Re: Elevated Liver Emzymes/bloodwork

[Guest guest]

Let me first say that I don't get my RX for LDN until late this week so I can't comment on LDN. HOWEVER, I do have Crohn's and had a history of elevated bilirubin and alk phos. I started taking a digestive enzyme every time I ate (Source Naturals Daily essential enzymes) and my levels have been normal ever since. This is just my personal history - good luck, Barb.

[low dose naltrexone] Elevated Liver Emzymes/bloodwork

Hi - I posted this a while back with a diff subjuect line and did not get any response so trying again - I would like to get info ASAP as I have the appointment for the inflam bowel clinic. - thanks to all that reply!! I updated info in postI have been taking LDN for approx 6 months now. I originally started in Sept 07 and was taking 3mg nite I increased the dose to 4.5 and within a week had a episode that revealed I had a gallbladder/stone blockage. I stopped the LDN for approx 1 month while I had surgery.I started LDN again Dec 07 and started off at 3mg nitely then increased to 4.5mg but found that I was having sleep issues (no dreams) just early waking and unable to get full nites rest that went on for well over 2 mths, i reduced the dose back down to 3 mg nitely and have been fine with sleeping now.I have Chrons and have not been on any other med for some time.I am 46 male and have no history of diabetes/ etc. I had an eye exam in Sept 07 and was thought to have a dry eye, my vision continued to get worse tho and I have recently been dx with cataracts in both eyes - 1 is being scheduled for surgery and the other will be left for now. I have never used steriods in treatment of chrons nor can I recall suffereing any eye injury. We beleive the cataracts are "just one of those things" and a total coincidence to the LDN. We do find it intersting tho that the timeline coicides with the start of LDN.I asked the group for any input and Dr. Skip concluded it was unlikely the compounding process was contaminated. I have noticed some small success with # times I go each day -somedays are better than others. I am still working on diet and Iknow this is a big factor.My question is for anyone who has had regular bloodwork done - espprior to starting LDN.I have been having problems with elevated liver emzymes or Alk Phoslevels and would like to know what other ppl on the LDN have beenexperincing for these levels.I have read that this was a problem with the full 50 mg dose forlong periods but of no real concearn on Low Dose Naltrexone.Unfortunately my pre LDN levels for the Alk Phos were high 140 andI had very very high levels at 261 back in Nov 07 but it was discovered that I had a gallbladder blockage/stones and had the gallblader and offenders removed in late Nov. The levels immediately dropped to the "high normal" range but have now continued to climb up again by about 2 points per testing cycle and are currently at 138.I am being referred to an Inflammatory Bowel Clinic.Has anyone else expereinced elevated liver emzyme levels on LDN?

[Guest guest]

Hi

As far as I know, cataracts is often a complication either for medications or

from iritis. Iritis, later on cataracts is a complication of the body breaking down

from diseases like Crohns and other IBD's.

I'll give you one of the links about this that I just found;

http://www.diagnose-me.com/cond/C554625.html#G548

Here is a copy and paste from that text:

Cataract (Cataracts)A steadily worsening disease of the eye in which the lens becomes cloudy as a result of the precipitation of proteins. Most cataracts are caused by the functions of the body breaking down. Eye trauma, such as from a puncture wound, may also result in cataracts. As far as I know, LDN does not cause eye diseases at all, we haven't had one rapport in here about it,

neither is it mentioned in the medical litterature. It could be a coincidence that your cataract started when

you started to use LDN, but as the litterature says it often starts with iritis, which also is typical for Crohns

disease. I have Crohns, and I have had red, painful eyes and floaters (black points floating on my eye), I have

been sensitive to the sun, and all this dissapeared when I started with LDN.

I remember when I had a surgery for my gall blather (this is quite common when having Crohns, either gall problems or surgery).

I had elevated liver enzymes before the surgery due to getting some trouble with my liver, I got hepatitis and I had to control the liver enzymes quite a long time after the surgery.

I hope you will do better on LDN, changes often comes slowly. Keep an eye on your elevated liver enzymes, and try to find out more about LDN and your liver enzymes. You're right that there has been some patients getting trouble while on HDN (high dose naltrexone), trials has shown that when using 300 mg a day, people with obesity have got increased liver enzymes.

I will add a word doc for you about some tests that Dr. JM Candless always use to find out if there is any clostridium (bacteries) or yeast in your microflora/intestines reducing the effects of LDN. Then you need some meds to get rid of those first / or while taking LDN.

Good luck from another Crohnie,

with all the best,

keep us informed how you are doing, please? :-) Ingrid

[low dose naltrexone] Elevated Liver Emzymes/bloodworkHi - I posted this a while back with a diff subjuect line and did not get any response so trying again - I would like to get info ASAP as I have the appointment for the inflam bowel clinic. - thanks to all that reply!! I updated info in postI have been taking LDN for approx 6 months now. I originally started in Sept 07 and was taking 3mg nite I increased the dose to 4.5 and within a week had a episode that revealed I had a gallbladder/stone blockage. I stopped the LDN for approx 1 month while I had surgery.I started LDN again Dec 07 and started off at 3mg nitely then increased to 4.5mg but found that

I was having sleep issues (no dreams) just early waking and unable to get full nites rest that went on for well over 2 mths, i reduced the dose back down to 3 mg nitely and have been fine with sleeping now.I have Chrons and have not been on any other med for some time.I am 46 male and have no history of diabetes/ etc. I had an eye exam in Sept 07 and was thought to have a dry eye, my vision continued to get worse tho and I have recently been dx with cataracts in both eyes - 1 is being scheduled for surgery and the other will be left for now. I have never used steriods in treatment of chrons nor can I recall suffereing any eye injury. We beleive the cataracts are "just one of those things" and a total coincidence to the LDN. We do find it intersting tho that the timeline coicides with the start of LDN.I asked the group for any input and Dr. Skip concluded it was unlikely the compounding

process was contaminated. I have noticed some small success with # times I go each day -somedays are better than others. I am still working on diet and Iknow this is a big factor.My question is for anyone who has had regular bloodwork done - espprior to starting LDN.I have been having problems with elevated liver emzymes or Alk Phoslevels and would like to know what other ppl on the LDN have beenexperincing for these levels.I have read that this was a problem with the full 50 mg dose forlong periods but of no real concearn on Low Dose Naltrexone.Unfortunately my pre LDN levels for the Alk Phos were high 140 andI had very very high levels at 261 back in Nov 07 but it was discovered that I had a gallbladder blockage/stones and had the gallblader and offenders removed in late Nov. The levels immediately dropped to the "high normal" range but have now continued to climb up again by

about 2 points per testing cycle and are currently at 138.I am being referred to an Inflammatory Bowel Clinic.Has anyone else expereinced elevated liver emzyme levels on LDN? ------------------------------------

[Guest guest]

Thank you for your response to my question - in your email you said

you would include a word doc about Dr mcCandless and gut bacteria -

I can not find this document can you please send it to my private

email - thank you for all you help in the forum

>

> Hi

> As far as I know, cataracts is often a complication either for

medications or

> from iritis. Iritis, later on cataracts is a complication of the

body breaking down

> from diseases like Crohns and other IBD's.

> I'll give you one of the links about this that I just found;

> http://www.diagnose-me.com/cond/C554625.html#G548

> Here is a copy and paste from that text:

> Cataract (Cataracts)

> A steadily worsening disease of the eye in which the lens becomes

cloudy as a result of the precipitation of proteins. Most cataracts

are caused by the functions of the body breaking down. Eye trauma,

such as from a puncture wound, may also result in cataracts. 

> As far as I know, LDN does not cause eye diseases at all, we

haven't had one rapport in here about it,

> neither is it mentioned in the medical litterature. It could be a

coincidence that your cataract started when

> you started to use LDN, but as the litterature says it often

starts with iritis, which also is typical for Crohns

> disease. I have Crohns, and I have had red, painful eyes and

floaters (black points floating on my eye), I have

> been sensitive to the sun, and all this dissapeared when I started

with LDN.

> I remember when I had a surgery for my gall blather (this is quite

common when having Crohns, either gall problems or surgery).

> I had elevated liver enzymes before the surgery due to getting

some trouble with my liver, I got hepatitis and I had to control the

liver enzymes quite a long time after the surgery.

> I hope you will do better on LDN, changes often comes slowly. Keep

an eye on your elevated liver enzymes, and try to find out more

about LDN and your liver enzymes. You're right that there has been

some patients getting trouble while on HDN (high dose naltrexone),

trials has shown that when using 300 mg a day, people with obesity

have got increased liver enzymes.

> I will add a word doc for you about some tests that Dr. JM

Candless always use to find out if there is any clostridium

(bacteries) or yeast in your microflora/intestines reducing the

effects of LDN. Then you need some meds to get rid of those first /

or while taking LDN.

>

> Good luck from another Crohnie, 

> with all the best,

> keep us informed how you are doing, please? :-)

>  Ingrid

>

>

>

> [low dose naltrexone] Elevated Liver Emzymes/bloodwork

>

> Hi - I posted this a while back with a diff subjuect line and did

> not get any response so trying again - I would like to get info

ASAP

> as I have the appointment for the inflam bowel clinic. - thanks to

> all that reply!! I updated info in post

>

>

> I have been taking LDN for approx 6 months now.

> I originally started in Sept 07 and was taking 3mg nite I

increased

> the dose to 4.5 and within a week had a episode that revealed I

had

> a gallbladder/stone blockage. I stopped the LDN for approx 1 month

> while I had surgery.

> I started LDN again Dec 07 and started off at 3mg nitely then

> increased to 4.5mg but found that I was having sleep issues (no

> dreams) just early waking and unable to get full nites rest that

> went on for well over 2 mths, i reduced the dose back down to 3 mg

> nitely and have been fine with sleeping now.

> I have Chrons and have not been on any other med for some time.

> I am 46 male and have no history of diabetes/ etc.

> I had an eye exam in Sept 07 and was thought to have a dry eye, my

> vision continued to get worse tho and I have recently been dx with

> cataracts in both eyes - 1 is being scheduled for surgery and the

> other will be left for now.

> I have never used steriods in treatment of chrons nor can I recall

> suffereing any eye injury. We beleive the cataracts are " just one

of

> those things " and a total coincidence to the LDN. We do find it

> intersting tho that the timeline coicides with the start of LDN.

>

> I asked the group for any input and Dr. Skip concluded it was

> unlikely the compounding process was contaminated.

>

> I have noticed some small success with # times I go each day -

> somedays are better than others. I am still working on diet and I

> know this is a big factor.

> My question is for anyone who has had regular bloodwork done - esp

> prior to starting LDN.

> I have been having problems with elevated liver emzymes or Alk Phos

> levels and would like to know what other ppl on the LDN have been

> experincing for these levels.

> I have read that this was a problem with the full 50 mg dose for

> long periods but of no real concearn on Low Dose Naltrexone.

>

> Unfortunately my pre LDN levels for the Alk Phos were high 140 and

> I had very very high levels at 261 back in Nov 07 but it was

> discovered that I had a gallbladder blockage/stones and had the

> gallblader and offenders removed in late Nov.

> The levels immediately dropped to the " high normal " range but have

> now continued to climb up again by about 2 points per testing

cycle

> and are currently at 138.

> I am being referred to an Inflammatory Bowel Clinic.

>

> Has anyone else expereinced elevated liver emzyme levels on LDN?

>

>

> ------------------------------------

>

>

[Guest guest]

> My question is for anyone who has had regular bloodwork done - esp prior to starting LDN. I have been having problems with elevated liver emzymes or Alk Phos levels and would like to know what other ppl on the LDN have been experincing for these levels. I have read that this was a problem with the full 50 mg dose for long periods but of no real concearn on Low Dose Naltrexone. Unfortunately my pre LDN levels for the Alk Phos were high 140 and I had very very high levels at 261 back in Nov 07 but it was discovered that I had a gallbladder blockage/stones and had the gallblader and offenders removed in late Nov. The levels immediately dropped to the "high normal" range but have now continued to climb up again by about 2 points per testing cycle and are currently at 138. I am being referred to an Inflammatory Bowel Clinic. Has anyone else expereinced elevated liver emzyme levels on LDN?>

Hello,

The following recent Messages on this topic may assist you: Naltrexone and the Liver Warning Explained (Part 1) - Clinical Trial & Naltrexone and the Benefits to the Liver (Part 2) - Clinical Trials .

Also, the below is an excerpt about the liver warning for Naltrexone. In my experience, I have always seen the studies indicate that the 300 mg a day warning was related to ALT and AST only (which are a very specific type of liver function or liver enzyme tests) in a sub-set of obese patients. I have never seen an indication of a raised ALP (Alkaline Phosphatase) due to Naltrexone on any of the clinical warning information. Therefore, I would not assume the raised liver ALP lab tests are due to Naltrexone, but instead may possibly be due to your billary issues you previously mentioned. Hopefully, your doctor will be able ot provide more information.

Hope this helps! ~~ Joyce

http://ncadi.samhsa.gov/govpubs/BKD268/28h.aspx

Liver Damage

One of the most serious potential adverse effects of naltrexone is liver toxicity. High doses of naltrexone administered to obese patients (up to 300 mg/day or five times more than an effective blockading dose of 50 mg/day) have been found to produce hepatocellular injury in a substantial portion of exposed subjects ( and Brogden, 1988). Although some of the obese patients in this study had mild abnormalities of liver function at baseline, elevated levels of serum aminotransferases (**Note-See definition of ALT & AST below, which are aminotransferases**) returned to baseline or normal within a short time after termination of naltrexone treatment. It is important to note, however, that liver abnormalities are common among obese patients and those who are opiate- or alcohol-dependent ( and Brogden, 1988).

High doses of naltrexone administered for treatment of Huntington's disease (up to 300 mg/day for up to 36 months) produced transient increases in serum aminotransferases (serum glutamic-oxaloacetic transaminase [sGOT] (Note - Also known as AST) and serum glutamic-pyruvic transaminase [sGPT]) (Note - Also known as ALT) in 2 of 10 patients, but these elevations returned to baseline with continued treatment (Sax et al., 1994). These investigators concluded that chronic administration of naltrexone in doses up to 300 mg/day for periods up to 36 months does not significantly change hepatic function as measured by SGOT and SGPT levels.

In a more recent safety study of 570 heterogeneous alcohol-dependent patients (Croop et al., 1997), LFT results were similar to a comparison group of 295 patients who did not receive naltrexone (see below for further details of this study).

In the first clinical trial of naltrexone for the treatment of alcohol dependence, the medication was actually associated with lower levels of liver enzymes in the normal range compared with those of placebo-treated participants (Volpicelli et al., 1992, 1995a). Similar results were found in the second trial: Endpoint levels of aspartate aminotransferase and alanine aminotransferase were lower for the naltrexone-medicated subjects than for placebo-treated participants (O'Malley et al., 1992). Another study of heavy drinkers treated with naltrexone reported improved hepatic enzyme levels that were consistent with these earlier findings (Bohn et al., 1994). Better hepatic function in naltrexone-treated patients compared with placebo-treated patients is probably a reflection of reduced drinking among those receiving naltrexone, because alcohol is a known hepatotoxin.

http://www.cdc.gov/NCHS/data/nhanes/nhanes_01_02/l40_b_doc.pdf

4.1.3 Alkaline Phosphatase (ALP)

Increased ALP activity is associated with two groups of diseases: those affecting liver function and those involving osteoblastic activity in the bones. In hepatic disease, an increase in ALP activity is generally accepted as an indication of biliary obstruction. An increase in serum phosphatase activity is associated with primary hyperparathyroidism, secondary hyperparathyroidism owing to chronic renal disease, rickets, and osteitis deformans juvenilia due to vitamin D deficiency and malabsorption or renal tubular dystrophies. Increased levels of ALP are also associated with Von Recklinghausen's disease with bone involvement and malignant infiltrations of bone. Low levels are associated with hyperthyroidism, and with the rare condition of idiopathic hypophosphatasia associated with rickets and the excretion of excess phosphatidyl ethanolamine in the urine.

4.1.1 Alanine Aminotransferase (ALT)

Alanine aminotransferase measurements are used in the diagnosis and treatment of certain liver diseases (e.g., viral hepatitis and cirrhosis) and heart diseases. Elevated levels of the transaminases can indicate myocardial infarction, hepatic disease, muscular dystrophy, or organ damage. Serum elevations of ALT activity are rarely observed except in parenchymal liver disease, since ALT is a more liver-specific enzyme than asparate aminotransferase (AST).

4.1.4 Aspartate Aminotransferase (AST)

AST measurements are used in the diagnosis and treatment of certain types of liver and heart disease. Elevated levels of the transaminases can signal myocardial infarction, hepatic disease, muscular dystrophy, or organ damage.

[Guest guest]

Dear hope4joyce,

My husband will not mind my sharing the following with you, as he makes no secret of his alcoholism and has actually spoken to groups about the disease, including high school athletes. believes himself to have been alcohol addicted since his senior year at the University of Virginia. He is now 72 years of age and has been consistantly sober since 1995. It's been a tough life for a kind and good man. Understandably, he has portal vein hypertension and cirrhosis and naturally *had* elevated liver enzymes. Since 1995, has been taking standardized milk thistle twice a day religiously, and his enzymes slowly improved and have to this date have remained normal - except when his liver is exposed to certain medications.

LDN is not one of the medications which causes his liver to go berserk. It may be that LDN is also innocent in your case as well and that another issue may be going on that is irritating your liver. Whatever the issue is, I pray that it is resolved easily.

Warm wishes,

Jan

[Guest guest]

Vote for your city's best dining and nightlife. City's Best 2008.

[Guest guest]

IF THERE IS A LIVER ISSUE IT MIGHT BE GOOD TO CONSIDER THE CREAM.I

KNOW THAT WITH BIO IDENTICAL HORNMONES WHEN THE LIVER IS THE PROBLEM

IT GOES WITHOUT PROBLEM WITH THE CREAM.

>

> Dear hope4joyce,

> & nbsp;

> My husband will not mind my sharing the following with you,

as he makes no secret of his alcoholism and has actually spoken to

groups about the disease, including high school athletes. & nbsp;

believes himself to have been alcohol addicted since his

senior year at the University of Virginia. & nbsp; He is now 72 years

of age and has been consistantly sober since 1995. & nbsp; It's been a

tough life for a kind and good man. & nbsp; Understandably, he has

portal vein hypertension and cirrhosis and naturally *had* elevated

liver enzymes. & nbsp; Since & nbsp;1995, & nbsp; has been taking

standardized milk thistle twice a day religiously, and his enzymes

slowly improved and have to this date have & nbsp;remained normal -

except when his liver is exposed to certain medications.

> & nbsp;

> LDN is not one of the medications which causes his liver to go

berserk. & nbsp; It may be that LDN is also innocent in your case as

well and that another issue may be going on that is irritating your

liver. & nbsp; Whatever the issue is, I pray that it is resolved

easily.

> & nbsp;

> Warm wishes,

> & nbsp;

> Jan

>

[Guest guest]

Hope,

Sending these links just in case they might help - hope I've got them properly embedded this time;)

Elevated alkaline phosphatase + bartonella infection:

http://www.ncbi.nlm.nih.gov/pubmed/12905141

http://jmm.sgmjournals.org/cgi/content/full/56/1/133

Bartonella infection + inflammatory bowel disease:

http://www.ncbi.nlm.nih.gov/pubmed/11072951

http://www.annals.org/cgi/content/full/124/8/735

http://pediatrics.aappublications.org/cgi/content/full/121/5/e1413

Bartonella infection + gallbladder involvement:

http://ijs.sagepub.com/cgi/reprint/14/4/349.pdf

Sue

>Posted by: "hope4joyce" hope4joyce@... hope4joyce

>Mon Jun 9, 2008 8:14 pm (PDT)

> My question is for anyone who has had regular bloodwork done - esp>prior to starting LDN. I have been having problems with elevated liver>emzymes or Alk Phos levels and would like to know what other ppl on the>LDN have been experincing for these levels. I have read that this was a>problem with the full 50 mg dose for long periods but of no real>concearn on Low Dose Naltrexone. Unfortunately my pre LDN levels for>the Alk Phos were high 140 and I had very very high levels at 261 back>in Nov 07 but it was discovered that I had a gallbladder blockage/stones>and had the gallblader and offenders removed in late Nov. The levels>immediately dropped to the "high normal" range but have now continued>to climb up again by about 2 points per testing cycle and are currently>at 138. I am being referred to an Inflammatory Bowel Clinic. Has>anyone else expereinced elevated liver emzyme l

evels on LDN?

[Guest guest]

Try adding milk thistle as a supplement. There have been many documented cases where milk thistle has really helped an alcoholic liver. [low dose naltrexone] Re: Elevated Liver Emzymes/bloodwork

IF THERE IS A LIVER ISSUE IT MIGHT BE GOOD TO CONSIDER THE CREAM.I

KNOW THAT WITH BIO IDENTICAL HORNMONES WHEN THE LIVER IS THE PROBLEM

IT GOES WITHOUT PROBLEM WITH THE CREAM.

>

> Dear hope4joyce,

> & nbsp;

> My husband will not mind my sharing the following with you,

as he makes no secret of his alcoholism and has actually spoken to

groups about the disease, including high school athletes. & nbsp;

believes himself to have been alcohol addicted since his

senior year at the University of Virginia. & nbsp; He is now 72 years

of age and has been consistantly sober since 1995. & nbsp; It's been a

tough life for a kind and good man. & nbsp; Understandably, he has

portal vein hypertension and cirrhosis and naturally *had* elevated

liver enzymes. & nbsp; Since & nbsp;1995, & nbsp; has been taking

standardized milk thistle twice a day religiously, and his enzymes

slowly improved and have to this date have & nbsp;remained normal -

except when his liver is exposed to certain medications.

> & nbsp;

> LDN is not one of the medications which causes his liver to go

berserk. & nbsp; It may be that LDN is also innocent in your case as

well and that another issue may be going on that is irritating your

liver. & nbsp; Whatever the issue is, I pray that it is resolved

easily.

> & nbsp;

> Warm wishes,

> & nbsp;

> Jan

>

Be smarter than spam. See how smart SpamGuard is at giving junk email the boot with the All-new

[Guest guest]

Hi Everyone,

Just to clarify, in my below note, I was responding to 'leethomas44' question. He was asking whether his rising liver tests that were specific to ALP (Alk Phos) could be caused by LDN. I put 'leethomas44' original question at the beginning of my response so that others knew what part of his original Message I was responding to. (Sorry if I confused people who may have thought I was asking the question)

In my response, based on my experience researching Naltrexone's liver warning for the Hepatitis_Children_and_CAM_Alternatives Group, the possibility of the increase of liver enzymes were specific to ALT and AST (and not ALP) - but this warning existed based on a clinical study of Naltrexone at excessive dosages of 300 or more mg a day in some obese patients. So therefore, I didn't think that the rising ALP was due to LDN, but possibly something else. But thanks to TLizzy, JingleJan, and Zahavi who responded (thinking it was my original question) -- Hopefully, 'leethomas44' sees everyone's very helpful answers!

JingleJan - hope you and are doing well. If you have a chance, would you please send me an off-line message? I had a question for you.

Thanks to all!

~~ Joyce (from the Hepatitis_Children_and_CAM_Alternatives Group)

-- In low dose naltrexone , "hope4joyce" <hope4joyce@...> wrote:>> Lee's Question:> > My question is for anyone who has had regular bloodwork done - esp> prior to starting LDN. I have been having problems with elevated liver> emzymes or Alk Phos levels and would like to know what other ppl on the> LDN have been experincing for these levels. I have read that this was a> problem with the full 50 mg dose for long periods but of no real> concearn on Low Dose Naltrexone. Unfortunately my pre LDN levels for> the Alk Phos were high 140 and I had very very high levels at 261 back> in Nov 07 but it was discovered that I had a gallbladder blockage/stones> and had the gallblader and offenders removed in late Nov. The levels> immediately dropped to the "high normal" range but have now continued> to climb up again by about 2 points per testing cycle and are currently> at 138. I am being referred to an Inflammatory Bowel Clinic. Has> anyone else expereinced elevated liver emzyme levels on LDN?> >>

Hope4Joyce's Respones:

Hello,

The following recent Messages on this topic may assist you: Naltrexone and the Liver Warning Explained (Part 1) - Clinical Trial & Naltrexone and the Benefits to the Liver (Part 2) - Clinical Trials .

Also, the below is an excerpt about the liver warning for Naltrexone. In my experience, I have always seen the studies indicate that the 300 mg a day warning was related to ALT and AST only (which are a very specific type of liver function or liver enzyme tests) in a sub-set of obese patients. I have never seen an indication of a raised ALP (Alkaline Phosphatase) due to Naltrexone on any of the clinical warning information. Therefore, I would not assume the raised liver ALP lab tests are due to Naltrexone, but instead may possibly be due to your billary issues you previously mentioned. Hopefully, your doctor will be able ot provide more information.

Hope this helps! ~~ Joyce

http://ncadi.samhsa.gov/govpubs/BKD268/28h.aspx

Liver Damage

One of the most serious potential adverse effects of naltrexone is liver toxicity. High doses of naltrexone administered to obese patients (up to 300 mg/day or five times more than an effective blockading dose of 50 mg/day) have been found to produce hepatocellular injury in a substantial portion of exposed subjects ( and Brogden, 1988). Although some of the obese patients in this study had mild abnormalities of liver function at baseline, elevated levels of serum aminotransferases (**Note-See definition of ALT & AST below, which are aminotransferases**) returned to baseline or normal within a short time after termination of naltrexone treatment. It is important to note, however, that liver abnormalities are common among obese patients and those who are opiate- or alcohol-dependent ( and Brogden, 1988).

High doses of naltrexone administered for treatment of Huntington's disease (up to 300 mg/day for up to 36 months) produced transient increases in serum aminotransferases (serum glutamic-oxaloacetic transaminase [sGOT] (Note - Also known as AST) and serum glutamic-pyruvic transaminase [sGPT]) (Note - Also known as ALT) in 2 of 10 patients, but these elevations returned to baseline with continued treatment (Sax et al., 1994). These investigators concluded that chronic administration of naltrexone in doses up to 300 mg/day for periods up to 36 months does not significantly change hepatic function as measured by SGOT and SGPT levels.

In a more recent safety study of 570 heterogeneous alcohol-dependent patients (Croop et al., 1997), LFT results were similar to a comparison group of 295 patients who did not receive naltrexone (see below for further details of this study).

In the first clinical trial of naltrexone for the treatment of alcohol dependence, the medication was actually associated with lower levels of liver enzymes in the normal range compared with those of placebo-treated participants (Volpicelli et al., 1992, 1995a). Similar results were found in the second trial: Endpoint levels of aspartate aminotransferase and alanine aminotransferase were lower for the naltrexone-medicated subjects than for placebo-treated participants (O'Malley et al., 1992). Another study of heavy drinkers treated with naltrexone reported improved hepatic enzyme levels that were consistent with these earlier findings (Bohn et al., 1994). Better hepatic function in naltrexone-treated patients compared with placebo-treated patients is probably a reflection of reduced drinking among those receiving naltrexone, because alcohol is a known hepatotoxin.

http://www.cdc.gov/NCHS/data/nhanes/nhanes_01_02/l40_b_doc.pdf

4.1.3 Alkaline Phosphatase (ALP)

Increased ALP activity is associated with two groups of diseases: those affecting liver function and those involving osteoblastic activity in the bones. In hepatic disease, an increase in ALP activity is generally accepted as an indication of biliary obstruction. An increase in serum phosphatase activity is associated with primary hyperparathyroidism, secondary hyperparathyroidism owing to chronic renal disease, rickets, and osteitis deformans juvenilia due to vitamin D deficiency and malabsorption or renal tubular dystrophies. Increased levels of ALP are also associated with Von Recklinghausen's disease with bone involvement and malignant infiltrations of bone. Low levels are associated with hyperthyroidism, and with the rare condition of idiopathic hypophosphatasia associated with rickets and the excretion of excess phosphatidyl ethanolamine in the urine.

4.1.1 Alanine Aminotransferase (ALT)

Alanine aminotransferase measurements are used in the diagnosis and treatment of certain liver diseases (e.g., viral hepatitis and cirrhosis) and heart diseases. Elevated levels of the transaminases can indicate myocardial infarction, hepatic disease, muscular dystrophy, or organ damage. Serum elevations of ALT activity are rarely observed except in parenchymal liver disease, since ALT is a more liver-specific enzyme than asparate aminotransferase (AST).

4.1.4 Aspartate Aminotransferase (AST)

AST measurements are used in the diagnosis and treatment of certain types of liver and heart disease. Elevated levels of the transaminases can signal myocardial infarction, hepatic disease, muscular dystrophy, or organ damage.