Minocin and Elevated Liver Enzymes

[umarwadia]

Hello,

I am on currently on 100 mg of Minocin, no MTX and an occasional (twice a week) celebrex with very good results. I have been on Minocin now for nearly 2 years. I recently had elevated lever AST/ALT levels. I have never had elevated AST/ALT in the last 10 years (blood work every 3 months). I was wondering if after a point, minocin affects the liver and whether you would need a holiday from it or substitute it with some other drug for some time.

[nspiker]

Hi umarwadia,

It’s scary to have your liver enzymes elevated 😕 . It may be the result of either minocycline or celebrex, as both have this as a possible side-effect. I know you’ve been on minocycline for two years, and how long for celebrex?

Are you taking anything to protect the liver like milk thistle? It has fabulous protective effects and can help get your liver enzymes back in balance.

You can always try switching to doxy, and see if that is effective in reducing your AST/ALT.
nancy

[lynnie_sydney]

Manish – it is unusual for Minocin to be implicated in elevated liver enzymes, especially on a MWF pulsed dose. So much so that the American College of Rheumatology – who list minocycline as a DMARD – dont recommend 3 monthly testing of liver enzymes, as they do for pretty well every other drug listed (including the methotrexate you were on). Here is a link
http://www.rheumatology.org/practice/cl … /index.asp

Nancy is right. Milk Thistle has been found to be very protective for the liver and to have helped some bring elevated liver enzymes down. You might want to do a search on previous discussion about liver enzymes and the various things that people have found effective. You can type “elevated liver enzymes” into the search box at the top of the Discussion Forum front page. Here’s a link to one thread.
viewtopic.php?f=1&t=6187&hilit=elevated+liver+enzymes

Be well! Lynnie

Palindromic RA 30 yrs (Chronic Lyme?)
Mino 2003-2008 100mg MWF - can no longer tolerate any tetracyclines
rotating abx protocol now. From Sep 2018 MWF - a.m. Augmentin Duo 440mg + 150mg Biaxsig (roxithromycin). p.m. Cefaclor (375mg) + Klacid 125mg + LDN 3mg + Annual Clindy IV's
Diet: no gluten, dairy, sulphites, low salicylates
Supps: 600mg N-AC BID, 1000mg Vit C, P5P 40mg, zinc picolinate 60mg, Lithium orotate 20mg, Magnesium Oil, Bio-identical hormones (DHEA + Prog + Estrog)

[umarwadia]

Hi Lynnie,

Thanks for the links. Since my doctor wants me to go off of everything for 4 weeks (incl. Minocin) and repeat the test, is that cause for concern from the standpoint of a RA flare if I am currently in remission? I doubt Minocin is implicated and I should be able to resume the pulsing dose but I at least wanted to give the doctor a fair shake.

Thanks,

[Maz]

@umarwadia wrote:

Since my doctor wants me to go off of everything for 4 weeks (incl. Minocin) and repeat the test, is that cause for concern from the standpoint of a RA flare if I am currently in remission? I doubt Minocin is implicated and I should be able to resume the pulsing dose but I at least wanted to give the doctor a fair shake.

Hi Manish,

I have, in the past, been off my abx for up to a month and it didn’t affect the overall course of my progress, although I did experience more herxing when I resumed therapy. I had to make a switch to doxycycline, which, unfortunately, wasn’t as effective for my RA as the minocycline had been in the same low doses. So, it was this switch in abx that eventually set me back. A few people here have taken abx “holidays” in order to do focus on detoxification.

There is always the chance for a flare whether on AP or off, because it’s not immune-suppressive (especially in the lower pulsed doses), like methotrexate or other more commonly-used DMARDs. While off your AP, however, you can do a lot to prevent a flare, like eating and sleeping well, using the break to detox, and avoiding the usual stressors.

Do you know if your labs showed an elevated ANA? If so, was it always elevated or only recently elevated?

[umarwadia]

Hi Maz,

Much obliged for your usual incisive questions and suggestions. We didn’t test ANA but we did do ESR, RF and CRP. All of these are well within normal ranges. This is borne out by my general feeling of well-being so the high AST/ALT caught me by surprise since both were in the 20’s just 4 months ago and nothing much has changed in terms of food/drug/drink. My doctor feels that it could be a combination of crestor and fish oil and hypothyroidism (it worsened). I am just perplexed since I have been taking crestor and fish oil for some time. I suppose sometimes it may just be a situation reaching a tipping point. Well, I will find out after my 4 week medication holiday.

Thanks,

Manish

[Maz]

@umarwadia wrote:

We didn’t test ANA but we did do ESR, RF and CRP. All of these are well within normal ranges. This is borne out by my general feeling of well-being so the high AST/ALT caught me by surprise since both were in the 20’s just 4 months ago and nothing much has changed in terms of food/drug/drink. My doctor feels that it could be a combination of crestor and fish oil and hypothyroidism (it worsened). I am just perplexed since I have been taking crestor and fish oil for some time. I suppose sometimes it may just be a situation reaching a tipping point. Well, I will find out after my 4 week medication holiday.

Hi Manish,

It just occurred to ask if you had a positive ANA, because further simple blood testing can be run on ASMA (anti-smooth muscle antibodies) that can be helpful in determining a cause when there is liver involvement. Thing is, in RA, it’s estimated that 25-60% of folk will have a positive ANA anyway, but if negative before, and only positive since the elevations in LFTs, in rare instances it can be indicative of minocycline-related autoimmune hepatitis. This is not to worry you, at all, just a precautionary measure to get checked out and to rule out and I am pretty skeptical that it is this, especially as you have been doing well otherwise with no other symptoms with normal inflam levels. 🙂 I have only heard of one or two people who have used minocycline who have had this problem and there have been thousands of folk running through here in the past 4 years since I began volunteering, so it’s pretty rare and only mentioning this to you so you could ask your doc about it. Having read studies on this phenomenon, it seems that doses of 700mg per week have been known to cause this problem.

There are so many things that can cause elevations in LFTs, though, so getting to the bottom of the cause can be quite important. For instance, gall bladder issues can cause back-up of bile leading to high LFTs. I had such an instance two winters ago when this happened and the LFTs were abnormal before I actually experienced GB discomfort, which was confusing to me, too. However, when I started getting sore under my right rib cage, within days of these results, I recognized that old nagging feeling and did a liver and gall bladder flush and two weeks later my LFTs had normalized again. I get this rumbling GB every now and again and this started a couple years prior to starting AP, so can’t really blame it on the abx in my case.

Also, when I first got very ill with Lyme and then RA, two months on the heels of that, my baseline labs with my Lyme doc (before starting antibiotics) showed really high LFTs, too. He explained that Lyme can get into the liver and cause this problem, but that he’d had patients on abx who had done very well. Within a month of being on high doses of tetracycline (750mg BID), biaxin (500mg BID) and plaquenil (200mg BID), my LFTs had normalized. Go figure!

I hope you can get to the bottom of this, Manish, that it’s easily resolved, and that your medication holiday will reveal some answers. Please come back and let us know how you’re doing when you can.

[umarwadia]

Hi Maz,

What is the regimen you followed for liver and GB flush? There are many different protocols out there and if you had success with one particular one, I would rather follow that.

[Maz]

@umarwadia wrote:

Hi Maz,

What is the regimen you followed for liver and GB flush? There are many different protocols out there and if you had success with one particular one, I would rather follow that.

Hi Manish,

I’ve only tried one liver/gallbladder flush recipe, because I had success with it the first time around for my GB attacks. I also joined the Yahoogroup, called “Gallstones,” which is a really busy discussion group, but was very helpful in learning how to eat a liver-friendly diet and what to do to stave off GB attacks. I really researched around prior to flushing to ensure I wasn’t doing anything that might be harmful, but my best fellow patient suggestion would be not to try this unless under the supervision of a good ND or holistic doc when trying it for the first time. It might even be a good idea to wait until you get to the bottom of why your LFTs are elevated.

Since doing my first GB flush, using this particular site’s protocol, they’ve added more of their products to it. However, initially, their only recommendation was Oxy-powder for colon cleansing in the days prior to the flush. Some protocols also suggest parasite cleansing prior to flushing, but with elevated liver enzymes I wouldn’t personally try this unless under the supervision of a good ND or holistic doc. Also, anyone with kidney issues should not be taking the epsoms salts required on flush day.

http://www.globalhealingcenter.com/cleansing/liver-and-gallbladder-flush

I have made the soup recommended and just drinking the broth staved off the flush day fasting hunger. Probiotics are essential to resume the day after the flush, but I believe the site recommends that all meds and supps should be avoided on the day of the flush.

[umarwadia]

Hello,

Just to post an update for other folks with a similar condition:

I had a normal ultrasound and CT scan prior to beginning the drug holiday.

After being off of all medications for 4 weeks, my AST/ALT retuned to normal (although higher than before). Besides the normal hepatic panel, the GI doctor also ordered: ANA IFA, Mitochondrial AB Screen and Smooth Muscle AB Screen (must have consulted Maz ;> ) and all 3 were okay along with AST/ALT after the 4 weeks. He has now asked me to reintroduce Celebrex, Crestor, Methotrexate and Minocin in that order ONE drug every 4 weeks with blood work every 4 weeks to detect the culprit drug. He suspects Minocin-induced acute hepatitis may have been the cause. He said I can also start milk thistle now if I want to.

[Maz]

@umarwadia wrote:

I had a normal ultrasound and CT scan prior to beginning the drug holiday.

After being off of all medications for 4 weeks, my AST/ALT retuned to normal (although higher than before).

He has now asked me to reintroduce Celebrex, Crestor, Methotrexate and Minocin in that order ONE drug every 4 weeks with blood work every 4 weeks to detect the culprit drug. He suspects Minocin-induced acute hepatitis may have been the cause.

Manish, many thanks for coming back with an update. I had wondered how your med break was panning out. Very glad to hear your liver panels were all okay as well as liver imaging. 😀

Yes, could be the culprit was Minocin, but could also be that methotrexate has something to do with this or even the combination. Would kind of be interesting to test each one on their own, rather than adding the mino after the methotrexate. Of course, you must follow doctor’s orders, but maybe this is something he would agree to you trying at some stage if this happens again?

http://www.medicinenet.com/drug_induced_liver_disease/page8.htm

Might also be worth asking your doc if you could also add NAC (N-acetylcysteine) to the milk thistle, as well as ALA(Alpha-lipoic acid). Anything that is anti-oxidative and boosts glutathione in the liver can only be supportive. Undenatured whey protein and Glutathione IV pushes are also worth checking out.

http://www.ei-resource.org/treatment-options/treatment-information/antioxidants-and-liver-supplements/

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