From the FDA Drug Label
• Liver: A moderate rise in AST and/or ALT has been noted, but the significance of this finding is unknown. Yes, amoxicillin can elevate Aspartate Aminotransferase (AST) and Alanine Aminotransferase (ALT) as a moderate rise in these enzymes has been noted, although the significance of this finding is unknown 1.
From the Research
Yes, amoxicillin can elevate liver enzymes including Aspartate Aminotransferase (AST) and Alanine Aminotransferase (ALT), though this is relatively uncommon. This antibiotic-induced liver injury typically occurs within the first few weeks of treatment and is usually mild and transient. The mechanism involves either direct hepatotoxicity or an immune-mediated hypersensitivity reaction to the medication, as reported in a case of amoxicillin-induced hepatocellular liver injury with bile-duct damage 2. Patients taking amoxicillin who develop symptoms such as fatigue, nausea, abdominal pain, dark urine, or jaundice should contact their healthcare provider immediately. Most cases resolve with discontinuation of the medication, though monitoring liver function may be necessary.
- The risk of clinically significant liver injury from amoxicillin alone is low compared to amoxicillin-clavulanate combinations, which have a higher association with liver enzyme elevations.
- Patients with pre-existing liver disease or those taking other potentially hepatotoxic medications should be monitored more closely when using amoxicillin.
- Elevated liver enzymes can also be caused by other factors, such as disease progression, other drugs or toxins, or other causes, as seen in patients treated with immune checkpoint inhibitors 3.
- A diagnostic approach to evaluate liver enzyme elevations should include a thorough medical history, physical examination, laboratory tests, and imaging studies, as outlined in a study on the evaluation of liver enzyme elevations and hepatotoxicity in patients treated with checkpoint inhibitor immunotherapy 3.
- In some cases, liver biopsy may be necessary to establish a diagnosis, as reported in a case of clarithromycin-associated acute liver failure 4.
- Other antibiotics, such as azithromycin, can also cause liver injury, as reported in a case of acute azithromycin-induced hepatocellular injury 5.
- The management of liver enzyme elevations should be individualized based on the underlying cause and severity of the elevation, as well as the patient's overall clinical condition, and may involve discontinuation of the offending medication, monitoring of liver function, and supportive care.