Can Canasa cause elevated liver enzymes?

My husband has his yearly physical, and everything was normal, except for a liver enzyme being elevated (AST). Normal range is between 10-40 U/L and his is at 64. For the past year and a half, he's been taking Canasa nightly (before that he used to take Canasa twice a week).

I see this online, when I searched for Canasa side effects:
In addition to the events observed in the clinical trials, the following adverse events have been associated with mesalamine containing products: nephrotoxicity, pancreatitis, fibrosing alveolitis and elevated liver enzymes.

His regular doctor has asked him to come back in 2-4 weeks to have labs done again - this time including hepatitis (A, B, C), Ferritin and the same liver tests performed in the physical. We're also called his GI's office to request a consult with his GI.

Obviously, one of the things I'm most worried about is PSC, and I'm hoping the elevated AST is not because he's in the first stages of PSC The questions I have are:
1.) Has anyone had something similar happen with mesalamine drugs?
2.) If you have had this happen, did you have to stop or reduce the dosage?
3.) What other tests should we take to rule out PSC (hopefully)?

Thanks for your help and advice.
PV

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Husband with Ulcerative Proctitis
Diagnosed March 2003, 1st Flareup after diagnosis Apr 2006
Currently in Remission
Nightly 1000mg time release Canasa
Even though he has no symptoms, he's on VSL # 3 (1 packet daily) for prevention
Was on the SCD, but we stopped after 4 months of no symptoms - he's doing fine on a normal diet

Hi..well, initially you can rule out pregnancy...LOL!!

The very fact that he has UC could be a cause for increased liver enzymes.

The 5ASA can also raise it, but he's on a very low dosage, so I'd say not.

If you or the doctors are thinking PSC...do NOT have the ERCP done...have an MRCP and if it's seen, then he should be put on URSO.

My lfts were increased for over 10 years. I refused the ERCP and once the MRCP was used for diagnosing, it confirmed visually PSC. One thing interesting is that the autoimmune blood testing comes back high positive for PBC (primary biliary cirrhosis). So, don't know if I can have both..but since being on the URSO, my lfts are now normal.

I've never stopped the 5ASA meds...I strongly believe (with no proof, however) that keeping the colon quiet will also keep the PSC quiet and from proressing quickly.

The ERCP has been known to trigger PSC active if it's in very early stages, as well, it can cause pancreatitis...that's why I suggest NOT having it done since there's another diagnostic available that's noninvasive.

Quincy:

I have a few more questions. You mentioned that just having UC can cause elevated liver enzymes. My husband's other liver enzymes are normal, except for AST (Aspartate transaminase). From what I've read, usually in PSC, Alkaline phosphatase (ALP) is the primary indicator in blood tests, and along with that AST and/or ALT may also be elevated. So, I'm hoping that this isn't PSC, and that he's having a transient elevation in AST.

* How common is elevated liver enzymes in people with UC? He's had UC since 2003, and he's had yearly physicals every year, and this is the first time he's had an abnormal reading.

* How often does it fluctuate - ie. if his AST is high today, when should he retest to see if it is transient? He now has a lab scheduled for the retest in 2 weeks, is that enough time?

* Should we try to taper Canasa to once every other day?

* Should we request an MRCP as well? I don't think the MRCP will catch anything because he has no symptoms, and only one liver enzyme is very slightly elevated (normal is 10-40, and his was 64). That would indicate he has no damage that can be easily visualized right?

Thanks for any assistance you can give. I'm obviously very anxious, and I think getting more information and making sure we do the right diagnositics things will make us both feel better. Thanks for your help.

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Husband with Ulcerative Proctitis
Diagnosed March 2003, 1st Flareup after diagnosis Apr 2006
Currently in Remission
Nightly 1000mg time release Canasa
Even though he has no symptoms, he's on VSL # 3 (1 packet daily) for prevention
Was on the SCD, but we stopped after 4 months of no symptoms - he's doing fine on a normal diet

I just read something that may answer why my husband's AST enzyme level is elevated. Apparently, strenuous exercise can result in increase AST levels - because AST is not just found in the liver, but also in heart muslce and skeletal muscle. Other liver enzymes like ALT and ALP are found predominantly in the liver, however AST is found in more than just the liver. Strenuous exercise can apparently result in elevated AST levels on liver function tests for upto a week after the exercise session. See: http://www.netwellness.org/question.cfm/53060.htm

My husband had his physical last Friday, and last tuesday is when we decided we better get back to exercising (after having found one excuse after another to not exercise for the past 6 months). So, last tues and wed, we worked out hard, and got really sore. And he had his physical on Friday. So, seeing that only his AST levels are increased, and that too only marginally above normal, we think that this exercising may be what caused it. So in other words, I think we have a false positive (or at least I'm really hoping it is!).

So, we're going to lay off the exercise, and get his liver function test done again in 2 weeks, and see if the levels return to normal. So, one thing to remember folks, is no strenuous exericse for a week before a physical or a liver function test.

I'll let you guys know how it turns out. But I'm feeling a whole lot better after finding this information.

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Husband with Ulcerative Proctitis
Diagnosed March 2003, 1st Flareup after diagnosis Apr 2006
Currently in Remission
Nightly 1000mg time release Canasa
Even though he has no symptoms, he's on VSL # 3 (1 packet daily) for prevention
Was on the SCD, but we stopped after 4 months of no symptoms - he's doing fine on a normal diet

DON'T Freak out. You are right that ALP is more closely associated with PSC. Mine is higher than normal and has been since being Dx with UC. PSC is suspected but no Dx after ERCP, liver biopsy etc. I would follow Dr.'s suggestions and do some periodic testing to create a baseline.

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My husband had his liver enzymes tested again last week, and his results came in normal. So, it appears his AST was elevated because he started a new exercise regimen at the same time that the test was taken. This is a major relief for me. I just thought I'd update the board, if anyone runs into a similar situation.

Thanks for your support
PV

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Husband with Ulcerative Proctitis
Diagnosed March 2003, 1st Flareup after diagnosis Apr 2006
Currently in Remission
Nightly 1000mg time release Canasa
Even though he has no symptoms, he's on VSL # 3 (1 packet daily) for prevention
Was on the SCD, but we stopped after 4 months of no symptoms - he's doing fine on a normal diet

Whew! Glad to hear!

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Pan-colitis and GERD diagnosed May 2003

 

Asacol 12 per day,  Azathioprine 75mg, Rowasa and Canasa as needed

Aciphex, Effexor XR, BCP, Rhinocort nasal spray

Forvia and a Probiotic

 

Osteopenia (hip and spine) from prednisone use.  Started Azathioprine because I was steroid dependent.

 

Co-Mod for the UC forum

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Good news!!  I'm assuming the doc will check them regularly.