This is topic Elevated Liver Enzymes from Cholestyramine in forum Medical Questions at LymeNet Flash.

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Posted by seibertneurolyme (Member # 6416) on :
Hubby has recently had elevated liver enzymes for the first time since he got sick 8 years ago.

He recently switched some meds. I looked at my lab manual and it said that amantadine, ativan, rifampin and cholestyramine all could cause elevated liver enzymes. He is on all those meds plus levaquin and minocycline. Also IV phenergan at low doses.

He stopped the cholestyramine which was the newest thing he had added (had been on it about a week) and his liver enzymes decreased to almost normal within 5 days.

Going to retest again next week and if they are normal will resume cholestyramine maybe every other day. Was only taking one dose per day.

The cholestyramine seemed to help a little with nausea but when his liver enzymes were elevated he complained of liver side pain and had several night time waking up spells with dry heaves and tremors.

His bilirubin remains slightly elevated -- has been that way for a couple of years mostly -- due to too rapid dieoff of red blood cells.

For hubby the cholestyramine actually causes extra bowel movements and we had hoped it would help flush out his liver but have doubts that it will work although we will give it another try.

Just wanted others to be aware of the possibility that cholestyramine can raise liver enzymes.

Bea Seibert
Posted by TerryK (Member # 8552) on :
Thanks for posting this Bea.

I've been on cholestyramine for 3+ years and I get elevated liver enzymes off and on. Mine are usually resolved when I take away one or more abx or one time it was artmesinin. Perhaps it is a combination of things for him??

Hope Steve is feeling better soon.

Posted by Jill E. (Member # 9121) on :
Thanks for posting, Bea. I use CSM for certain periods when I can fit it into my dosing schedule, but only one dose a day.

Never had the elevated liver enzymes but thanks for the reminder, given that my liver issues were severe in the past.

Posted by seekhelp (Member # 15067) on :
Bea, can you explain what co-infection is causing your husband's RBCs to break apart? I have the same issue. You said his Babesia was cured years ago. I'm just curious.
Posted by seibertneurolyme (Member # 6416) on :

It is either bartonella, BLO, mycoplasma or the mystery pathogen seen on blood smears from Fry and Clongen labs. Wish I knew for sure what it was.

Meds which treat for bart etc do help, but don't seem to eradicate the infection. Hubby's RBC finally went back to normal when he went on Factive. But since he was pulsing that med every 5 days it seemed like the infection would start getting more symptomatic after 2 or 3 days off the Factive.

He is now doing both Levaquin and Rifampin -- has never combined those 2 meds before. His RBC has remained in the normal range, and WBC has also returned to normal -- we are assuming that whatever this infection is it was suppressing his immune system and decreasing his white blood counts.

Both RBC and WBC had been low or very borderline for over 9 months -- has bloodwork done every 2 weeks.

The bilirubin initially went down to normal on the first round of factive, but has gone high again. Not 100% sure at this point if this means the meds are killing off infected cells or if the infection is still to blame.

Has been on the Levaquin and rifampin combo for one month now. Next LLMD appointment is still a month away. At that time we are hoping to add in clindamycin if the LLMD is agreeable.

Bea Seibert
Posted by karenl (Member # 17753) on :
I was on high cholestyramine for a year or more, with no elevated liver enzymes.

Just wanted to start again, but will not.I think there is a warning on the bottle.
Rifampin is bad for the liver.
Posted by tickled1 (Member # 14257) on :
I've been feeling horrible lately. Flu-like, eyes turning yellow. Just requested blood work, got results today, bilirubin 2.2. Recently started cholestyramine. I think that's what is responsible. Anyone else have this happen with cholestyramine?
Posted by momlyme (Member # 27775) on :
Just looked up the reference ranges for bilirubin and they are:

0.3-1.0 mg/dL or 5.0-17.0 mmol/L

So, I am assuming this 2.2 is mg/dL?

Sounds like your liver is having trouble detoxing and you need to help it...

I just sent you a PM with a link to a thread 17hens posted with castor oil packs and more. Here it is again in case anyone else needs it:

Great info here on helping the liver when it is clogged.

Personally, I don't think this is the cholestyramine doing this... I think it is the mold.

Taking cholestyramine while you are still living in the moldy home will not have good results. You need to remove yourself from the source of the toxins.
Posted by seibertneurolyme (Member # 6416) on :
You need to know the breakdown between direct and indirect bilirubin. That will help pinpoint the cause of the elevated number.

An elevation in direct bilirubin would probably indicate gallstones or possibly sludge.

But an elevation in indirect bilirubin usually indicates hemolysis -- destruction of red blood cells. This can be caused by babesia. This is the number that used to be elvated for hubby when he treated babesia.

But lately his AST and ALT numbers act up sometimes -- these numbers are more directly related to actual liver function. One of these numbers was what was elevated when he tried the cholestyramine. The AST number is supposed to go up first and the ALT number is the last to go down.

Another thing that can be tested is GGT -- supposed to indicate more long term liver function. Have read that an elevated number can indicate fatty liver.

This is not medical advice, just my opinion based on hubby's treatment.

Bea Seibert
Posted by Lymetoo (Member # 743) on :
Man, I have to give TerryK a big gold star and maybe a blue ribbon too!! I don't see how ANYONE could take that #&%$# CSM for 3 years. I hated hated hated that stuff. Made me entirely miserable. I think it accelerated my need for gallbladder surgery too.

Bea .. I'm so glad you figured this one out quickly!
Posted by tickled1 (Member # 14257) on :

Was your bilirubin elevated before you needed the gallbladder surgery?
Posted by Razzle (Member # 30398) on :
Artichoke can help with the fatty liver.

Milk Thistle also can improve the liver.

Artemesia is also a liver herb.

Best to consult a doctor before trying the Milk Thistle or Artemesia, but because artichoke is a food, it is probably a safer thing to try first.

I have had fatty liver as a result of being on IV nutrition exclusively at times, and the artichoke plus milk thistle seems to work wonders for helping my liver enzyme levels to come down and the pain and swelling around my liver to go away.

BTW, my Bilirubin was never elevated when I had the high liver enzyme levels, nor was it elevated when I had gallstones (but I had nausea/vomiting and pain from the gallstones).

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