liver function test & MTX | Arthritis Information

Hi. I'm new here and am hoping you can give me some reassurance. I am currently on 15 mg MTX weekly. I just had blood work done a few days ago and my ALT is 45 - though it had been 17 and 18 the prior two months. I am due to take my weekly dose tonight and am feeling a little nervous about taking it. Is an ALT of 45 really that bad (it's my understanding that 35 is the upper limit of normal)? Can your liver values fluctuate from month to month? I did take several doses of extra-strength tylenol the week before this latest bloodtest - maybe that caused the higher ALT? Anybody have any thoughts/suggestions?
Thanks,
Mary-Pat
Hi Mary-Pat!

Welcome to the board!

Well... I guess I am not going to be too reassuring, since I cannot offer any insight to your problem.

I am sure someone with more insight will be along soon and offer more than I have.

Once agian welcome to the board!!

Not sure about this, but bumping it for you. Hopefully someone can help. By the way, welcome!sorry... I don't know... but let's keep this on the front page til someone who knows comes along.....

Welcome!

Mine was around 125 when my RD took me off of MTX to try to get it to come back down. It remained elevated after our attemps to lower it by reducing my dose. After being off of it for about a month mine is now in the 40ties. That's much better than it was. I saw a GI specilist who couldn't find any other reason for the elevation other than the medication. He wanted to do a liver biopsy but I refused. I feel like it's just the medication. I think the noticable difference after stopping the medication proves that.

I'd been on MTX at a dose as high as 25mg for more than 5 years before it ever became elevated. You can do a general search of liver function test and I think 40ties is pretty normal. I wouldn't worry too much at this point. I'm sure your doctor will take you off MTX if he feels it's too high.

To be on the safe side I'd use Advil instead of tylenol from now on. Alcohol isn't good for you on MTX either although I drank in moderation all the years I was on MTX. Course I ended up having to be taken off of MTX due to elevated liver test so now looking back I wouldn't say that's a smart idea. The majority of RD doctors warn against alcohol at all while on MTX although my doctor wasn't one of them until my liver started testing high and then he made me swear it and tylenol off all together until things returned to normal.

I see my RD later this month and we'll see if he thinks my levels are closer to normal for me.

Mine pop up elevated occasionally but the next time they were tested, they were fine. Talk to your dr. to help put your mind at ease.

Welcome to the board.

Hi Mary-Pat..welcome!Welcome Mary-Pat!

I just got blood work back and my report says 6-40 U/L is within range for ALT and 10-35 U/L is within range for AST.

Did your doctor talk to you about the results? If not I would give them a call and explain your concern. They will probably reassure you that they will be keeping an eye on it and make a determination next blood test.

Best of luck to you.

If you took a bit of tylenol then that could be to blame if the AST and ALT have been normal prior to this instance. Maybe try to not take any tylenol and have it rechecked to see if they come down. The values should go down as I've had this happen to me before too and was told to avoid any "unnecessary" meds and get it rechecked in a few weeks. If the doc wasn't alarmed, then you shouldn't let it worry you either.

Hope this helps some.

Bob H.

I was prescribed methatrexate and took it for several years. Blood test must of always been okay...I dont recall the dose. i think I swallowed somehting like 7 pills a week. Never bothered my stomach or nuttin. Ironically I took it fo my MS as I was not DX with RA at the time. Funny how some drugs are used for different disease. I think autoimune diseases co-exsist frequently. Please call your doctor if you are concerened. I think it would ease your mind. I took myself of MX when I started Betaseron. Told my neuro that I felt it was all to much. I prob should of stayed on it not for ms but for my arthritis and it's friend Rheumey.

take care Bob.

I think that's an O.K. high. If you dr was concerned about it being high, he/she would have told you to lay of the MTX. Drink lots and lots of water. Call your dr if you are concerned. I hope it all turns out well for you and welcome to the forum.

take care

Oh, my! Thanks to all of you for responding! It's nice to be welcomed here. As it turned out, I went ahead and took my dose of MTX Friday night, and I have since done my best to stop worrying about the ALT results. I really think that the tylenol I was taking prior to the lab work could have contributed to the elevated reading. My RD is very much from the "NO alcohol school" so I have been avoiding that - but I just wasn't thinking when I took the tylenol. I do have lots of Advil in assorted strengths, and will stick to that in the future. Does anybody know if Mobic is metabolized in the liver? I may wait a bit to see if the RD calls me first re: the lab results. The results are posted online (Kaiser Permanente) so that's how I know what it was. I don't know if the RD has seen them yet, or if he even thinks it's a problem. My next appt is in 6 weeks, at any rate. I want to continue to take the MTX and reap the benefits which I am just now beginning to feel. I cannot take plaquinil due to retinopathy and can't take the sulfla med due to allergy so the MTX seems like my best choice so far. I am going to forge ahead, believing that A. an ALT of 45 is not that high; B. that the reading was just a fluke; and C. I will be feeling really good on this dose of MTX. I will drink lots of water, too. Thank you again for all the input. I appreciate it very much.

I have been struggling a lot with the DX and what may lie ahead; my mother and my aunt had HORRIBLE RA and both have passed away (in their early 60's) due to complications of the disease. I would give anything now to be able to talk with them about how they managed so bravely in spite of the pain and disability. I am not as strong as they were. But somehow, we all have to live the best life we can, in spite of the difficulties. I guess I'm in dire need of all the helpful hints I can get!

Looking forward to getting to know you all,

Mary-Pat
All drugs are metabolised by the liver. But the liver has different channels that metabolise different things, like a complicated series of rivers, so all the stuff it metabolises takes different paths.

It's scary when you look at your relatives and think you see your own future, but keep in mind that more is known now about RA (and there are many more treatment options, so your prognosis isn't necessarily what theirs were. I do understand wanting to "mine their wisdom" though.

PS. I agree with inflamed that most auto-immune diseases are related. In fact, I think they are all basically the same thing manifesting itself in different ways. Yes, I'm a "lumper".aren't most kaisers all electronic these days? you might consider emailing your doc for peace of mind, i never assume they read or get all reports.

i've been on mtx for yrs and the last time my alt/sgpt was elevated was when i was also taking darvocet prior to hip surgery, i stopped the mtx, lab went back to normal, had my surgery, restarted mtx and my labs have been in the normal range since then.