Elevated Liver Enzymes and bilirubin

I was sick last week, chills, aches, unbelievable fatigue.  Had been on Augmentin for a sinus infection, just finishing up the script, and take Crestor, Nexium, and Zyrtec on a regular basis. Symptoms started a few days after starting generic Zyrtec, which also caused unbelievable dryness that felt like I was dehydrated (no vomiting, though). A day after the chills, I noticed my urine was dark and my stools were very light, almost gray, and I started getting very itchy but no rash.  Looked at the drug interactions monograph, thought it was a reaction to the generic Zyrtec and called my doc.  He told me to stop taking the zyrtec and ordered liver function tests.  Well, tests came back with high enzymes and bilirubin and he told me to stop taking ALL medications.  Ordered an ultrasound which he said was negative, and ordered the blood work again.  He seems to think it's liver damage due to drug toxicity.  Problem is, he doesn't seem to be able to tell me what I should be doing, other than not taking my meds, to get healthy again.  AND because I have a hiatal hernia and GERD, not taking the Nexium has caused severe heartburn.  Well, after downing half a bottle of tums, I figured I'd take a Nexium cuz it can't be any worse for me than all that calcium, can it?

My biggest question is, is my doctor doing enough to diagnose and treat the problem?  Is there something I should do with my diet to help my liver heal?  And what about taking the Nexium, will that cause more damage?  Urine is still a little dark but better than a few days ago; stools are no longer gray but are still kind of light. And the itching.......

[boron]

If the stool is grey and the urine is dark, it means the following: bilirubin (which gives the normal brown color to the stool) is not excreted from the liver into intestine (as it should), but it rather enters directly into the blood, and from there into the skin (itching) and into urine (dark color).

In general, there are two reasons, why bilirubin is not excreted into intesine:
1. extrahepatic cholestasis - a blockage outside the liver prevents bile flow. Gallstone, impacted within the hepatobiliary duct is the most often cause.
2. intrahepatic cholestasis - a blockage of bile flow within the liver - drugs could cause it.

If laboratory results are improving after drop of medicines, it is likely, that they were the cause. From blood test, it can be said, if there is any inflammation (raised white cells), and this inflammation can be treated with ...well, doctor should say.

Zyrtec is an antihistaminic drug - it is against allergy. You was diagnosed to have an allergic sinusitis? Zyrtec can cause dry mouth and less urination. Cholestasis is a rare side effect.

Nexium may cause itcing (pruritus).

Crestor may cause less urination, jaundice...it is a possible cause of your problems. http://www.drugs.com/mtm/crestor.html

It is possible that only a combination of the two drugs caused problems.

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Conclusion:
- if symptoms are from a drug, it is from INTRAHEPATIC CHOLESTASIS. I wouldn't dare to say which drug is the culprit in your case. With eliminating all, the doctor wants to confirm if drug toxicity exists. If lab results will improve, I believe you'll be allowed to start with Nexium...

[achrisa]

My gut feeling is that it was a combination of drugs, as I have been taking Crestor for quite some time without elevation of liver enzymes but the difference was the addition of augmentin and then GENERIC zyrtec, which seemed to have more side effects than the brand I have taken in the past.  

The itching is driving me CRAZY...liver enzymes still elevated but are coming down.  You were right, Nexium is now allowed, but hope that isn't contributing to the itching.  Doc won't start crestor again until liver tests are normal.

Any guess when the itching subsides......arrrrggghhhhhhh

[boron]

Itching will subside when the serum bilirubin will fall enough.

There is one drug - cholestyramine - which binds bile acids in the gut, so they can't return into the liver. Ask your doctor, if this is an option for your pruritus.
http://www.cigna.com/healthinfo/d00193a1.html