Rifampin and Elevated Liver Test

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mudshark
Regular Member


Date Joined Aug 2017
Total Posts : 121
   Posted 4/11/2018 7:57 PM (GMT -6)   
I'm wondering how to interpret my lab test and if anyone has some understanding of it. I'm 5 weeks on rifampin now for bart and just had my monthly liver panel labs done. All looked within range expect the ALT. Normal range defined as 30-65 and my current level is 74. 5 weeks ago when testing before starting this abx my reading was 52. I've been taking Milk Thistle daily the whole time on it.

I've read conflicting things about whether to be concerned or not. Also conflicting info to stop taking it or continue on as long as levels remain within 3x the upper limit. I've even seem some saying having this marker elevated is related to toxin load and not the abx. I know that I herxed after starting it, but I really feel that it is working on the bartonella and hate to stop.

My results just came in today so I'm waiting to hear from my LLMD about this. I just saw him yesterday and he was so impressed with the recent gains we have made with rifampin that he felt it worth continuing another month or two to achieve more gains.

So I'm wondering if anyone has any info they can share on this, and specifically the suggestion that this could be a result of toxins.

mudshark
Regular Member


Date Joined Aug 2017
Total Posts : 121
   Posted 4/11/2018 8:01 PM (GMT -6)   
Oh yes and the other thing I have noticed the last week is body-wide itching. I've read that is a symptom of some elevated liver things, but all is normal but the ALT.

I'd gone all winter for the 1st time in years not itching with dry skin, which I attributed to the abx treatment. So it was kind of weird to start itching when spring is in the air.

Girlie
Forum Moderator


Date Joined May 2014
Total Posts : 33939
   Posted 4/11/2018 8:44 PM (GMT -6)   
Are you getting other liver function tests done as well ? What are they on the recent lab tests?

Your level isn't high...My LLND waited until after 3 monthly liver function tests that were rising..and it wasn't just the ALT. I also had two more that were higher than normal. After 3 in a row...I stopped abx for 2 1/2 months...and they normalized.

75 is not high at all.

My regular Dr. wasn't the least bit concerned about them...either.
Moderator, Lyme Forum
Symp started April/2013; Buhner's Lyme May 15-July24/14; Igenex pos. July 3/14
Doxy: July 4-Aug.24/14;Zithro July26-Aug24/14; Amox + Proben. Aug. 29/14;
added biaxin Sept. 26/14
Disc. amox,added Ceftin Nov. 20th.;
Disc. biaxin added Buhner bart herbs Dec/14;Jan/15 pulsing Tinda (w/ Ceftin);
Abx/herb break Apr-July/15; July-mino; Aug. added Rif;
Nov./15 mino - to biaxi

mudshark
Regular Member


Date Joined Aug 2017
Total Posts : 121
   Posted 4/11/2018 10:29 PM (GMT -6)   
Girlie said...
Are you getting other liver function tests done as well ? What are they on the recent lab tests?

Your level isn't high...My LLND waited until after 3 monthly liver function tests that were rising..and it wasn't just the ALT. I also had two more that were higher than normal. After 3 in a row...I stopped abx for 2 1/2 months...and they normalized.

75 is not high at all.

My regular Dr. wasn't the least bit concerned about them...either.


It was a complete liver function panel test, so there were several other things tested but only ALT was elevated. The report highlighted it and the note said mild inflammation has developed. I get the result via a portal and it may be another day before my LLMD sees them. The sample me was taken and tested just today. Same test 5 weeks ago was normal on everything.

Like I said things are really improving so I would hate to stop short on treatment.

Thanks

Girlie
Forum Moderator


Date Joined May 2014
Total Posts : 33939
   Posted 4/12/2018 12:41 AM (GMT -6)   
You shouldn't stop treatment at that minimal increase.


And...it's good that the other LFT were in normal range.

I had three that went up in unison....and it was after the third month I think when my LLND had me stop the abx.
Moderator, Lyme Forum
Symp started April/2013; Buhner's Lyme May 15-July24/14; Igenex pos. July 3/14
Doxy: July 4-Aug.24/14;Zithro July26-Aug24/14; Amox + Proben. Aug. 29/14;
added biaxin Sept. 26/14
Disc. amox,added Ceftin Nov. 20th.;
Disc. biaxin added Buhner bart herbs Dec/14;Jan/15 pulsing Tinda (w/ Ceftin);
Abx/herb break Apr-July/15; July-mino; Aug. added Rif;
Nov./15 mino - to biaxi

mudshark
Regular Member


Date Joined Aug 2017
Total Posts : 121
   Posted 4/12/2018 5:56 AM (GMT -6)   
Thanks that's good info. I'm going to call today and see if my doc received them. I'm bit concerned that the results contained a note that I should check with some doctor I've never heard of to see if they want to change my abx. Hopefully that was just a goof and they are not sending them to the wrong person.

tickbite666
Veteran Member


Date Joined Mar 2014
Total Posts : 1664
   Posted 4/12/2018 6:12 AM (GMT -6)   
Agree with all above. My first time on Rifampin/Doxy/Zith combo I too had slightly elevated AST/ALT reading about 6 weeks into the protocol. But my LLMD did have me take a break and re-test since I was scheduled to start IV Rocephin 4 weeks later. AST/ALT levels can fluctuate between tests and with technicians. Bart alone also can elevate AST/ALT readings.

My AST/ALT levels were elevated several times after that first incident and we always plowed through. Note that different labs set different upper limit ranges for these test. Quest had set 40, and if I recall Labcorp had set 50 or so (only went there once so memory is vague). If your lab has 65 upper limit you are OK.

mudshark
Regular Member


Date Joined Aug 2017
Total Posts : 121
   Posted 4/12/2018 11:12 AM (GMT -6)   
This is encouraging to hear. My LLMD is not in Fridays so I will carry on until he tells me differently.

Yes the lab my pcp uses seems to have a higher upper limit than others I saw when researching this. I had looked up something unrelated recently and saw similar variations in normal thresholds. I have a few liver panel test results available though my patient portal going back a number of years, so there is consistency with results and the lab doing the testing. Like I mentioned my results have always been normal until now, so I assumed it is the rigampin or as suggested, the Bart .
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