Raised liver enzymes

Hi, I started Plegridy mid Jan. Around the same time I also started taking 10mg of Amitriptyline but it didn’t suit me and I stopped after 4 weeks. I then had my first blood tests since starting Plegridy in mid Feb which showed elevated liver enzymes of 397. I went back 2 days ago and they have dropped to 297 and my MS nurse has asked me to go back at the end of next month to be tested again. She is saying that it it may have been the Amitriptyline that caused my levels to rise and as the levels have dropped (and I am no longer taking it) she is happy for me to continue with the Plegridy and see what happens with next months blood test. I was a little concerned as she advised that my levels should be between 0 and 42 and I will have another 3 injections in that period!

Has anyone got any experience of this happening that can put my mind at ease? (I was that concerned that I haven’t allowed myself a glass of wine tonight lol!)

Hello Belle

I’ve had elevated liver enzymes as a drug side effect 3 times as a result of different drugs. The worst was from Tysabri.

Each time I’ve had to stop the drug.

It’s difficult when you’ve started two drugs roughly simultaneously, to work out which one is the cause. Looking at the listed side effects from each drug, it seems that Amitriptyline is more likely to have liver problems as a side effect than Plegridy. Plus, if the results have already started getting better, I should think your MS nurse is right.

The really good thing about the liver is that it recovers quite quickly from this sort of drug effect. And recovers pretty quickly. With Tysabri one of the tests was at something like 1100. But with a couple of months it was fine. I went on holiday to India just after the toxic effect of the Tysabri was discovered, and it was only the day before we went that I was given the OK to go.

And I drank while I was getting better. With no ill effects. Not that I drink masses, but don’t worry about the odd glass of wine. It’ll be fine.

My liver is in perfect condition, the last time it was ultra sound scanned, it was a picture of health. And that was following the last bout of drug related hepatitis last year (that time it was Betmiga).

So don’t worry about Plegridy. Just see what your test results are next month.


Thanks Sue,

I really appreciate your reply. It puts my mind at rest just to know that despite you having had this happen 3 times you still have a perfectly healthy liver! We don’t need anything else going wrong with us!

I think you are probably right that a glass of wine won’t hurt so I am going to continue having the odd glass but will ‘take it easy’ I had already thought that if i knock it on the head completely and I get a clean bill of health next month it wouldn’t be a true picture (as I usually have one or two glasses of wine with my evening meal 4 or 5 nights a week) and I would be left wondering if it was safe to have a drink!

Bottoms up :wink: x

I’m being monitored at the moment because of the Tizanidine and Clonazepam that I’m taking, blood test every month. I can recall a year or so ago being taken off Carbamazepine because my liver enzymes started to rise.

Hi how is Plegridy taken pill or injection. Just wondered as I’m currently on Tecfidera but getting gi problems after eating so may consider changing soon. Ann x

Hi Ann

Have a look at the MS Trust Decision Aid. It allows you to compare different DMDs.

Plegridy is a subcutaneous (ie just under the skin) injection every two weeks. It’s not considered to be as effective as Tecfidera, but many people find it works for them. And if you’re finding the stomach issues too difficult with Tecfidera, then it’s worth considering. It can give you a couple of iffy days after you take it (flu type symptoms), but completely different to ‘Tec.

Maybe you should think about making changes to the way you take Tecfidera first before swapping though. Are you finding the morning dose more problematic than the evening? (I think that’s what most people have trouble with.) If that’s the case, try changing your breakfast routine, eat toast with peanut butter, then a piece of cheese and a full fat yogurt? It’s probably the wrong time of year now for porridge, but that’s an excellent stomach filler, you could even eat half a decent size bowl of porridge, take the ‘Tec, then the other half? But if you’ve tried all these kinds of things, or are just having trouble taking the time to get it right, then swapping drugs might be as well.

Good luck with whatever you decide to do.


Thanks Sue.

My problem is complex. I had Gallstones and had my Gallblader removed in December before it was removed I was on Ranitidine twice daily plus 30mg Lanspranol at breakfast stomach wasn’t too bad coul even eat fatty things every now and then. I stopped the Ranitidine about 6 weeks after op then the Lanspranol as I thought providing I gradually introduced fatty foods I should be ok however I ended back on both meds and am still getting pain I’m even back to skimmed milk again and bland food so thinking it maybe the Tecfidera causing my troubles and not my Absent Gallblader. To make thinks worse 10 years ago I had hernia but assumed it had healed up as it wasn’t mentioned in my last endoscopy I had last year.

im going to see if I can get Doc to call me back Monday and see what he says.

Ann x

Well hopefully you should be able to change the Tecfidera to something kinder to your stomach. It actually sounds like it was never a good idea for you with your background.

Good luck with sorting it out.


I was taken off Tizanadine 2 weeks ago due to raised liver enzymes, however even though 2 weeks have passed my GP rang me today and said that my latest blood test has shown an even greater increase ?

Is 2 weeks long enough for this med to start dropping out of the system ?

A similar thing happened when I tried Carbamazepine 2 years ago.

I’m also still taking a low dose of Clonazepam, 0.5mg once at night, sometimes 2 x 0.5mg, but my GP doesn’t seem to think this would cause raised liver enzymes, yet the leaflet that comes with the tablets says it can in rare cases ?

So my liver ALT levels still climbed AFTER coming off Tizanadine, and peaked at 388, thankfully they’ve started to drop.

My GP said normal ALT levels are around 40 !

I’ve also learned from the secretary at spasticity clinic that I’ll probably be starting Sativex next week, thats when I have an appointment with the consultant that put me on the Tizanadine.

Not sure what to expect with Sativex ?