Elevated ALT levels and Crestor and/or Allopurinol?

[kevinh]

Hello,

I am a 6' 200 lb male and exercise 3-4 times per week.  I do not smoke and drink very little.  I have started drinking 3 (4 oz.) glasses of red wine/week (for health) and don't even average 2 beers per week.  I feel that I'm healthy, however, my ALT levels have become increasingly elevated over the past few years. The history is as follows (date, ALT measurement); 04/2003-56, 06/04-32, 09/04-55, 12/04-66, 03/05-70, 06/05-50, 11/05-85.  My AST levels; 04/04-17, 06/04-22, 09/04-21, 12/04-33, 03/05-25, 06/05-22 and 11/05-32.  Also, my Sodium level was low (barely) at 135 (this month's test) and this is the first time for low Sodium.

My medicines; 100 mg Allopurinol (formerly 300 mg prior to 07/05), Allegra D, Crestor 5mg.  Also, I take an 81 mg baby aspirin and two fish oil tablets each day.  Finally, I take a Lutein and Bilberry tablet for eye health (detached retina in 1997), Saw Palmetto for prostate (kidney stone in 2004) and a One a Day Mens Vitamin.

First, can you give me a general impression of my ALT (and AST) levels.  My doctor has indicated that worry doesn't really kick in until 3 x the upper end of normal range (which I calculate to be 108).  Can you discuss the medicines that I'm taking and any correlation/risk to my ALT levels?  I have read that both Allopurinol and Amphetimine cause elevated ALT levels.  Actually, in light of all the bad publicity with Crestor, I've been most concerned with it (although I didn't start taking it until 06/04).  My (total) cholesterol levels have gone from 262 in 06/04 (prior to starting Crestor) to 155 in 11/05 so the low dose Crestor (and I believe the red wine helps) seems to be getting great results.  My HDL stays in the mid 30's and my triglycerides have gone from 321 down to 162, for the same time period.  Finally, I have scheduled an appt. with my Family Physician for early December.  What further tests should I seek? Also, please tell me any other impressions or concerns whatsoever.

Thank you.

[JudyRae]

A related discussion, Crestor was started.

[kevinh]

I forgot that I am age 38 and take the Allopurinol for Chronic Gout (elevated uric acid level-chronic).  Also, would the herbs that I'm taking be a factor in the ALT levels?  Is Crestor associated with elevated ALT levels?

Thanks.

[kevinh]

I forgot that I am age 38 and take the Allopurinol for Chronic Gout (elevated uric acid level-chronic).  Also, would the herbs that I'm taking be a factor in the ALT levels?  Is Crestor associated with elevated ALT levels?

Thanks.

[Kevin Pho, MD]

Your doctor is right - normally the concern for ALTs start when they rise about 3x the upper limit of normal.  At this time, your ALT levels are mild elevated.  It is possible that the medications may be affecting this.

Further testing would include a screen for hepatitis as well as an ultrasound of the liver to exclude any anatomical abnormalities.  

Continued serial testing of the liver enzymes can be considered to ensure the levels do not continue to rise.  

These options can be discussed with your personal physician.

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
http://www.straightfromthedoc.com