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What Causes Elevated Liver Enzymes Inspite Of Taking Bactrim?

Posted on Tue, 29 Apr 2014

Question: hello. I about 3 weeks ago took Bactrim (which on the 9th day found out I was allergic) I have since then had elevated liver enzymes....increased bilirubin.... and clay colored stools and dark urine (these 2 things have gotten better). On 4/5/14 my BUN was 6, creatinine 0.47, Total bilirubin 3.3, Alkaline Phosphatase 138, AST 103, ALT 437, A/G ratio 1.1, and Globulin 3.4. As of today 4/8/14 BUN 8 Creatinine 0.50, Total Bilirubin 3.4 (Concerned about this) Alkaline Phosphatase 125, AST 56, ALT 273, A/G Ratio 1.1, Globulin 3.4. I had an abdominal ultrasound which ruled out anything bad on Saturday 4/5. I am concerned about my labs still should these be decreasing more rapidly ESPECIALLY concerned about the bilirubin and why it went up 0.1. When will these things start resolving and when can I maybe expect the HORRIBLE ITCHY skin to go away? I have scratched some areas raw but I would almost rather feel the pain than the itch!!!

Answered by Dr. Enrique Molina (30 minutes later)

Brief Answer: see below Detailed Answer: Bactrim can cause allergies and actually cause hepatitis. This is called "drug induced hepatitis" or "drug induced liver injury". This usually gets better once you stop the offending medication. I saw your lab values, and i would actually not be concerned, let me explain why: AST and ALT, usually go up fast, and then these are the first to come back down to normal. They both came down by about half the value in 3 days. The alkaline phosphatase and bilirrubin usually lag behind the AST/ALT. Therefore i would not expect a drop yet, but this doesn't mean your liver is not getting better, since your AST/ALT are coming down nicely. Bilirrubin can actually continue to go up even after the medication (Bactrim) was stopped, and even after the other enzymes start to come down. This is because it takes longer for the body to get rid of the bilirrubin, it is not because your liver is being damaged further. Bilirrubin accumulates in the skin as well and can cause severe itching. I suggest you take anti-histaminics (such as benadryl); your doctor can also prescribe a medication called ursodiol which can help decrease bilirrubin levels, and therefore improve your itching. I expect your bilirrubin to start to come down within the next 1-2 weeks. If it doesn't come down then further investigation is necessary. Hope that helped. Let me know if you have any further questions.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Enrique Molina (22 minutes later)

I do have the hydroxyzine 25mg capsules. Is that relatively safe to take? I am very skeptical on taking anything new at this point. Scares the hell out of me to be honest. I have completely stopped drinking caffeine the last week (I was a HEAVY pop drinker). I don't want to tick off my liver any further or have any adverse reactions to any meds that's why I am a nit scared to take this medication. This itching will drive me crazy!! About a month and a half ago I stopped taking Effexor as I have been on antidepressants since age 12. I cant take another sleepless night of up and itching all night and Im guessing since its an "internal" issue the hydrocortisone and calamine lotion will continue to not work. Benedryl did work the first few times I took it about a week ago and now It does not help with the itch and seems to keep me awake more than sleep!!

Answered by Dr. Enrique Molina (13 minutes later)

Brief Answer: yes Detailed Answer: hydroxyzine is another anti-histaminic which is usually given for itching so it might be more effective than benadryl. it should not harm your liver. I find it highly unlikely that Effexor was doing any damage to your liver if you were taking it since age 12! You can hopefully resume it soon - as soon as your doctors ok it. If itching does not improve with hydroxyzine, consider asking your physician for a prescription for ursodiol as i mentioned above. Itching should improve once the bilirrubin start to go down (it is relatively rare to have itching with a bilirrubin <3).

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Enrique Molina (17 minutes later)

I didn't quit the Effexor in relation to all of this I quit it because my body was ready Its a very good medication if needed!! Saved me from a lot of bad in my life. I was on many different antidepressants over the years. I will definitely keep the ursodiol in mind if the hydroxyzine does not work this is drving me crazy. Hopefully the bili will come down I'm kinda scared it wont!! Ugh, worry worry. How long does it usually take for bilirubin to return to "normal limits" after enzymes are coming down? I just want to say in advance thank you so very much you have been INCREDIBLY helpful and have put my mind at ease. I thank you so much. I have never had anything like this happen before and I am just beside myself scared. I am in nursing school it has effected everything I just generally feel like crap and no motivation because of all of this schooling has suffered and my life in general Im just scared. Thanks again in advance for your last reply here. It has been a pleasure speaking with you doctor. (((HUGS))) thanks you!!

Answered by Dr. Enrique Molina (7 hours later)

Brief Answer: no problem! Detailed Answer: you are very welcome. Your bilirrubin may take up to 4 weeks to completely normalize, but hopefully in your case it will be beforehand, as it is not that high either. Let me know if you have further questions in the future Take care

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Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar