Elevated aminotransferases

Poorly treated hyperthermia may lead to metabolic acidosis, rhabdomyolysis, elevated aminotransferases, seizures, renal failure, and disseminated intravascular coagulation (DIC)... 

Adverse effects include fever, leucopenia, thrombocytopenia, alopecia, neurotoxicity and elevated aminotransferase levels. Other less common side effects include hypotension, cardiomyopathy and hyperglycaemia. 

Cl) = 0.30 - 0.92] was offset by an increased risk of death in remission (OR = 2.22, 95% Cl = 1.20 - 4.14), mainly due to infections. Strikingly, 11% of patients in the 6-TG arm compared to less than 2% in the 6-MP arm developed non-fatal hepatic toxicity with features of veno-occlusive disease (VOD) characterized by symptoms including tender hepatomegaly, hyperbilirubinaemia with elevated aminotransferases, thrombocytopenia out of proportion to neutropenia, and portal hypertension. In 85% of affected 6-TG recipients, these symptoms were observed during maintenance or interim maintenance. Of interest, in patients randomized to 6-MP, hepatic toxicity was associated with intensification elements in which both treatment arms received exclusively 6-TG. 

Initially, the patient is asymptomatic or has mild gastrointestinal upset (nausea, vomiting). After 24-36 hours, evidence of liver injury appears, with elevated aminotransferase levels and hypoprothrombinemia. In severe cases, fulminant liver failure occurs, leading to hepatic encephalopathy and death. Renal failure may also occur. 

Adefovir dipivoxil (Hepsera) was approved for use in chronic HBV, including lamivudine-resistant HBV, in 2002. End points of therapy for HBV include disappearance of HBV DNA and elimination of HBeAg (virologic response), resolution of elevated aminotransferases (biochemical response), and improvement of liver histology. HBeAg seroconversion, an even stricter marker of viral response, denotes the loss of both HBeAg and HBV DNA and the appearance of anti-HBe. Loss of HBsAg can occur even years after completion of therapy. 

Cholestatic hepatocanalicular jaundice has been reported in up to 2% of patients receiving phenothiazines. Additionally, liver function test (LFT) abnormalities (elevated aminotransferases and alkaline phosphatase), often asymptomatic, were reported in up to 50% of patients. If aminotransferases are greater than three times the upper limit of normal, antipsychotic therapy should be changed to a chemically unrelated antipsychotic. 

The concurrent use of fluconazole and nevirapine doubled the exposure to nevirapine compared with historical control data, although nevirapine did not have any clinically relevant effect on fluconazole pharmacokinetics. The manufacturer suggests that patients should be closely monitored for nevirapine-associated adverse effects if fluconazole and nevirapine are used concurrently. However, in a retrospective study of patients who had received a nevirapine-based HAART regimen, there was no increase in the incidence of clinical hepatitis, elevated aminotransferases or skin rashes, when the outcomes of225 patients not receiving fluconazole, 392 patients treated with fluconazole 400 mg weekly, and 69 patients receiving fluconazole 200 mg daily with nevirapine were compared. ... 

Toxic liver damage with elevated aminotransferase levels and joint stiffness in the right hand were reported in a 38-year-old woman who had taken 400 mg chaparral daily for "many years." The patient had a history of drug abuse, alcohol use, and previous exposure to hepatitis C. The reporting authors indicated that chaparral might have potentiated or exacerbated underlying liver disease. The patient eventually required a liver transplant (Sheikh et al. 1997). 

Toxic liver damage with symptoms of cholecystitis and elevated aminotransferase levels were reported in a 60-year-old woman who had taken an unspecified amount of capsules containing chaparral (Sheikh et al. 1997). 

LIVER A long-term study of patients with hepatitis C who were randomised to buprenorphine versus methadone for long-term pain control did not show any adverse elevation to transaminases over a 4-week period [85 -]. The combination product buprenorphine/naloxone, however, was associated with an elevated aminotransferase in 25/150 (17%) HIV-negative patients over 4 weeks in a different study [86 ]. 

Observational studies Therapy-related adverse events to moxetumomab pasudotox were assessed in a phase I trial in 28 patients with relapsed/refractory hairy cell leukaemia. Three patients experienced serious adverse reactions two showed depressed platelet counts and the third hypoxia and bronchospasm. The most common adverse events were grade 1 to 2 hypoalbuminaemia and elevated aminotransferases. Other less often seen events included headache, hypotension, nausea, fatigue, weight gain and myalgia [173 ]. 

Antithyroid drags have several side effects. The most frequent side effects are maculopapular rashes, pruritus, urticaria, fever, arthralgia and swelling of the joints. They occur in 1-5% of patients [1, 2]. Loss of scalp hair, gastrointestinal problems, elevations of bone isoenzyme of alkaline phosphatase and abnormalities of taste and smell are less common. The incidence of all these untoward reactions is similar with MMI and PTU. Side effects of MMI are dose-related, whereas those of PTU are less clearly related to dose [1]. PTU may cause slight transient increases of serum aminotransferase and y-glutamyl transpeptidase concentrations but also severe hq atotoxicity whereas methimazole or carbimazole can be associated with cholestasis. The side... 

The most common adverse reactions seen with celecoxib include dyspepsia, abdominal pain, diarrhea, nausea, and headache Like other NSAIDs, celecoxib may compromise renal function. Elevation of aminotransferase levels also occurs. 

When administering tacrine, the nurse must monitor the patient for liver damage. This is best accomplished by monitoring alanine aminotransferase (AIT) levels. ALT is an enzyme found predominately in the liver. Disease or injury to the liver causes a release of tiiis enzyme into the bloodstream, resulting in elevated ALT levels, hi patients taking tacrine, ALT levels should be obtained weekly from at least week 4 to week 16 after die initiation of tiierapy. After week 16, transaminase levels are monitored every 3 months. 

The nurse immediately reportsany elevated alanine aminotransferase (ALT) level to the primary health care provider. The primary health care provider may want to continue monitoring the ALT level or discontinue use of the drug because of the danger of hepatotoxidty. However, abrupt discontinuation may cause a decline in cognitive functioning. 

HCV infection is rarefy diagnosed in the acute phase, as most acutely infected individuals are asymptomatic. Between 50% and 90% of patients develop chronic infection, however, and this warrants early therapy. After occupational exposure with a known date, treatment should not be started before the acute episode characterized by alanine aminotransferase elevation, but it should always be started within 24 weeks after the onset of symptoms. The optimal treatment schedule for acute hepatitis C is controversial. Pegylated IFN-a monotherapy at the standard dose for 24 weeks yielded SVR rates close to 100% in symptomatic patients referred to tertiary care centers (De Rosa et al. 2006 Jaeckel et al. 2001 Santantonio et al. 2005 Wiegand et al. 2006). Shorter therapy may be envisaged (Calleri et al. 2007). Combination with ribavirin is recommended if a first course of pegylated IFN-a monotherapy fails to eradicate the infection. Viral elimination appears to be independent of the HCV genotype and the HCV RNA level (Calleri et al. 2007 De Rosa et al. 2006 Jaeckel et al. 2001). 

Transamination is not restricted to a-amino groups. The 5-amino group of ornithine—but not the e-amino group of lysine—readily undergoes transamination. Serum levels of aminotransferases are elevated in some disease states (see Figure 7-11). 

Serum aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase, y-glutamyl transferase, and bilirubin may be elevated in patients with hepatobiliary disease. 

Hepatocellular damage manifests as elevated serum aminotransferases [alanine aminotransferase (ALT) and aspartate aminotransferase (AST)]. The degree of transaminase elevation does not correlate with the remaining functional metabolic capacity of the liver. An AST level two-fold higher than ALT is indicative of alcoholic liver damage. 

Isoniazid Adults S mg/kg (300 mg) Children 1 0-1 S mg/kg (300 mg) Asymptomatic elevation of aminotransferases, clinical hepatitis, fatal hepatitis, peripheral neurotoxicity, CNS system effects, lupus-like syndrome, hypersensitivity, monoamine poisoning, diarrhea LFT monthly in patients who have preexisting liver disease or who develop abnormal liver function that does not require discontinuation of drug Dosage adjustments may be necessary in patients receiving anticonvulsants or warfarin... 

May present with high fever with significant leukocytosis with left shift, anemia, elevated alanine aminotransferase, and dull abdominal pain on palpation... 

Toxicities are GI (stomatitis, diarrhea, nausea, vomiting), hematologic (thrombocytopenia, leukopenia), pulmonary (fibrosis, pneumonitis), and hepatic (elevated enzymes, rare cirrhosis). Concomitant folic acid may reduce some adverse effects without loss of efficacy. Liver injury tests (aspartate aminotransferase or alanine aminotransferase) should be monitored periodically, but a liver biopsy is recommended during therapy only in patients with persistently elevated hepatic enzymes. MTX is teratogenic, and patients should use contraception and discontinue the drug if conception is planned. 

Constipation occurs in fewer than 10% of patients taking statins. Other adverse effects include elevated serum aminotransferase levels (primarily alanine aminotransferase), elevated creatine kinase levels, myopathy, and rarely rhabdomyolysis. 

A myositis syndrome of myalgia, weakness, stiffness, malaise, and elevations in creatine kinase and aspartate aminotransferase may occur and seems to be more common in patients with renal insufficiency. 

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