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Taking Fenofibrate for Jaundice with Hepatitis- E. Done with LDL and SGPT tests. Suggestion?

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Practicing since : 1962
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Dear Doctor,

I was suffering from Jaundice with Hepatitis- E virus. Now almost recovered after 6 weeks with SGPT =26 and total billrubin =1.4.

I have been with extreme care for diet with zero fat , low protein and almost on fruit juice and fruits for this period.

Befor infection my LDL = 76 and Total cholesterol was 160 about.

After clearance from HEV , my lipid profile is very bed. Total cholesterol =260 and LDL = 179 mg/dl. My uric acid level is also rising above 7.7.

I am very surprise that even with extremely low fat & low protein diet how it is possible to raise lipid level to such a great extent.

My physician has prescribed me, Fenofibrate ( 145 mg/day) for high lipids but not any statins as statis may give side effects on liver (sgpt ) which I just recovered.

I am taking vitamin-E and B-complex supplements now twice a day.

As a pharma professional , I have read and understand that during hepatitis viral infection , viral particles tend to bound with lipoproteins ( LDL) and make lipoviroparticles in host’s blood circulatory system .This Lipoviroparticles then uses (LDL – Receptors) on hepatocytes to travel various cells to spread infections. Reason why reduces LDL , while infection and on virus clearance it rebound to normal or slightly higher values of lipid profile.
Higher lipid Levels . Is is true .Please educate me on this matter.

Also confirm that My drug fenofibrate is Ok or should I start statin therapy to recover fast from high LDL. Will fenofibrate work for LDL , I know that it is much better for triglycerides but mine TG = 115 is ok. I need more control on LDL.


Posted Sat, 1 Jun 2013 in Digestion and Bowels
Answered by Dr. Charles S Narasi 3 hours later

Thank you for your query.

Since you are a budding pharmacist , I will try to give you my assistance by giving you some research data on this particular findings.

First of all I am glad that you are completely recovering from Acute hepatitis-E which we understand a little bit more than 20 years ago. As you are probably aware , unlike Hepatitis-A, this can cause chronic hepatitis just like B or C types. Since all your enzyme levels have come down to normal , I doubt you would have chronic hepatitis. I am sure you will have the levels monitored periodically.

It is interesting that you went on both low fat and low protein diet. I would have recommended a high protein, high carbohydrate diet along with vitamin supplementation with B-Complex & Vit-C & E.
I can understand , if you were in liver failure or hepatic pre-coma or encephalopathy , I would restrict protein intake to reduce the ammonia build up.

Now as to the specific question regarding your lipid levels , I will direct you to a very nice paper by L.Luo published in WWW.WWWW.WW There is a pdf you can download and print and study. If I can summarize the findings , in acute hepatitis , depending on the level of severity of Hepatitis , the lipid levels,especially Total Cholesterol, HDL-C and Apoprotein-A1 levels are low. But the levels of Triglycerides, LDL-C are higher. As the hepatitis improves the opposite happens. Under normal physiological conditions, liver plays an important role to regulate lipid and lipoprotein metabolisms. It synthesizes,secretes endogenous lipoprotein and also a key enzyme called LCAT (Lecithin cholesterol acyl tranferase ) , hepatic lipase and apoproteins.

I am not sure what your lipid levels were prior to contracting Hepatitis. I see that your doctor has already started you on Fenofibrate. He is right in not starting you on a statin drug. I probably would have waited about 3 months and repeat the blood studies before any medication.

I recommend Vit-C 1000 mg, and Vit-E 800 i.u. daily along with a good high protein diet.
The title of the article that I mentioned earlier is as below:
"Impaired plasma lipid profiles in acute hepatitis XXXXXXX

I hope this is of help to you.

I wish you the very best and a very bright future.
Above answer was peer-reviewed by
Follow-up: Taking Fenofibrate for Jaundice with Hepatitis- E. Done with LDL and SGPT tests. Suggestion? 8 hours later

First of all , Thank you very much for quick and very informative answer. I am fully satisfied with the technical justification you wrote and information i understand from research paper you suggest.

My previous lipid profile (before infection ) was Total-C = 160 , LDL = 76 and TG = 176, And after the recovery from Hep-E ( now ) it is Total -C = 260 , LDL = 179 and TG = 115.

I recovered but still the values of LDL is not returning to normal values. Is it really come back to normal values within 3 Months even without starting medicines.

Yes, I should wait for 3 months before starting drug , but I have CHD history ( my father ) and my Lpa = 60 , ( Lipoprotien – a) is also on higher side so I need strict control on LDL immediately. So I have started Fenofibrate immediately.

Do you feel that Fenofibrate is safer than statin in terms of heptic concern ( sgpt ) ? Should I continue this ?

Will it control LDL , as i understand that it is more effective for TG rather than LDL ?

My uric acid level since last six months is also boarderline ( 7.5 to 8.0 ) so since long time I am on low protien diet with mild dose of Tab. Zyloric.

I am already on Vit-E and B-complex , and now start Vit-C also as per your advise.

Thanks & Regards,

Answered by Dr. Charles S Narasi 7 hours later

Glad you found the article helpful. I understand that your family history puts you at high risk.

I saw the lipid values pre hepatitis. I see the big difference in the values. But I still believe the levels should come down in time with your liver healing completely. You can ask your doctor about Nicotinic acid, slow release ,which has more effect on improving your HDL-C and also bringing down LDL-C. Fenofibrate is safer than Statins with regards to

Make sure that your lipid profile is done fasting for 12 hours.

I wish you the very best.
Above answer was peer-reviewed by
Follow-up: Taking Fenofibrate for Jaundice with Hepatitis- E. Done with LDL and SGPT tests. Suggestion? 11 days later
Respected Dr.

Hello, Happy to write you again.

In continution of my above post , I could refer my treatment paper. I have found that I was given hydrocortisone therpy to immediate flush out raised billrubin , which might give positive effect of reducing Billrubin but on other way Hydrocortisone might reduce LDL catabolism by reducing LDL receptor acitivity (mRNA) on hepatocytes and therby increse in LDL more than it was before HEV Infection. Do you agree with this cause ??

Anyway, As per your advice I am taking Vitamin-E , B-Complex and vitamin-C 1000mg/OD since last few days. I observed tremendous improvement in my Lipid Profile – with Fenofibrate ( 145 mg/OD x 15 days)

Previous : Total Cholesterol : 259 , LDL = 179 , TG = 114 and HDL = 56 .
Present : Total Cholesterol : 168 , LDL = 100 , TG = 65 and HDL = 59 .

SGPT = 25 and Total Billrubin = 1.2

Also observed that Fenofibrate also have less hepatotoxicity and it also helps to control my high Uric acid levels. However I got raised serum creatinine from 0.8 to 1.1 may be due to side effects of Fenofibrate.

Now on other part of story,

While my HEV treatment, gall stones was accidentally identified in a sonography performed to rule out obstructive jaundice. But it was not obstructive it was HEV.

In my recent sonogram also shows very small mobile gall stones which are non obstructive.

My physician advised me to plan for surgical removal of gall bladder once after I completely recover from HEV. ( next -2 to 3 Months).

Meanwhile he prescribes me Ursodeoxycholic Acid (300 mg twice a day) till I undergo surgical removal of gall bladder.

I seek your advice on following;

I read that Ursodeoxycholic Acid completely dissolves gall stones then why surgery is required? My gall stones are very small and I can undergo long treatment.
Is Ursodeoxycholic Acid is a Steroid drug ? Will it have any other systemic side effect on long term use ?

Somewhere I read that , Ursodeoxycholic Acid interact or contradict with other cholesterol lowering drug ? Because I am also taking Fenofibrate will it give any bad effect?

Is Ursodeoxycholic Acid reducing LDL or it increase LDL?

Is there any potential side effect of drug combination (Fenofibrate + Ursodeoxycholic Acid ) in terms of hepatic or serum cholesterol. ?

Thanks & Regards,
Answered by Dr. Charles S Narasi 8 hours later
Hello, XXXXXX,
Glad to hear that you are recovering very nicely from your
recent Hepatitis-E bout and your LFTs are returning to normal.
Hydrocortisone works on inflammation via several pathways
including cytokines and also immune mechanism. The lipid
effects , I am not so sure.
As for the floating small gallstone , if single and less than 5 cm.
in size , urso will dissolve it . It may take upto six months.
But the problem is , stone can come back after the drug is
stopped. Surgery is the definitive cure.
I agree that waiting another 3-6 months before you have
surgery is appropriate in your case.
I wish you the very best.
Above answer was peer-reviewed by
Follow-up: Taking Fenofibrate for Jaundice with Hepatitis- E. Done with LDL and SGPT tests. Suggestion? 5 hours later
Dear Dr. Narasi,

Thanks for your opinion on gall stones.

As per sonogram gall stones are 1-2 mm diameter in multiples making cluster.

My physician who suggested fenofibrate is different and doctor who suggested urso is different,

So my basic question is that

Is it worth while to take Ursodeoxycholic Acid (300 mg twice a day) along with fenofibrate 145 mg/od for cholesterol. As the ultimate action of both the drug is same.

I observed mild rise ( 0.8 to 1.1) in serum creatinine while 15 days of fenofibrate therapy .

As I needs to take both this drug for long time I am confused and worried about the interaction toxicity.


Answered by Dr. Charles S Narasi 2 hours later

I do share your concern about the drugs.

If you have had no symptoms related to the very small stone , at this point I would not recommend Urso for dissolution of stone. As I mentioned before , when you stop the drug the stone can reappear.

As for slight increase in your creatinine level , I would follow the kidney functions closely , rechecking the levels once a week and if it continues to go up , you may have to talk to your doctor about getting off Fenofibrate and look for alternative therapy.

Hope this answers your concerns.

Best of luck.
Above answer was peer-reviewed by
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