff.

get all the blood tests that are available to figure out what it is and isn't.

that's how we came to NAFLD due to diabetes / metabolic syndrome.

Glad you had the dreaded iron storage disease ruled out, Sue.

Nice to see you, by the way!