From the Guidelines
Yes, Relefen (nabumetone) can cause elevated liver enzymes, and it is essential to monitor liver function tests (LFTs) in patients taking this medication, especially if they have pre-existing liver conditions or are at risk for liver injury. According to the guidelines for detection, assessment, and management of suspected acute drug-induced liver injury during clinical trials in patients with nonalcoholic steatohepatitis 1, the degree of variation in ALT reference ranges between laboratories should be considered, and baseline ALT should be determined by taking at least two measurements prior to enrollment, at least 2 weeks apart.
If a patient develops isolated elevated liver enzymes while taking Relefen, the healthcare provider should:
- Repeat ALT, AST, ALP, and total bilirubin (TBL) in 2-5 days
- Follow up for symptoms such as severe fatigue, nausea, vomiting, and right upper quadrant pain
- Initiate evaluation for other etiologies of abnormal liver tests
- Consider interrupting the study drug if ALT ≥8× ULN or if TBL ≥2× ULN, and restart only if another etiology is identified and liver enzymes return to baseline 1.
Additionally, the management of immune-related adverse events in patients treated with immune checkpoint inhibitor therapy suggests that liver biopsy should be considered if the patient is steroid-refractory or if concern for other differential diagnoses that would alter medical management 1.
It is crucial to note that while serious liver injury from nabumetone is rare, continued monitoring is essential, especially if the patient needs to remain on the medication long-term. The healthcare provider might suggest alternative pain management options if the elevation persists or if the patient develops symptoms such as fatigue, abdominal pain, dark urine, or yellowing of the skin or eyes.
Key considerations for managing elevated liver enzymes in patients taking Relefen include:
- Monitoring LFTs regularly
- Evaluating for other causes of elevated liver enzymes
- Considering alternative pain management options if necessary
- Providing close follow-up and management to prevent potential liver injury.
From the Research
Elevated Liver Enzymes and Relefen
- Elevated liver enzymes can be caused by various factors, including drug-induced liver diseases 2
- Relefen, as a medication, may potentially cause elevated liver enzymes, but the provided studies do not specifically mention Relefen as a cause
- The studies suggest that elevated liver enzymes can be a sign of underlying liver disease, but can also be caused by extrahepatic diseases or other factors such as pregnancy or adolescence 2, 3, 4
Patterns of Elevated Liver Enzymes
- There are three different patterns of increased liver enzymes:
- Predominant increase in transaminase activities, indicating hepatocellular integrity disturbance 2
- High serum alkaline phosphatase and γ-glutamyltranspeptidase activities, indicating cholestatic liver diseases 2
- Predominant rise in γ-glutamyl transpeptidase, observed in alcoholic or non-alcoholic fatty liver disease and infiltrating liver diseases 2
Evaluation and Management of Elevated Liver Enzymes
- Evaluation should be guided by both the clinical presentation and the pattern of injury 3
- An algorithmic approach can be taken to help narrow the spectrum of a differential diagnosis and ensure appropriate management and evaluation of the patient with elevated liver enzymes 4
- Measurements of serum liver enzymes may support the identification of individuals at increased risk for all-cause mortality 5