Serum transaminase levels

A serious and potentially fatal adverse reaction to tolcapone ishepatic injury. Regular blood testing to monitor liver function is usually prescribed. The phys dan may order testing of serum transaminase levels at frequent intervals(eg, every 2 weeks for the first year and every 8 weeks thereafter). Treatment is discontinued if the ALT (SOFT) exceeds the upper normal limit or sgns or symptoms of liver failure develop. 

When administering the HMG-CoA reductase inhibitors and the fibric acid derivatives, the nurse monitors the patient s fiver function by obtaining serum transaminase levels before the drug regimen is started, at 6 and 12 weeks, then periodically thereafter because of the possibility of liver dysfunction with the drugs. If aspartate aminotransferase (AST) levels increase to three times normal, the primary care provider in notified immediately because the HMG-CoA reductase inhibitor therapy may be discontinued. 

Hepatic Effects. Jaundice and abnormal liver function tests including increases in serum transaminase levels have been reported in individuals occupationally exposed to trichloroethylene by both dermal and inhalation exposure (Bauer and Rabens 1974 Phoon et al. 1984). 

Hepatic function impairment- Use with caution in patients with hepatic impairment. Do not initiate rosiglitazone therapy if the patient exhibits clinical evidence of active liver disease or increased serum transaminase levels (ALT more than 2.5 times the ULN) at start of therapy. Liver enzyme monitoring is recommended in all patients prior to initiation of therapy with rosiglitazone and periodically thereafter. 

Serum transaminase levels -0.2% of patients treated with rosiglitazone had reversible elevations in ALT greater than 3 times the ULN compared with 0.2% on placebo and 0.5% on active comparators. Hyperbilirubinemia was found in 0.3% of patients treated with rosiglitazone compared with 0.9% treated with placebo and 1% in patients treated with active comparators. 

Hepatotoxicity Fever has occasionally occurred within the first 3 weeks of therapy, sometimes associated with eosinophilia or abnormalities in 1 liver function test or more. Jaundice with or without fever may occur, usually within the first 2 to 3 months of therapy. Incidence of elevated serum transaminase levels and impaired hepatic function ranges from 1% to 27%. 

Monitoring For lovastatin, perform LFTs before initiating therapy, at 6 and 12 weeks after initiation of therapy or after dose elevation, and periodically thereafter (approximately 6-month intervals). For rosuvastatin, fluvastatin, and atorvastatin, it is recommended that LFTs be performed prior to and at 12 weeks following both the initiation of therapy and any elevation in dose, and periodically (eg, semiannually) thereafter. For pravastatin and simvastatin, perform LFTs prior to the initiation of therapy, prior to elevation of dose, and when otherwise clinically indicated. For patients titrated to the 80 mg dose of simvastatin, perform LFTs prior to titration, 3 months after titration to the 80 mg dose, and periodically thereafter (eg, semiannually) for the first year of treatment. Pay special attention to patients who develop elevated serum transaminase levels. If transaminase levels progress. 

Perform liver function tests on all patients during therapy with nicotinic acid. Monitor serum transaminase levels, including ALT and AST, before treatment begins, every 6 to 12 weeks for the first year, and periodically thereafter (at approximately 6-month intervals). Discontinue the drug if the transaminase levels show evidence of progression, particularly if they rise to 3 times the upper limit of normal and are persistent or if they are associated with symptoms of nausea, fever, or malaise. Consider liver biopsy if elevations persist beyond discontinuation. 

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. 

Hepatotoxicity- Duloxetine increases the risk of elevation of serum transaminase levels. The combination of transaminase elevations and elevated bilirubin, without evidence of obstruction, is generally recognized as an important predictor of severe liver injury. Because it is possible that duloxetine and alcohol may interact to cause liver injury, duloxetine should ordinarily not be prescribed to patients with substantial alcohol use. 

Dose adjustment Monitor serum transaminase levels (specifically ALT) every other week from at least week 4 to week 16 following initiation of treatment, after which monitoring may be decreased to every 3 months. For patients who develop ALT elevations more than 2 times the upper limit of normal (ULN), the dose and monitoring regimen should be modified as described in the table below. 

Monitoring Monitor serum transaminase levels (specifically ALT) every other week from at least week 4 to week 16 following initiation of treatment, after which... 

Stevens W, Nabors CJ, Jr, Berliner DL. 1967. A comparison of serum transaminase levels and other serum constituents in dogs burdened with 239-Pu, 228-Th, 228-RA and 226-Ra. NY Acad Sci 145 817- 829. 

Patients should be warned that rifampicin colors urine, tears and other body fluids reddish-orange. Adverse effects further include rashes and pruritus and gastrointestinal complaints like nausea, anorexia and diarrhoea. With intermittent therapy a probably allergic hypersensitivity reaction can occur which mostly manifests itself as a flu-like syndrome with fever but can also result in nephritis and acute tubular necrosis. Elevation of serum transaminase levels occur frequently but clinical hepatitis is rare. Fatal outcome has been reported however. 

Contraindications Concurrent use of a hydroxymethylglutaryl-CoA (HMG-CoA) reductase inhibitor (atorvastatin, fluvastatin, lovastatin, pravastatin, or simvastatin) in patients with active hepatic disease or unexplained persistent elevations in serum transaminase levels, moderate or severe hepatic insufficiency... 

Contraindications Active hepatic disease, unexplained increased serum transaminase levels... 

Contraindications Active hepatic disease diabetic ketoacidosis increased serum transaminase levels, including ALT greater than 2.5 times normal serum level type 1 diabetes mellitus... 

Hepatotoxicity. Duloxetine is rarely associated with increases in serum transaminase levels, typically in the first 2 months of treatment. In controlled trials in major depressive disorder, elevations of alanine aminotransferase (ALT) to greater than three times the upper limit of normal occurred in 0.9% (8 of 930) of the duloxetine-treated patients and in 0.3% (2 of 652) of the placebo-treated patients. Current product labeling contains a caution regarding the use of duloxetine in patients with significant alcohol use or chronic liver disease. Postmarketing reports have indicated that increases in transaminases have occurred in some patients with chronic liver disease (Cymbalta 2005). 

Hepatic effects. Increased transaminase levels occur in approximately 2% of the patients taking olanzapine. In many cases, these levels normalize without medication discontinuation, and all cases to date have been clinically benign. Routine laboratory monitoring is not recommended, but olanzapine should be used with caution in patients with hepatic disease or with additional risk factors for hepatic toxicity. In this group of patients, serum transaminase levels must be monitored. 

Tacrine Cognex Administer 10 mg po qid for 4 weeks, dien 20 mg qid for 4 weeks, then 30 mg qid for 4 weeks, and dien 40 mg qid. Titration is based on tolerability and serum transaminase levels. Refer to current product labeling for guidelines on dose adjustments, monitoring, and rechallenging. 10-, 20-, 30-, 40-mg capsules... 

In female Sprague-Dawley rats, daily intraperitoneal injections of 10, 30, 50 or 70 mg/kg bw 1,1-dimethylhydrazine resulted in the death of 0,5, 6 and 9 out of 10 animals per group (Cornish Hartung, 1969). Surviving animals showed diuresis, increased serum transaminase levels and histopathological signs of mild kidney damage. 

In contrast, type II hepatotoxicity is associated with massive centrilobular liver cell necrosis that can lead to fulminant liver failure. Type II hepatotoxicity is characterized by fever, jaundice, and very high serum transaminase levels. It may be immune-medi-ated and is thought to occur in genetically predisposed individuals. The incidence of type II hepatotoxicity 1 35 000 with one exposure to halothane and... 

Serum transaminase levels should be monitored q2 weeks for the first year q4 weeks for the next 6 months and q8 weeks thereafter. 

Patwardhan R, Smith O, Farmelant M. Serum transaminase levels and cholescmtigraphic abnormalities in acute bihary tract obstruction. Arch Intern Med 1987 147 1249-53. 

Souza M, Castro-e-Silva JO, Picinato M, Franco C, Mazzetto S, Ceneviva R, et al. Serum transaminase levels in the acute phase of chronic extrahepatic cholestasis. Braz J Med Biol Res 1990 23 995-7. 

Side Effects, Adverse Effects. Gastrointestinal disturbances in the form of flatulence, abdominal discomfort, and, to a lesser extent, diarrhea are common side effects of therapy with a-glucosidase inhibitors. Use of acarbose at higher doses (100 mg or greater) has been associated with a low incidence of elevated serum transaminase levels, most often in patients weighing less than 60 kg. 

Hepatic Effects. Stewart and Andrews (1966) reported a case in which a man survived drinking 1 ounce (600 mg/kg) of 1, 1, 1-trichloroethane. Serum transaminase levels remained within normal limits, but serum bilirubin levels became slightly elevated after 48 hours. Increased serum bilirubin levels may result from reduced biliary excretion (i.e., cholestatic liver damage). Alternatively, hyperbilirubinemia may result from diminished hepatic conjugative metabolism of bilirubin. 

H4. Harris, R. H., and Hitchcock, C. R., Serum transaminase levels (SGOT) in dogs with induced myocardial infarction treated with hyperbaric oxygenation. In Clinical Application of Hyperbaric Oxygen (I. Boerema, W. H. Brummelkamp, and N. G. Meijne, eds.), pp. 110-115. Elsevier, Aimsterdam, 1964. 

---