Q:  Liver Function Tests, Epilim, Alcohol

HI I was diagnosed MD some 15 years ago but have only recently begun to understand myself. What my problem is now that I enjoy a drink or two and am nowfinding that my LFT's are going rather high. I had a very high lft 2 years ago yet within 12 months they came down to a normal level. ( Ihave them done every 3 months ) For the past 12 months they have been good yet on my last test they have all of a sudden shot through the roof so to speak. My Gp and Psych are naturally blamming my alcohol intake which I must confess does vary. My concern now is of my Liver. I realize that I must still keep taking Epilum ( 1000 mg's twice daily )but wont this affect my liver still and does the liver regenerate as such.

Thanks
Peter

Dear Peter -- 
With apologies, as I'm sure it's not really this simple, but wouldn't it be easiest to figure this out by just cutting out the remaining drink or two and then knowing for sure if it's alcohol that could be causing or contributing to this?  (you might have trouble convincing your doc's that you've been 100% abstinent, but at least you would know for sure if you've gone 2 or 3 months with zero alcohol and your Liver Function Tests are still abnormal).  

I'm afraid you may well discover it's the Epilim (Depakote in the US) but you won't know for sure that you need to go through the tricky process of trying to find an alternative medication unless you try my little experiment first.  

If you have difficulty getting to zero, then perhaps the doc's are right that there's a problem with alcohol?  Not that I've concluded so, mind you; just wanted to point out a necessary consideration.  

Generally in the US the standard of care, as I understand it (these aren't written anywhere) is to watch carefully if LFT's are up to twice or even sometimes 3 times the upper limit of normal.  Beyond that, something needs to change.  I'm pretty comfortable letting patients go on with LFT elevations up to twice normal. Beyond that, we start having to have discussions about the relative risks of changing medications (e.g. what other options does the patient have?) versus leaving the liver irritated to some degree.  

Good luck figuring that out. 

Dr. Phelps

Published July, 2003