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What Prescription Drugs Can Elevate Your Liver Enzymes?

by
author image Karla Casco
Karla Casco began writing in 2010, focusing her work on diseases and treatments and their side effects. She has also created patient handouts, PowerPoint presentations and journal clubs. Karla has a doctorate in pharmacy from St. John's University and holds a pharmacy license for the state of New York.
What Prescription Drugs Can Elevate Your Liver Enzymes?
Your pharmacist can explain your medication's effect on the liver. Photo Credit Jupiterimages/Polka Dot/Getty Images

Elevated liver enzymes may indicate liver damage or inflammation. Liver injury results in the leakage of enzymes called aminotransferases, which include alanine aminotransferase, or ALT, and aspartate aminotransferase, or AST. These enzymes are typically detected during a liver function test. Other enzymes that may be included in a liver function test are alkaline phosphatase, or AP, gamma-glutamyltranferase, or GGT, lactate dehydrogenase, or LDH, and 5-nucleotidase. Many prescription medications may cause an elevation in liver enzymes and some lead to severe liver injury if not discontinued.

Statins

Statins, or HMG-CoA reductase inhibitors, are cholesterol-lowering medications that include lovastatin, atorvastatin, simvastatin, pravastatin, rosuvastatin, pitavastatin and fluvastatin. This class of medications may cause an increase in the transaminases, GGT and AP, according to the "Drug Information Handbook." Before you are prescribed a statin, your physician should perform a liver function test to ensure that the levels are within normal range. Liver enzymes must be measured periodically, because statins have the potential to cause liver injury.

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Tetracyclines

Tetracyclines are antibiotics used for gonorrhea and syphilis in patients who are allergic to penicillin and infections caused by certain bacteria including Mycoplasma, Chlamydia and Rickettsia. The common tetracylcines include tetracycline, doxycycline and minocycline. These medications may impair liver function, especially during pregnancy, in patients with pre-existing liver impairment and when high doses are administered intravenously, explains "Basic and Clinical Pharmacology." Periodic measurements of liver function tests must be assessed in order to determine if liver dysfunction is present.

Amiodarone

Amiodarone is an antiarrhythmic agent used for the management of irregular heartbeats. This medication may cause phospholipidosis, which is an accumulation of phospholipids or fat found in cells. One of the presenting signs is elevated transaminases, especially in patients who have received higher doses, according to "Pharmacotherapy: A Pathophysiologic Approach." Liver function tests should be monitored regularly.

Anti-Seizure Medications

Phenytoin, valproic acid, carbamazepine and phenobarbital are medications used for the prevention and treatment of seizures and may lead to elevated enzymes. Liver function tests should be assessed periodically as part of the monitoring parameters. Valproic acid requires liver function tests before initiating therapy and during therapy. If you have liver impairment, you will require a reduced dose. Carbamazepine may enhance the potential of certain medications, such as acetaminophen, to cause liver toxicity. You should always inform your physician of all the medications you use.

Other Medications

Non-steroidal anti-inflammatory drugs, or NSAIDs, such as ibuprofen and diclofenac, may increase liver enzymes. Isoniazid, nitrofurantoin, trimethoprim, hydralazine and quinidine may also cause elevations in the liver enzymes. Captopril, lisinopril, erythromycin, sulfonylureas, such as glyburide and glipizide, and sulfonamides, such as sulfadiazine and sulfamethoxazole, may rarely cause cholestatic jaundice, which manifests as elevated liver enzymes, states "Pharmacotherapy."

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References

  • "Drug Information Handbook"; Charles F. Lacy, Lora L. Armstrong, et al.; 2009
  • "Basic and Clinical Pharmacology"; Bertram G. Katzung; 2007
  • "Pharmacotherapy: A Pathophysilogic Approach"; Joseph T. DiPiro, Robert L. Talbert,et al.; 2008
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