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Dr. Andrew Rynne
Dr. Andrew Rynne

Family Physician

Exp 50 years

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Can Methotrexate contribute to elevated liver enzymes?

Answered by
Dr. Mohammed Taher Ali

General & Family Physician

Practicing since :1988

Answered : 4315 Questions

Posted on Wed, 23 Sep 2015 in Abdominal Pain
Question: My son with Crohn's is on methotexrate (he's been taking 20 mg/week for 9 weeks) and just had a test with his ALT level at about 100. AST was lightly elevated but not as much. He's a long distance runner, and had run about 8 miles about 2 hours before the test and had woken up with a sore throat and by that afternoon had a full blown viral cold/cough. Could any of these explain the elevation? He also was having a flare up of SIBO and diarrhea that week, esp the previous day.
Answered by Dr. Mohammed Taher Ali 10 hours later
Brief Answer:
The raised enzymes could be due to long distance running.

Detailed Answer:

Dear Sir, Hi & Welcome.
I appreciate your concern for your beloved son.

After having gone through your query, I am of the opinion that

1. The raised liver enzymes (ALT & AST) may be due to long distance running. Long distance running may cause muscles this enzyme to be released during the extra work.
However, possibility of Methotrexate causing the raised enzymes also should be kept in mind. Hence it is hereby advised to kindly repeat the the liver function tests after 2-3 weeks.

2. Small intestinal bacterial overgrowth (SIBO) is an important complication of Crohn's disease. This is attributable to decreased immunity caused by the disease itself or by Methotrexate. SIBO develops when the normal defence mechanisms that control the intestinal bacterial populations are disrupted due to deficient immunity.

Hope to have clarified the doubts regarding the raised enzymes and SIBO.

However I shall be happy to answer if you have any follow-up query.

Above answer was peer-reviewed by : Dr. Prasad

The User accepted the expert's answer

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