[onmyway]

Hello and thanks in advance for any advice. I have been on epival 500mg for several months and my ALT has been a tiny bit elevated, running 62-ish when 'normal' is 1-40, and my platelets have been a little low, but i don't believe they've gone below 144 (150+ is normal) and i think the last time my platelets were even something like 169 and i almost fell over because they hadn't been that 'high' in a while.

Last week i saw a new psychaitrist and he wants to increase the epival to 750mg (375 2X a day), and for the past week the only change he made was that instead of 1 500mg pill once a day, he split it to 2- 250mg pills, one in AM one in PM. So when i left the office last week they sent me directly for bloodwork as a current 'baseline' for when the epival would be increased, which should/would've been today.

They are pretty concerned, as my ALT came back at 258! My platelets have dropped to 135, which i know isn't tooooo alarming, but it's a pretty good drop from where they were not long ago. And the rest of my liver functions were within normal range, but literally BARELY on the borders.

They have decided to go ahead with the increase to 750mg anyway, but will watch my blood work closely/often and told me to come in if i start feeling sick. Now, what i forgot to ask them is: are these numbers extremely alarming? (like the 258? i know my former psychaitrist said she doesn't worry until they hit 140 and up, soooo... ) AND more importantly, what kinds of symptoms would i need to look out for that would warrant a call to them right away? Yeah, you'd *think* that'd be my first question but we had a lot to talk about otherwise so i forgot.

Anyone had liver affected by epival? Is it permanent? What were your numbers? Did anything need to be done? Anything else i'm forgetting? THANKS!

[online user]

I'd call them and inquire if you have any unusual symptoms. Sometimes, with liver failure, you will become jaundiced (yellow skin or eyes), or have upper right quadrant pain. There are other symptoms as well, but I couldn't find the list--I'm working from memory here. Another might have been itchy skin. With the drug I take, Cymbalta, there were some cases of liver failure in a clinical trial--but in subjects who drank a "substantial" amount. They said some subjects had slightly increased ALT levels, and a very, very few had alt readings up to 20x normal! So, apparently there is quite a range that is possible and still be OK.

But you are wise to be concerned--I'd call if you notice ANY new symptoms when you start the higher dose.