Venetoclax + Antibiotics + Hepatotoxicity

[BMFCDRW]

Hi All, my journey continues and things are going well besides the infections and so on. Finished Obinituzumab some months ago and now i have four more months of Venetoclax ahead. The problem is that due to antibiotics (almost one or two every month) and maybe Venetoclax i started suffering from hepatotoxicity. My hematologist told me that the values are not hight but despite that it makes me think. My father-in-law recently died of liver cancer and that left me a little traumatized. Sorry for the venting and thank you for all the wonderful help everytime.

[Spark_Plug]

Nothing to apologize for, you've seen what a damaged liver can do, it should be important to you.

Try asking your doctor when will they will be concerned. It may show how far away the real danger exists. 🙂

[AussieNeil Partner Administrator]

Our livers are amazing organs in the way that they can heal if we look after them well. It's good that your haematologist is monitoring your liver health. I don't think you should get too concerned if your liver function tests go significantly above the upper reference limits, provided they don't keep climbing and your haematologist remains unconcerned. Your liver could also have a degree of CLL infiltration. After the spleen, it's the second most commonly infiltrated organ. My spleen was quite enlarged prior to my clinical trial, but quickly shrank back to normal. What surprised me was that CT scans showed that my liver also shrank. My CLL specialists hadn't noticed it was enlarged from palpitating it, probably because it wasn't markedly enlarged.

Have you reviewed all possible causes besides the antibiotics and venetoclax for liver toxicity? I presume you aren't drinking alcohol, but quite a few dietary supplements can cause hepatotoxicity. Your relative youth for someone with CLL should help with your liver recovery. See pmc.ncbi.nlm.nih.gov/articl... and pubmed.ncbi.nlm.nih.gov/361...

Neil

[LeoPa]

"Studies have shown that the excessive consumption of fructose can be toxic to the liver. When large quantities of fructose reach the liver, the liver uses excess fructose to create fat, a process called lipogenesis. "

pennmedicine.org/news/news-....

In addition to the supplements mentioned by Neil, this is worth paying attention to as well.

Sodas, sweetened beverages and processed foods are the worst offenders.

[JerrysGirl3]

interesting because I was on Vidaza infusions and venetoclax and voraconizole pills and my liver counts were HIGH!!! Taken off voraconizole and then venetoclax and infusions stopped and was put on azacitidine pills (Onureg) which were a nightmare! Now I wonder if it was the voraconizole that caused the high liver counts or the venetoclax or even the azacitidine 😳😳😳😳 which I am starting again (not voraconazole) on Monday !!

[Bluesinthenight]

Depends on how high the liver function tests have moved. There is a scale we use to grade the elevations of the various parameters: AST, ALT, Alkaline Phosphatase, bilirubin, and GGT. Your hematologist will know the grade, and if its grade 1 (up to 3 x the upper limit of normal for AST or ALT) follow up measurements would be normal practice. You can ask him the grade of your liver functions, though if he said they are mild, it's likely grade 1.

Regarding your father-in-law and liver cancer, that is an entirely different condition, not related to CLL or liver abnormalities related to your treatment or other substances. Primary liver cancer is most commonly associated with chronic hepatitis B or hepatitis C infections.

[JerrysGirl3]

can you please tell me how antibiotics are involved with affecting liver issues? I've been taking one 500 mg levofloxacin every day at noon since April or May and maybe even before 😳😳. Bad enough to find out the anti fungal voriconazole which I had been taking every day for the same amount of time was destroying the liver!!!

[AussieNeil Partner Administrator in reply to JerrysGirl3]

How well our liver handles the challenge of dealing with medications varies with the individual. Our doctors should be checking our liver health by an appropriate frequency of liver function testing, so that dose reduction or switching to an alternative treatment is done to maintain adequate liver health as appropriate. Some drugs are known for coming with a higher risk of hepatotoxicity, so more frequent liver function testing is warranted when we are prescribed those drugs.

[JerrysGirl3 in reply to AussieNeil]

Thanks Neil!! 🦄