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What Do Increased AST And ALT Levels Indicate?

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Posted on Tue, 13 Jan 2015
Question: I have had recent blood tests which are showing a steady increase in AST and ALT. They are now 56 and 66, respectively. They have risen steadily since the summer as I get tested every 3 mos. My Alk Phosphate is normal. my primary care dr has ordered hep panel and abdominal sonogram. I am 4 years out of lobular breast cancer stage 3c during which I had chemo, radiation, surgery-double mas. I have been taking anastrazole which has caused me to have increased my cholesteral greatly. My primary care has increased atorvastatin from 20 to 40 mg which has lowered my chol from 215 to 160. However, i know that atorvastatin can irritate the liver. I also use voltaren for arthritis, cymbalta, well butrin for depression. I am worried to death that the increase in these liver values indicate liver mets. I had a blood transfusion in 2012 during breast reconstruction. He is also ordering Hep tests. I would like to know statistically, with the given info, do you think it is liver mets or irritation from so many meds and or blood trans. Thank you
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Answered by Dr. Panagiotis Zografakis (46 minutes later)
Brief Answer:
Drugs probably

Detailed Answer:
Hello,

with breast cancer you can never be absolutely certain but in your case the drugs are likely the cause. Cymbalta is well known for causing hepatoxocity. The same applies for atorvastatin, voltaren and wellbutrin. Your AST and ALT are not very high, so you could continue using them but the investigation is needed.
The test you mentioned are appropriate for your case, that is investigation for various infectious hepatitis causes, ultrasound scan (very important) and repeat testing of all the liver function tests to check whether their values are variable or stable.
If the enzymes remain close to the values you mentioned and your liver is OK on the ultrasound scan then you won't have to worry that much.
I hope I've helped!
If you'd like more information, please use your follow-up questions.
I'll be glad to help more.

Kind Regards!
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Above answer was peer-reviewed by : Dr. Prasad
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Answered by
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Dr. Panagiotis Zografakis

Internal Medicine Specialist

Practicing since :1999

Answered : 3810 Questions

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What Do Increased AST And ALT Levels Indicate?

Brief Answer: Drugs probably Detailed Answer: Hello, with breast cancer you can never be absolutely certain but in your case the drugs are likely the cause. Cymbalta is well known for causing hepatoxocity. The same applies for atorvastatin, voltaren and wellbutrin. Your AST and ALT are not very high, so you could continue using them but the investigation is needed. The test you mentioned are appropriate for your case, that is investigation for various infectious hepatitis causes, ultrasound scan (very important) and repeat testing of all the liver function tests to check whether their values are variable or stable. If the enzymes remain close to the values you mentioned and your liver is OK on the ultrasound scan then you won't have to worry that much. I hope I've helped! If you'd like more information, please use your follow-up questions. I'll be glad to help more. Kind Regards!