Raised ALT Levels

[PickledGinger]

Is anyone on 20mg of injected methotrexate having trouble with their ALT levels? If so what did your doctors do about it? My levels are more than double what they should be and my lymphocyte count is very low, so they said I may have to come off it but the problem is they don't want to put me on steroids as I'm diabetic. Have any of you been offered any other medications? At the moment they just have me stop the drug the odd week here and there and then my levels return to normal but as soon as I'm back on it the levels go up again. They're worried about stopping it as my lupus has never been that controlled and they don't want to cause a flare up but neither can they afford to damage my liver. I feel like I'm stuck between a rock and a hard place.

[Purpletop]

I'm not on MTX but I have elevated liver function tests most of the time. Twice the upper limit isn't something that would worry a hepatologist - it is an indication of liver injury but those with serious liver disease have far higher readings than that.

I'm not saying that it isn't important - I'm saying that the liver is an amazing organ that compensates all the time, so it may be that your doctors are trying to get you to a stable state first, even if that means 'bruising' the liver a bit, on the basis that hopefully the liver will recover easily once the drug is stopped. Having said that, this approach will only work for a limited time and should your liver enzymes increase even more, they'll probably stop MTX.

You need to keep an eye on this too - don't fully rely on your doctors to know the time to switch. Maybe ask them to get the opinion of a hepatologist if levels continue to increase.

[PickledGinger in reply to Purpletop]

PurpleTop, thank you for taking the time to respond, I feel loads better and thank you for your advice, it's much appreciated.