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 Post subject: Elevated Liver Enzymes
PostPosted: Thu Sep 27, 2012 9:42 am 
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As many of you know, I've been on sub for almost 4 years this December, but about 8 weeks ago I dropped my dose from 16+ down to 4-6 mg/day. I also have psoriasis and am on Humira (a biologic) and methotrexate (a low dose chemotherapy). Because of the methotrexate, I have to have liver studies done every month. For the first time my ALT and AST came back elevated, indicating a possible problem with my liver. (I've been tested and don't have Hepatitis.) My dermatologist told me if my enzymes don't come back down I'll probably have to discontinue and/or lower my methotrexate (which would not be good for my psoriasis).

Then it occurs to me, shit, woman, you've been on suboxone for nearly 4 years! Could the sub be causing and/or contributing to the elevated liver enzymes? I've read that sub doctors are supposed to do baseline liver enzyme levels at sub induction and re-checks throughout treatment. Mine didn't/doesn't (but I get them checked regularly by my dermatologist). I've also read a study that people with hepatitis who are also on suboxone can experience increased liver enzymes (to my understanding more than non-hepatitis patients). I then have to wonder if the two medications are combining to cause the elevation.

Have any of you read additional/other studies about suboxone affecting liver enzymes? Or have any of you experienced elevated liver enzymes since you've been on suboxone?

Thanks, guys.

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PostPosted: Thu Sep 27, 2012 10:18 am 
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When I had Hep C, I was a bit concerned about Suboxone's supposed liver side-effects. But it turns out it was never really a problem. It was other medication which seemed to contribute - Epilim.. and Agomelatine. I talked to my doctor a bit about it, and he said that the liver warnings are for the most part precautionary, and he only starts to worry if the patient is elderly or has an already compromised liver.

In my experience, Suboxone is not really much of a risk in this regard. While I'm no doctor, I'd be looking first at your other medicines. With a quick googling it seems methotrexate is known for its hepatoxicity a lot more than Suboxone.

Also another thing to note is that doctors are well aware that many people prescribed Suboxone have Hep C. If it had any significant risk of hepatoxicity, it wouldn't be indicated for opioid addiction because of how many opioid addicts already have compromised livers.


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PostPosted: Thu Sep 27, 2012 10:32 am 
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TeeJay wrote:
I talked to my doctor a bit about it, and he said that the liver warnings are for the most part precautionary, and he only starts to worry if the patient is elderly or has an already compromised liver...Also another thing to note is that doctors are well aware that many people prescribed Suboxone have Hep C. If it had any significant risk of hepatoxicity, it wouldn't be indicated for opioid addiction because of how many opioid addicts already have compromised livers.


Thanks for that info from you and your doctor. That's new information and much appreciated. I know MTX is much more likely to be the culprit, I just found myself wondering if the two together could have had an additional effect. But from what you're saying, it doesn't sound likely.

For now, I'll wait for the next blood draw to see where the levels are then and go from there.

Oh and TJ, if the normal range for ALT is 2-45 and mine is 149, is that dreadfully high or just a bit high? (I failed to clarify with my doctor.) Do you know?

Thanks again. I'm much happier when the questions in my head have answers instead of suppositions.

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PostPosted: Thu Sep 27, 2012 5:01 pm 
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I can only relay my own personal experience and doctors' advice. In 1999, was diagnosed with primary sclerosing cholangitis (along with Crohn's disease). PSC is an autoimmune disease that causes the bile ducts to narrow and scars the liver, gradually destroying it. My liver enzymes have always been out of range, though were mostly a manageable level. But then, about a year ago, they went through the roof.

My first thought was it had to be Suboxone because it would make sense that it's something I like. However, my liver specialist and my Suboxone doctor (who is also my primary care physician) both tell me that it's definitely NOT the Suboxone.

Whether Suboxone is playing a role in your situation, I am not qualified to comment. But I just thought it'd be helpful to share my own experience. I hope you can figure it out and get it taken care of. Being on the transplant list sucks.


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PostPosted: Fri Sep 28, 2012 3:01 am 
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I honestly couldn't tell you Hatmaker. I never really paid much attention to the numbers. All I remember was my gastroenterologist telling me my tests were moderately high ... or normal. And seeing a lil red square on his computer screen.


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PostPosted: Fri Sep 28, 2012 9:56 am 
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Thanks, surgerybound for your input. It DOES indeed help. It's more evidence that it's not likely the suboxone, but the MTX that's the culprit.

Agreed - it must suck to be on the transplant list. Know that we're here for you, too. Have you been on the list a long time? I hope you get a call soon, the waiting has got to be the hardest part. Hang in there and thanks again for sharing your experience with me.

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PostPosted: Fri Sep 28, 2012 10:08 am 
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My liver enzymes were within the normal range when I had a test in the last month. Actually, my Doctor said they were 'nicely normal, given your history.' I have also heard as someone else said that the warnings associated with opioids and increased liver enzyme counts are for the most part precautionary.

Travis

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PostPosted: Fri Sep 28, 2012 3:51 pm 
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Thanks, Hatmaker. I've been on the list since April, though my enzyme levels have actually gone down a bit over the past two months, so I'm lingering at the bottom of the list. I'm having my next test on Monday, and I'm going to see my liver specialist next Friday, so I'm hoping to learn more.


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