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Elevated Liver Enzymes, Consuming Alcohol, Gout Attacks. On Allopurinol Medication. Cause For Rise In SGPT Levels Inspite Of Reducing Alcohol ?

Posted on Sun, 10 Jun 2012

Question: Hi. 6 months ago I had a check-up and my liver enzymes levels were slightly elevated 59 SGOT and 71 SGPT. At the time I was consuming a fair amount of alcohol. I have really cut back on the alcohol recently (have abstained completely for past 2 wks) and yesterday I had another blood test done and my levels are now 44 SGOT and 88 SGPT. I can't understand why my SGPT has risen. As I understand it if alcohol is the cause of elevated enzyme levels then SGOT would typically be higher than SGPT by a ration of 2:1. So if it's not alcohol then why the rise? I also get gout and recently (last 2kws) started allopurinol 200mg daily - could this be the cause? If so, if there an alternative to allopurinol that is less harsh on the liver? I did ask my Doctor about this yesterday and he said it was unlikely to be allopurinol though I from what I've ready, I'm not so sure. He thought my SGPT was rise could be explained by my recent jump in LDL Cholestorol from 120 to 144. My triglycerides are also quite hight at 277. He prescribed me Supralip NT 145 (Fenobibrate) to get the LDL and try levels down but I understand that this medication can also be harsh on the liver, so I'm in a bit of quandary as to what to do. Forgot to mention that I have mild fatty liver and mild inflammation of the liver. BTW, my HDL cholesterol is low at 37 if that has any bearing. I don't smoke (quit a year ago) and take regular exercise (50 mins jogging 3-4 times per week). My blood pressure is normal (125/85 average reading) and I have no know allergies. Other than Allupironl I am taking no other medications but take 1 multivitamin supplement and plan to increase my daily intake of fish oil from 1 to 3 times daily. I also have been taking silymarin/milk thistle 140mg for the past 6 months as I heard it's has good healing properties for the liver. If at all possible I would prefer to stay away from synthetic prescription medicine and try natural products. Many thanks!

Answered by Dr. CS Narayan (20 minutes later)

Hello and thanks for your query.

I shall make an effort to provide you with good professional recommendations specific to your questions.

1. So if it's not alcohol then why the rise?
SGPT levels are elevated by liver injury, hepatitis and other conditions. Even drugs like anti-inflammatory drugs, antibiotics, cholesterol medications and anti-convulsants.

Yes, your fenofibrate can increase SGPT levels, also your mild fatty liver and mild inflammation of liver.

2. allopurinol 200mg daily - could this be the cause?
No. It is quite safe on the liver.

Your present levels of 88 SGPT is not a really high alarming rise. So, do not be concerned now.

Yes, you can take fish/silymarin/milk thistle for the liver.

I would advise you to continue medications especially to set your cholesterol levels right, and then SGPT can be monitored if really increasing further.

Yet again, I duly appreciate your query to me, I do hope that you have found something useful to help you and I shall be glad to answer any further apprehensions.

Sincerely,

Above answer was peer-reviewed by : Dr. Raju A.T

Follow up: Dr. CS Narayan (37 minutes later)

Thanks for your reply.

A few follow-up questions:

1. Would you accept that SGPT could be high because of Cholesterol and Trigclycerides?

2. Do you really think it's necessary for me to take Supralip NT 145 given my current cholesterol levels or would you recommend trying to change diet first?

3. Would plant-based Phytosterol be as effective as Supralip?

3. If I were to take the Supralip when would I be able to come off of the medicine?

4. How long before I can observe a change in cholesterol from diet and/or medication?

Thanks, XXXXXXX

Answered by Dr. CS Narayan (12 hours later)

Hello again Mr. XXXXXXX

Thank you for writing back.

1. No.

2. Yes, Fenofibrate is necessary to reduce your current levels.

3. Phytosterols are currently supplementary, not alternative to fenofibrate.

4. No definite period. It depends on your response, and response varies with everyone.

5. Lipid profile tests are usually recommended every 3-6 months. Usually the initial change is lesser, but when starts to dip, then it is more visible.

Let me know if you have further queries.

Wishing you good health.

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Above answer was peer-reviewed by : Dr. Yogesh D