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Liver panel and Imuran

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Ulcerative Colitis
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Posted 12/6/2012 2:00 AM (GMT 0)
Finally got my lab results back
ALKALINE PHOSPHATASE 172 H    40-115 U/L
AST 174 H                               10-40 U/L
ALT 260 H                                 9-60 U/L

My PCP was not overly concerned and my GI basically said that's not really high and not to worry about it. He then bumped my Imuran up to 75 mg per day since I am now at 10 mg on my pred taper. Not itching every day but I was this morning. Otherwise I'm feeling good.
Posted 12/6/2012 11:30 AM (GMT 0)
Thats bloody high, is your PCP nuts? And who is PCP to up your Imuran? Don't you have a GI? If not, get one. How much do you weigh? male or female? It could very well be a fatty liver if you are on Pred for long time, STILL its high.
Posted 12/6/2012 12:25 PM (GMT 0)
"my GI basically said that's not really high and not to worry about it. He(my Gi) then bumped my Imuran up to 75 mg per day." The PCP just did the blood test and forwarded it to my GI. I'm thinking of stopping the Imuran since it is causing me to itch so much and I think it is the cause of my elevated liver test. I wanna trust my GI because he is a well respected DR in his field but not at the cost of my liver. Male 5'8" about 150 lbs

Post Edited (scum1) : 12/6/2012 5:31:29 AM (GMT-7)

Posted 12/6/2012 1:15 PM (GMT 0)
When my liver enzymes were that high, they made me go in for a liver ultrasound and testing. But anything can make your liver enzymes go up. a virus, a trauma, etc. Definately get retested in a few days. Keep a close eye on this one, IMO the raise in imuran is ridiculous with elevated liver enzymes.
Posted 12/6/2012 4:37 PM (GMT 0)
So I am so itchy(mostly hands and feet) I cannot sleep and it is driving me crazy. No way I can continue to take the Imuran. No amount of antihistamine (over the counter or prescription) helps. It's got to be the liver levels causing the itch. I just hope the asacol alone will keep me in remission once the Pred taper is finished. What a set back :( Guess I'll call my GI and tell him this evening.
Posted 12/6/2012 5:42 PM (GMT 0)
I would get new docs asap. Your PCP is wrong. My daughter's ALT was 74 and all else normal for a few weeks when she was on 6mp. Her GI wanted to watch it. It stayed this way for a few weeks and then all of a sudden her alt and ast were ten times the top limit ad we had to get off. Thankfully, all returned to normal in a few weeks but it was incredibly scary. We were told that they "start to worry" when the numbers are twice the limit, so I wouldn't mess with this med if I were you (unfortunately for us it was working well for our daughter)
Posted 12/6/2012 6:56 PM (GMT 0)
I don't blame my PCP as he called me immediately when the results came in and was at least a little concerned. MY GI on the other hand just kind of blew it off as nothing. I figure my GI should be way more experienced with Imuran and it's side effects. He did not even order future liver test to monitor my levels in the coming months. Right now I have a call in to both. I need something to stop this itching before I go crazy so I called my PCP. I also called my GI to tell him I was stopping the Imuran. Of course I am waiting for both to call back and trying not to claw my skin off. I'm thinking of getting a new GI. The one I use is older and is the head of 3 busy GI locations in the area so I expected him to be the best.

My PCP just called and is giving me something else for the itching and has ordered another liver panel. He will then get with my GI. I still think I am going to switch GIs though

Post Edited (scum1) : 12/6/2012 12:20:06 PM (GMT-7)

Posted 12/6/2012 7:52 PM (GMT 0)
when I took Imuran by the 15 day my lipase was way high and I was in a lot of pain, that was pancrea***. I'm glad you're stopping it. I just went in for new blood tests today hopefully since it's been a month off imuran my levels are back to normal...we'll see sometime today
Posted 12/7/2012 12:46 AM (GMT 0)
Have you been tested for hep c?
Posted 12/7/2012 1:27 AM (GMT 0)
Don't think so. I had no symptoms until I was on the Imuran and tapered my Prednisone down to 10 mg. I have donated blood in the past though and they test for Hep C. Really don't think that is the problem since I don't engage in any risky behavior. Been married for 23 years and although I have some Tattoos they were all done with new sterile equipment.

DMC2011 said...
Have you been tested for hep c?

Posted 12/7/2012 1:38 AM (GMT 0)
those are pretty high levels. when mine were high, my doc had me do a liver ultrasound as well as an MRCP. also had me get off 6mp immediately- definitely not up it like your GI said to do. you also could have developed that weird liver disorder that UC people get- primary sclerosing cholangitis.

http://www.mayoclinic.com/health/primary-sclerosing-cholangitis/DS00918
Posted 12/7/2012 2:34 AM (GMT 0)
Well my GI did not call me back today. Looks like I'm shopping for a new GI
Posted 12/7/2012 10:46 AM (GMT 0)
Shop for a new GI and leave a note on http://www.ratemds.com/
Posted 12/7/2012 10:42 PM (GMT 0)
GI(his nurse) finally called and said I needed to see a dermatologist since itching is not a side effect of Imuran. I explained to her that the elevated liver results were most likely the cause of the itching and I think she actually got it. GI sad to stop taking Imuran for now but he would like me to be on it in the future. Meanwhile I gave a blood and urine sample to be tested at my PCP office and got something different to try and stop the itching. Been off the Imuran 2 days.
Posted 12/8/2012 12:14 AM (GMT 0)
Scum1, I got terrible neurological itching from prednisone withdrawal. It's a severe side effect. It also passes. Anti-anxiety meds helped me.
Posted 12/8/2012 12:24 AM (GMT 0)
I guess if this passes and I make it off pred I can add the Imuran back. So you had no rash just itching? Still my liver numbers are high and that can't be good.

journey2health said...
Scum1, I got terrible neurological itching from prednisone withdrawal. It's a severe side effect. It also passes. Anti-anxiety meds helped me.

Posted 12/8/2012 7:25 PM (GMT 0)
When I was on Azathioprine, within a month, my ALT/AST went up a little higher than yours. My Dr had me checked for Hepatitis (negative) and had me stop the Azathioprine immediately once he got the test results back. With a week of stopping my ALT / AST went back to the normal range. He said the Azathiorprine caused me drug induced hepatitis. Luckily I had no damage and things all stayed normal after I stopped taking it.
In many cases skin problems are manifestations of something toxic or out of balance in your body. I had severe skin blisters from taking Cimzia and got dishydrodic eczema from taking too much iron.
Posted 12/11/2012 6:51 PM (GMT 0)
Talked to my PCP(he called me Sunday at home!) and my second blood test numbers came back about double (don't have a copy yet so I don't know the exact levels). what the first ones were. He said I needed to get off the Imuran ASAP. I told him I already had stopped taking it. In 2 weeks I am going back for another blood test to see if the numbers on my liver are back to normal. Still having some itching but not as bad and no as much on my hads and feet. Hope it goes competly away soon.
Posted 12/11/2012 7:14 PM (GMT 0)
hi Scum1, I'm glad you stopped it! Hope you feel better soon and you listened to your body!
Posted 12/13/2012 4:44 PM (GMT 0)
Got my numbers today.

AST 297

ALT 528

Alkaline Phosphatase 292

Bilirubin total 1.9

Good thing I stopped my itching has almost totally gone away now. Can't wait to the how the numbers have went back down when I do another test in a couple of weeks

Posted 12/28/2012 8:26 AM (GMT 0)
how is everything going here?
Posted 12/28/2012 1:25 PM (GMT 0)
Doing well with no Imuran. Will get blood re checked first of year to see if my liver numbers are back to normal. I am down to 5mg of prednisone( for about 7 days) and still doing ok. Only hitting the bathroom twice a day. Kind of scared to go down to 2.5 mg but will do so after Jan 1. Hoping I can stay somewhat in remission only on Asacol because I'm not planning on trying the imuran again even though my GI wants be to be on it. By the way thanks for asking :)
Posted 4/26/2014 1:31 PM (GMT 0)
Hey sorry to restart an old post. Just wondered what your final outcome was with you raised enzymes? I'm currently going through a similar problem I am on 6mp for UC and my enzymes are off.

ALT 235
ALP 170

So would be interesting to hear what happened.
Posted 4/26/2014 5:31 PM (GMT 0)
As long as I have been off of the Imuran I have had zero liver issues. All my levels went back to normal and have stayed that way.  When I was on the Imuran they also thought I might have primary sclerosing cholangitis but I think it was  symptoms caused by the imuran as well.  Currently I take Methotrexate and Humira and of course have a different GI Dr
Posted 4/26/2014 5:56 PM (GMT 0)
Ah cool glad to hear that thanks for the reply, my doc dosnt think its PSC but cant rule it out. But as the as the alt is higher its probably drug related, I have my mrcp on Tuesday.
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