Liver-function test, clinical

There is no universal guideline for follow-up care for MM. The National Comprehensive Cancer Network recommends annual skin examination for all patients.61 Educate patients with stage IA disease to have a history and physical examination every 3 to 12 months as clinically indicated and an annual skin examination for life. For stage IB to III disease, schedule a history and physical examination every 3 to 6 months for 3 years, every 4 to 12 months for 2 years, and then annually as indicated. It is optional to obtain a chest x-ray, LDH, complete blood count (CBC), and liver function tests (LFTs) every 3 to 12 months. CT scan can be obtained as indicated clinically.61 For NMSC, educate patients to schedule follow-up visits with... 

A measurement of renal function (creatinine and/or BUN) is an essential test for most clinical studies, as is the inclusion of an panel of liver function tests (SGOT, SGPT, LDH, CPK, GGT, and/or alkaline phosphatase). The specific tests chosen to be included in a study are somewhat dependent on both the investigator s and/or clinical scientist s experiences and the characteristics of the drug. Other important parameters to measure include serum electrolytes and at least some of the tests listed in Table 20.12. 

Adverse reactions occurring in 3% or more of patients with RA include the following Nausea, dyspepsia, rash, headache, abdominal pain, vomiting, fever, dizziness, stomatitis, pruritus, abnormal liver function tests, and leukopenia. One report showed a 10% rate of immunoglobulin suppression, which was slowly reversible and rarely accompanied by clinical findings. 

Hepatotoxicity A few cases of reversible clinical hepatotoxicity have occurred in some patients, asymptomatic rises in serum alkaline phosphatase or serum transaminase levels have been observed. If anorexia, weight loss or pruritus develop in patients on allopurinol, evaluation of liver function should be part of their diagnostic workup. Perform periodic liver function tests during early stages of therapy. 

Monitoring Perform complete blood counts, including differential white cell count and liver function tests before starting sulfasalazine and every second week during the first 3 months of therapy. During the second 3 months, perform the same tests once monthly and, thereafter, once every 3 months and as clinically indicated. Also perform urinalysis and assess renal function periodically during treatment. 

Evaluate liver function tests at the start of and during the course of voriconazole therapy. Monitor patients who develop abnormal liver function tests during voriconazole therapy for the development of more severe hepatic injury. Discontinuation of voriconazole must be considered if clinical signs and symptoms consistent with liver disease develop that may be attributable to voriconazole. Hepatic function impairment It is recommended that the standard loading dose regimens be used but that the maintenance dose be halved in patients with mild to moderate hepatic cirrhosis (Child-Pugh class A and B) receiving voriconazole. 

The combination of amprenavir and low-dose ritonavir has been associated with elevations of cholesterol and triglycerides, AST, and ALT in some patients. Consider appropriate laboratory testing prior to initiating combination therapy with amprenavir and ritonavir and at periodic intervals, or if any clinical signs or symptoms of hyperlipidemia or elevated liver function tests occur during therapy. 

Peripheral neuropathy - Patients developing moderate discomfort with signs or symptoms of peripheral neuropathy should stop zalcitabine. Zalcitabine-associated peripheral neuropathy may continue to worsen despite interruption of therapy. Reintroduce the drug at 50% dose (0.375 mg every 8 hours) only if all findings related to peripheral neuropathy have improved to mild symptoms. Permanently discontinue the drug when patients experience severe discomfort related to peripheral neuropathy or moderate discomfort progresses. If other moderate to severe clinical adverse reactions or lab abnormalities (eg, increased liver function tests) occur, interrupt zalcitabine (or both zalcitabine and the other potential causative... 

Liver function tests - Because elevations of liver enzymes have been observed during clinical trials and hepatitis has been reported, perform pretreatment and followup liver function tests at weekly or biweekly intervals until the response to isotretinoin has been established. 

Although it is estimated that 1 in 118,000 patients dies from non-dose-related hepatic failure, no cases have occurred in patients older than 10 years who were receiving valproate monotherapy. Nonetheless, baseline liver function tests are indicated. If baseline test results are normal, monitoring for clinical signs of hepatotoxic-ity is more important than routine monitoring of liver enzyme levels, which has little predictive value and may be less effective than clinical monitoring (Pellock and WiUmore 1991). 

An excellent brief article on buprenorphine treatment has been provided by Taikato et al. (2005), which notes the common possible side-effects (headaches, nausea and vomiting, sweating, constipation, etc.) and drug interactions. The limited central depressant effect of buprenorphine may be compounded by alcohol and antidepressants, while the metabolism of buprenorphine can be enhanced by anticonvulsants, with therefore possibly reduced efficacy. There have been some case reports of liver toxicity from buprenorphine that is reversible if the medication is stopped (Herve et al. 2004), and often clinical guidelines will recommend that liver function tests are included in buprenorphine treatment, as they definitely should be with naltrexone. 

Liver disease is a continuum, ranging from abnormalities of liver function tests found on routine biochemical screening, with no adverse clinical consequences, to severe end-stage liver failure. 

A 65-year-old woman developed fatigue, jaundice, and altered liver function tests while taking atorvastatin (20 mg/day for some weeks) (14). On the basis of clinical, serological, and histological findings, a diagnosis of autoimmune hepatitis was made. 

Based on the low frequency of raised alanine transaminase activity and the lack of clinical evidence of hepato-toxicity, some clinicians have called for a change in the current practice of monitoring liver function tests. However, a 71-year-old woman taking atorvastatin had raised transaminase activity on two occasions and developed pruritus on rechallenge. Thus, clinicians should be aware of asymptomatic rises in liver function tests in patients taking atorvastatin who do not have known susceptibility factors for liver damage (15). 

Compliance with disulfiram therapy is often low, and both compliance and clinical outcome can be improved by supervised administration. When the drug is prescribed, the alcohol content of common nonprescription medications should be communicated to the patient some of these are listed in Table 64-3. Management with disulfiram should be initiated only when the patient has been free of alcohol for at least 24 hours. The drug may cause mild changes in liver function tests. The safety of disulfiram in pregnancy has not been demonstrated. The duration of disulfiram treatment should be individualized and determined by the patient s responsiveness and clinical improvement. The usual oral dose is 250 mg daily taken at bedtime. 

Clinical findings may include hypertrophied muscles, acne, oily skin, hirsutism in females, gynecomastia in males, and needle punctures. Edema and jaundice may develop in heavy users. Common laboratory abnormalities include elevated hemoglobin and hematocrit measurements, elevated low-density lipoprotein cholesterol and depressed high-density lipoprotein cholesterol levels. Liver function test results may be elevated, and luteinizing hormone levels are usually depressed. 

Objective measures of disease. The clinical team will monitor the patient s response to treatment by CT scan or other objective measure of tumour size in any original sites of disease (i.e. primary tumour in the breast or sites of metastases). This is typically done every 6-8 weeks during treatment. Monitoring of liver function tests is appropriate as an improvement in Mrs CR s transaminase and GGT levels may indicate disease response conversely a worsening of these parameters may indicate unresponsiveness to treatment. 

Diagnosis of alcoholic cirrhosis of the liver was made based on Mrs MW s clinical features, liver function tests, abdominal ultrasound, CT scan and liver biopsy. 

There is no indication for routine liver function tests in patients taking tricyclic antidepressants raised transaminases and alkaline phosphatase within the limits of the reference ranges are not a cause for serious concern, unless they are accompanied by clinical signs or symptoms indicative of liver dysfunction. 

A 44-year-old woman developed weakness with abnormal liver function tests (aspartate transaminase 661 IU/1) about 6 months after starting to take venlafaxine 150 mg/day. Biopsy showed confluent necrosis in zone 3, with unaffected portal tracts. No other cause for the hepatitis could be found. The clinical and biochemical features resolved within 12 weeks of withdrawal of venlafaxine. 

The safety and tolerability of once-daily oral metrifonate has been evaluated in patients with probable mild to moderate Alzheimer s disease in a randomized, doubleblind, placebo-controlled, parallel-group study (9). Metrifonate was given to 29 patients as a loading dose (2.5 mg/kg) for 2 weeks, followed by maintenance dose (1 mg/kg) for 4 weeks 10 patients received placebo. The proportion of patients who had at least one adverse event was comparable in the two groups metrifonate 76%, placebo 80%. Selected adverse events, defined as those for which the incidence in the metrifonate and placebo group differed by at least 10%, were diarrhea, nausea, leg cramps, and accidental injury. The adverse events were predominantly mild and transient. Those who took metrifonate had a significantly lower heart rate. Metrifonate had no clinically important effect on laboratory tests, such as liver function tests, and did not affect exercise tolerance or pulmonary function. 

---