What medications could be affecting liver function and glucose levels in a patient with elevated liver enzymes and hyperglycemia?

From the Guidelines

Medications such as acetaminophen, allopurinol, diclofenac, divalproex, and risperidone may be affecting liver function and glucose levels in this patient, given their potential for hepatotoxicity and impact on glucose metabolism, as noted in studies such as 1 and 1. When evaluating the patient's medication list, it's crucial to consider the potential effects of each medication on liver function and glucose levels.

• Acetaminophen, for example, is known to cause liver injury at high doses or with chronic use, as mentioned in 1.
• Allopurinol, a medication used to treat gout, can also cause liver damage in some cases, as noted in 1.
• Diclofenac, a nonsteroidal anti-inflammatory drug (NSAID), has been associated with liver injury, particularly at high doses or with long-term use, as seen in 1.
• Divalproex, an anticonvulsant medication, can cause liver damage, especially in the first six months of treatment, as mentioned in 1.
• Risperidone, an antipsychotic medication, has been linked to an increased risk of hyperglycemia and diabetes, as noted in 1. A thorough review of the patient's medication list and medical history is necessary to determine the potential causes of elevated liver enzymes and hyperglycemia.
• The patient's current medications, including acetaminophen, allopurinol, diclofenac, divalproex, and risperidone, should be carefully evaluated for potential hepatotoxicity and impact on glucose metabolism.
• Consideration should be given to alternative medications or dosage adjustments to minimize the risk of liver damage and hyperglycemia, as suggested in 1 and 1. Regular monitoring of liver function tests and glucose levels is essential to assess the effectiveness of any medication changes and to promptly identify any potential adverse effects, as recommended in 1.

From the FDA Drug Label

Valproate-induced acute liver failure and liver-related deaths have been reported in patients with hereditary neurometabolic syndromes caused by mutations in the gene for mitochondrial DNA polymerase γ (POLG) In patients over two years of age who are clinically suspected of having a hereditary mitochondrial disease, divalproex sodium extended-release tablets should only be used after other anticonvulsants have failed The drug should be discontinued immediately in the presence of significant hepatic dysfunction, suspected or apparent Cases of life-threatening pancreatitis have been reported in both children and adults receiving valproate.

The medications that could be affecting liver function and glucose levels in this patient are:

• Divalproex: due to the risk of valproate-induced acute liver failure and liver-related deaths, as well as the potential for pancreatitis, which can affect glucose levels.
• Diclofenac: as a nonsteroidal anti-inflammatory drug (NSAID), it can cause liver damage and affect glucose levels, although this is not directly stated in the provided drug labels. Other medications listed, such as omeprazole, losartan, and acetaminophen, may also have potential effects on liver function or glucose levels, but these are not directly stated in the provided drug labels 2, 2.

From the Research

Medications Affecting Liver Function and Glucose Levels

The patient's medication list includes several drugs that could potentially affect liver function and glucose levels. Some of these medications include:

• Acetaminophen, which has been shown to cause liver injury, particularly when taken in high doses or for extended periods 3
• Diclofenac, a non-steroidal anti-inflammatory drug (NSAID) that has been associated with elevated liver enzymes and liver injury 4
• Omeprazole, a proton pump inhibitor that has been linked to changes in liver function and glucose metabolism
• Losartan, an angiotensin II receptor antagonist that has been shown to affect glucose metabolism and liver function

Liver Enzyme Elevations

The patient's laboratory results show elevated liver enzymes, including AST and ALT. These elevations can be caused by a variety of factors, including medication use, viral hepatitis, and non-alcoholic fatty liver disease (NAFLD) 5, 6. The patient's medication list and laboratory results suggest that medication use may be contributing to the elevated liver enzymes.

Glucose Levels

The patient's glucose level is elevated, which could be related to medication use, particularly the use of corticosteroids like hydrocortisone, or other medications that affect glucose metabolism, such as losartan and omeprazole. Additionally, the patient's use of acetaminophen and diclofenac may also contribute to changes in glucose levels 3, 4.

Potential Interactions and Effects

The patient's medication list includes several drugs that could potentially interact with each other or with the patient's underlying medical conditions to affect liver function and glucose levels. For example:

• The use of acetaminophen and diclofenac together may increase the risk of liver injury
• The use of omeprazole and losartan together may affect glucose metabolism and liver function
• The use of hydrocortisone may contribute to changes in glucose levels and liver function

Key Findings

• The patient's medication list includes several drugs that could potentially affect liver function and glucose levels
• The patient's laboratory results show elevated liver enzymes and glucose levels
• The patient's use of acetaminophen, diclofenac, omeprazole, losartan, and hydrocortisone may contribute to changes in liver function and glucose levels 7, 3, 4, 5, 6