High ALT, taking methotrexate for Psoriasis

[waqaszaidi]

My alt is increasing constantly from 60 to 90 (LFT done recently). I am on methotrexate for treatment of psoriasis. Show i continue the treatment because i am really worried for my ALT level

[Kristian]

This is easy to answer. This is something you need to discuss with your doctor. It is not unusual for drugs to affect LFTs. Hence the reason they monitor it routinely when you are on Disease Modifying Dugs such as methotrexate. If they were concerned they would look at your dosage and amend or stop if necessary. However, they will also be happy to discuss your concerns with you as they don't want you to be uncomfortable taking what they have prescribed for you.

[Hidden]

Based on the following quote from 'Dr. Melissa Palmer's Guide To Hepatitis and Liver Disease' methotrexate shouldn't be used for more than six months.

"For some drugs, such as methotrexate (a type of chemotherapy), the longer it is used, the greater the likelihood of liver damage or even cirrhosis."

"The term drug-induced steatohepatitis is typically applied to cases in which NAFLD stems from the use of a medication. Examples of drug-induced steatohepatitis include prednisone (a steroid), estrogen (the female hormone), tamoxifen (a medication used for breast cancer), and methotrexate (a type of chemotherapy). Drug-induced steatohepatitis may occur when these medications are used for more than six months."

[Hidden]

Hi.

My husband is on methotrexate for polymyalgia rhumatica. Recent blood tests also showed raised alt so his specialist took him off it until it was back to normal then went back on it. Blood tests have all been normal since however methotrexate has now given him a blood clot ( another of the side effects) and is now being treated for that. Just keep having the regular blood tests, your specialist will adjust your medication accordingly.

[kurtymac]

It very well could be the methotrexate, as always speak to your doctor before stopping any medication. Also, get a hepatologists opinion if need be, there are documented cases of fatty liver, fibrosis and cirrhosis from people taking methotrexate long-term. Also, you can read about it on the livertox website. I'd be concerned about the medication regiment, your doctor will probably have to find other ways of treating your condition. You don't want treatment for one condition to cause other medical conditions. I kept taking a medication after bad liver labs and I ended up with drug induced hepatitis. When in doubt check livertox, I posted the link for you. It seems to be pretty rough on the liver. Again, speak to your tending physician before making any decision and make sure you discuss your concerns with him or her. livertox.nlm.nih.gov/Methot...

[Radnor]

Just a personal opinion but I would never have used methotrexate, knowing what it has done to me! It is rare that it causes liver damage, but I had no symptoms of this. I had regular blood tests and it was only by chance that the true picture emerged. I had a fibroscan in 2016, it showed I had a fatty liver. A year later the next one showed my fat had reduced by 25% which was likely due to losing 1.5 stone. I have not drank for 15 years as I went off it after having EBV. This 2nd scan was showing I had severe liver

fibrosis!!! I came off the methotrexate but I wasn't even alarmed by this as I had no idea of how serious it was. Only when I tried to book travel insurance did I find out! I love my holidays in the sun, it eases my psoriasis a lot. I also discovered how painful my joints were after stopping the metho. I have asked my GP to refer me for a second opinion, to verify the actual state of my liver now. It seems incredible that in just one year my liver went from fatty to having severe fibrosis, just one step away from cirrhosis. Is there anyone else in this position?