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null, NY
A 42-year-old male asked:

Alt high 60, ast high 45 on methotrexate 25mg, arava (leflunomide) 20mg, enbrel weekly. should i be concerned? never had pblm.

2 doctor answers5 doctors weighed in
Dr. Ronald Krauser
A Verified Doctoranswered
A US doctor answeredLearn more
Maybe: I, personally am not a big fan of using Methotrexate and Arava (leflunomide) in combination because of the increased risk of liver toxicity. Your enzymes are only mildly elevated but i would talk to your rheumatologist about reducing dosages or eliminating one of the meds altogether.
Dr. Tracy Lovell
Rheumatology 21 years experience
agree. if one is still requiring arava plus methotrexate plus a TNF; perhaps a class switch of biologic should occur so that one of the oral DMARDS can be eleiminated
Jul 4, 2013
Dr. Robert Lowe
Dr. Robert Lowe commented
Pediatric Rheumatology 17 years experience
Agree. I have never used Arava at the same time as methotrexate--much more potential for liver toxicity without significant benefit. Particularly since there are a range of excellent biologic agents to choose from (and switch to if one isn't working).
Jul 19, 2013
Dr. Robert Lowe
Pediatric Rheumatology 17 years experience
Talk to your doctor: Those are not terribly high lab values for alt and ast. Such modestly elevated labs that measure liver irritation (or damage/disease when > 2-3 times the upper limit of normal) can be temporarily caused by common viral infections, alcohol consumption, or interactions with other meds that affect the liver. Getting labs checked within 48hrs of Methotrexate can also result in higher lab values.
Dr. Thomas Namey
Rheumatology 48 years experience
CAN'T TELL YOU HOW MANY TIMES I SEE THIS AND SLIGHTLY WORSE. WEEKS LATER, ALL IS NORMAL. SHOULDN'T GET TOO EXCITED, FRIGHTENS PATIENTS! YOU ARE RIGHT!
Aug 4, 2013

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Last updated Jun 28, 2014

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