Ast, Alt so high nurse called

[Tippyclubb]

to ask if I had been drinking.  I have not--drinking is the last thing on my mind.  The study doctor wanted her to called because he is concerned they going up so high.   Just before started tx  Alt 59, Ast 47 and I was drinking then.  First month of tx both #'s in the 20's.  Today Ast 98, Alt 97.  Almost double when I started.

This is all so confusing.  I'm not suppose to be telling this but I just don't give a damn anymore about the privacy issues with the trial.  I never was one to keep secrets anyway.  I was RVR and UND by week 4 .  Had my own PCR done--Heptimax  < 5.  

The question is if I had a break through wouldn't they tell me to discontinue.  I had my 12th week PCR done Monday by the trial, but did not do the private one.  Now I think maybe I should do one with the high numbers.  Maybe I had a break through?  I'm so confused as to how that works.

The consent form states:  If your virus responded more quickly and could not be detected in your blood at week 4 or week 12 you will be randomized to either stop tx at week 24, or continue to week 48.  Sounds like if I had a break through I would be told to stop?

This is  a whole lot of stuff to keep track of with so many of my numbers going wacky.  Its almost like a part time job anymore.  Very confusing!

[Tippyclubb]

P.S.     In other words really sucking up.  Lol!

[Tippyclubb]

Lots of holes in my theory.  According to the first link you provided I would have to take 4 grams for 14 days to have levels rise like mine.  Its taken me 13 weeks to go through 24, 650 mg.  Normally 2 pills once a week, sometimes twice.  Who knows  I will run it by the nurse and see what she thinks.

Its funny how we spend so much time trying to figure this disease and tx out.  Its really all I have to do now, seeing as I barely function in the real world.  Lol !  I'm sure you understand that.

I am going to let Tom slide this time, as he has been a trooper with taking care of me.  Hes' put up with a lot.  Don't want to test the waters--there will be no fussing at him now.  Just words of praise, thanking him, lots of I love you.

[can-do-man]

Tippy, good luck to you and don't worry.

Port-a-pot says........ I noticed that every single time I had a big Tylenol week, it would be followed with a worrisome rise in ALT.
-------------------------------------
And here i thought it was them little blue pills that caused the rise..... Oh well

[portann]

Anecdotally, my husband and I noticed that every single time I had a big Tylenol week, it would be followed with a worrisome rise in ALT. Then it would decrease on a non-Tylenol week. This is strictly anecdotal, though, and maybe even imaginary. It made us feel better to think that.

My nurse told me the maximum recommended dose per day is 2000 mg per day during tx. She was never concerned about an elevation but it never went as high as yours did. (Then again, I never accidentally took as much as you and I admit I would have given hubby Riba heck about the mix-up.)

These articles only discuss a link at 4 g a day, which you probably didn't take, even with the 650 mg pill mix-up:

http://www.healthandage.com/public/health-center/15/article/3141/Tylenol-and-Liver-Function.html

Tylenol may elevate liver enzymes
Updated 7/4/2006 7:49 PM ET
By Rita Rubin, USA TODAY
CHICAGO — The maximum recommended daily dose of acetaminophen, the pain reliever best known as Tylenol, can cause liver blood tests that suggest the presence of disease, according to a study.
"Several of the subjects actually had (liver enzyme) elevations to the point that any physician would become very alarmed and want to know why," says lead author Paul Watkins of the University of North Carolina-Chapel Hill. Still, Watkins emphasized, "I don't think it means that acetaminophen is dangerous as it's being consumed."

Acetaminophen overdoses can severely damage the liver, but when taken as directed, the drug has a long track record of safety, Watkins notes. In addition, he says, no previous study had ever found that taking the maximum daily recommended dose of 4 grams — or eight Extra-Strength Tylenol — raised liver enzyme levels.

The study, in the Journal of the American Medical Association, was financed by Purdue Pharma, which had halted clinical trials of a combination opiate and acetaminophen product because of elevated liver enzyme levels, Watkins says.

He figured that the combination had a synergistic effect on the liver. So Watkins enrolled 145 men and women, ages 18 to 45, and divided them into five groups: Three received an opiate and 4 grams of Extra-Strength Tylenol daily; a fourth received the Tylenol and placebo opiate pills; and the fifth received two sets of placebo pills.

The opiates had no effect on liver enzymes. But one in five of those who received Tylenol had five times the upper limit of normal enzyme levels, which dropped back to normal within two weeks of stopping Tylenol.

The findings show the importance of taking no more acetaminophen than recommended, Watkins says. And, he says, doctors should ask patients with elevated liver enzymes about recent acetaminophen use.
http://usatoday.printthis.clickability.com/pt/cpt?action=cpt&title=USATODAY.com+-+Tylenol+may+elevate+liver+enzymes&expire=&urlID=18753505&fb=Y&url=http%3A%2F%2Fwww.usatoday.com%2Fnews%2Fhealth%2F2006-07-04-painkiller-liver_x.htm&partnerID=1660
------------------------------------------------------------------------

And this old article from 2003 is an easy read:

http://www.familymedicinenews.org/archives/2003/2650(FM).htm

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As for buying the wrong dosage, don`t be too hard on him. :) This will be an increasing problem for us as we age. I think older people are on so many prescription drugs I sometimes wonder if the chief reason they end up in the emergency is because of med mix-ups.

Sometimes I can`t even fish out my riba from the correct day of the week in my pill box and when I try to apply brain power to the problem, there just ain`t enough juice to sort it out.

If your hunch turns out right, your doc will have to eat crow about his comment.

[justme53]

You shold be OK if you are taking only two a day now and again. I was told 2000 mg. of Tylenol was OK, even for cirrhotics.

Pam

[Tippyclubb]

I think I have figured out why my numbers are so high.  Also last blood work my GGT is high too 38.  

When I started tx my husband bought me Tylenol.  It was suppose to be a low dosage but each pill is 650mg and I was taking two at a time,1300mg. I just discovered the mistake today.  I remember the nurse saying a low dosage and I think she said 200mg.  I have taken 24 of these Tylenol since tx.

Let this be a lesson to all, always double check everything.

Do you think that could be the root of the problem.  I wonder if I have really messed myself up doing this?  

[jmjm530]

Yes, your doc sounds like an a*ss and I'd dumpt him unless it's less bother to continue on. One bottle of wine per week isn't a lot although in one night, yes, too much but still "horrified" is a bit over the top.

-- Jim

[charm27]

Just wanted to say hang tough! All wil be ok! I can sure understand how you feel. I too have heard of people with high liver enzymes EOT and all turned out A-OK!

Good and healthy prayers Im sending to you!

Charm

[AnotherJourney]

From what I read there are a whole lot of OTCs that can elevate ALT as well.. So shame on your Dr for being so single sighted.

[AKHepper]

Sounds to me like your doctor is full of 'you know what'.

[Tippyclubb]

When he asked about my drinking before starting tx I told him I drank one bottle of wine a week, but I drank the whole thing in one night.  He didn't think much of that, and was horrified.   I asked him how they could tell a person had been drinking and he said it was by the MCV number.  Started at 102 and pretty much stayed there until a few weeks ago, and is now 105 , normal range being 100.  I am thinking this is also why he would ask that question.  I googled MCV and high MCV is also associated with anemia , which I am and that started a few weeks ago.   Makes me wonder why he didn't make that connection instead of assuming I was drinking.  


To All:  Thanks for the input, it sure has helped to ease my weary mind.  

[jmjm530]

The study doctor wanted her to called because he is concerned they going up so high.   Just before started tx  Alt 59, Ast 47 and I was drinking then.  First month of tx both #'s in the 20's.  Today Ast 98, Alt 97.  Almost double when I started.
---------------------
Did you have a drinking problem prior to treatment that you disclosed to the trial doctors? That's the only reason I can think of why they might focus in on the drinking angle, because other than that, the questions  they're raising doesn't seem very professional or even informed.

First of all ALT and AST numbers cannot be compared clinically in a linear fashion meaning that ALT 97 is not twice as high as ALT 57. It's just slightly higher.

Also, it's not uncommon for ALT to rise during treatment as it has for many here, and the reason frequently is that the rise is simply a reaction to the treatment drugs. In cases like this ALT and AST return to normal once treatment is over, assuming SVR. In three years here, I remember dozens of such reported enzyme elevations and can't once remember anyone saying that their medical team asked them if they were drinking alcohol. I mean, it's probably a prudent question to ask among many, but to zero in on it as they appeared to do doesn't make any sense.

And speaking of SVR, the only way to tell if you've had a viral breakthrough is via a viral load test, not looking at your enzymes. Since your tx team is either not motivated to test or more probably hampered by trial protocols -- if it were me, I'd get another private viral load test (like Heptimax) the day before your next injection in order to rule out viral breakthough which I doubt very much it is based on your previous UND.

-- Jim
.

[Trish77]

My enzymes starting going up while on treatment also.  They were at 45 at start of treatment, not bad.  They dropped to around 20 on treatment.  When the thyroid issues started, they started going up. They hit in the 90's also. When they put me on antibiotics as a preventative measure due to a weakened immune system, they continued to go up and they then switched me over to a different antibiotic.  So some questions, are you taking anything or on any meds that might be for something else that might be contributing to your enzymes going up?  Interferon can sometimes make liver enzymes go up and so can other things. As it is, I went UND at 6 weeks into treatment and even with the liver enzymes going wacky like that, I was still UND at 12 weeks post treatment.  Watch the enzymes though.  The interferon can trigger autoimmune diseases and you keep an eye on the enzymes for those things.  Very rare is triggering autoimmune Hepatitis so you just watch and keep an eye.

Good luck.

Trish

[jankar]

I found my ALTS and ASTS were raised when I was taking lots of Ibuprofen and dropped again when I stopped taking it and started taking Panadol (your Tylenol) instead.

[copyman]

hey Tippy,

As you know I'm in the same trial as you and I did my own PCR's. Just to put your mind at ease my Alt was 64 before starting and has stayed around there the whole time. My AST has always been in the high normal range. My trial nurse told me many of her patients LFT's flucuates and some stay high even after clearing virus. She said the interferon can elevate LFT's.  The odds of a break through are very small with taking 12 weeks of Telaprevir. I would look at other reasons why the LFT's are elevated. Other meds,  Supplements, etc.

[lapis]

Hang in there, I know this is tough.  Yes, they will definitely tell you if you need to stop tx, though they won't tell you why, because of the blinding.  I think that even if you had a breakthrough you'd go to 24 weeks, but you've just finished triple therapy so how could you have a breakthrough at this point?  At least, that's my reasoning.  I know how frustrating this is but wow, you were UND at wk 4, that is something to comfort you.

You're in the no-placebo triple therapy trial, right?  I wonder if the triple therapy might have caused the elevation, and if your numbers will go back down since you've just finished triple therapy.  Anyway, this stuff is dynamite, try to stay positive, maybe others will have more advice but I just wanna add my support.

Lapis

[Trinity4]

You're getting good mileage even though the tank is empty Port.  :)

[portann]

Here's another old, long thread but comments are not always about elevated AST and ALT:

http://www.medhelp.org/posts/Hepatitis-C/Week-17--but-AST-and-ALT-rising/show/97240
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And this one, which includes:

"I searched the web, and racked EVERY medical board and Medical mind that would listen. Two of the greatest Hepatologist in the world, Dr Schiff, and Dr Cecil, BOTH stated that interferon, SPECIFICALLY Pegasys, CAN elevate liver enzymes. And that the elevation will not decrease, until tx is stop. 15-20% of patients who undergo combination therapy, will not obtain normal ALT levels until the discontinuation of treatment."

http://www.medhelp.org/posts/Hepatitis-C/liver-enzymes-going-higher-on-treatment/show/91199

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And lastly (note ALA was asked the same question about drinking!):

http://www.medhelp.org/posts/Hepatitis-C/Sudden-increase-in-ALT-level---Shocking/show/651044

[JennyPenny]

Don't give up. The only odd experiences I know about are people who had very high elevations of liver enzymes after stopping treatment. One of my friends actually had an ALT of 600. All 3 of these people had EOT response and SVR and their liver enzymes returned to normal in a few months afrter end of treatment.

[portann]

Am looking for relevant threads in archives (sorry, I'm on empty today). Here's one:

http://www.medhelp.org/posts/Hepatitis-C/Higher-Enzymes-During-Tx/show/86728

AKHepper started that thread and I noticed he's been around recently, so maybe he'll be able to help sort this out.

[GreatBird]

If the disclosure doesn't address breakthrough prior to 24, I doubt that they will reveal it to you--or even the trial people you are dealing with. So, you might want to have your own PCR run.