AST/ALT ratios. How much should we be paying attention to this?

[No_stone_unturned]

According to lab explanation I have alcohol liver injury, except I don’t drink 🤷🏾‍♂️ . Does anyone have insight on this? My drs have never brought it up as a concern which makes me think they know something I don’t

[tango65]

Do you take statins and/or zytiga?

[No_stone_unturned in reply to tango65]

zytiga yes, statins no, sertraline yes.

[tango65 in reply to No_stone_unturned]

Zytiga nay cause elevation of the liver enzymes which is usually manage by reduccing the dose.

"For patients who develop hepatotoxicity during treatment with ZYTIGA (ALT and/or ASTgreater than 5X ULN or total bilirubin greater than 3X ULN), interrupt treatment with ZYTIGA [see Warnings and Precautions (5.3)]. Treatment may be restarted at a reduced dose of 750 mg once daily following return of liver function tests to the patient’s baseline or to AST and ALT less than or equal to 2.5X ULN and total bilirubin less than or equal to 1.5X ULN. For patients who resume treatment, monitor serum transaminases and bilirubin at a minimum of every two weeks for three months and monthly thereafter.

If hepatotoxicity recurs at the dose of 750 mg once daily, re-treatment may be restarted at a reduced dose of 500 mg once daily following return of liver function tests to the patient’s baseline or to AST and ALT less than or equal to 2.5X ULN and total bilirubin less than or equal to 1.5X ULN.

If hepatotoxicity recurs at the reduced dose of 500 mg once daily, discontinue treatment with ZYTIGA. The safety of ZYTIGA re-treatment of patients who develop AST or ALT greater than or equal to 20X ULN and/or bilirubin greater than or equal to 10X ULN is unknown. "

accessdata.fda.gov/drugsatf...

[Huzzah1]

That doesn't line up with what he posted above. That says that if ratio is >2 it's an issue.

[timotur]

Zytiga can cause liver enzymes to increase up to 3-5x ULN. Also, ADT is associated with NAFLD, which can progress to NASH and cirrhosis.

pubmed.ncbi.nlm.nih.gov/323...

I had borderline NAFLD after only 18 months ADT— manifested as small cysts composed of fatty deposits, which showed up on an unrelated CT for Calcium Score index.

[No_stone_unturned]

I should also add that last months results were less than 1 and today was s greater than 2; I’ve seen this sort of pattern since treatment started. Doesn’t make any sense to me, but then again why would it, I am not a dr.

[Tall_Allen]

it says "suggests" not that that is the reason for it.

[dadzone43]

many substances other than alcohol can damage liver cells and release these enzymes. Which "hepatotoxic" medications are you taking? The warnings will say something like "may cause liver damage.

[No_stone_unturned in reply to dadzone43]

I don’t think any outside of SOC drugs. I take supplements and fenbendazole but all non toxic to my knowledge.

[dadzone43 in reply to No_stone_unturned]

you might want to "drill down on" the SOC drugs and read the warnings for them.

[hansjd in reply to No_stone_unturned]

I would suggest that the fenbendazole could the reason for your issue with liver enzymes. It’s processed by the liver and can affect its functioning. No great harm in stopping to see what happens.

[No_stone_unturned in reply to hansjd]

Valid suggestion, however I don’t think it plays into it because I stop taking supplements Fenben and all other complimentary treatments 48 hours before blood work as well as a 18 hour fast.

[hansjd]

48 hours may not be long enough. When I started Zytiga I was taking Mebendazole as well as some other supplements. My liver enzymes which had been normal went up somewhat, which I know can happen with Zytiga. But I was concerned and knowing that Mebendazole (or fenbendazole) can be a bit hard on the liver I stopped taking it. Next blood results a month later liver enzymes were normal again. It was the only change I made. I haven’t taken it since and enzymes have remained normal for past two years.