From the Guidelines
I strongly advise against taking Tylenol with AST/ALT levels of 79 and 93, as this could exacerbate liver damage. These enzyme levels are significantly elevated above the normal range, indicating some degree of liver inflammation or injury. Given that acetaminophen is a dose-related toxin and can cause severe liver injury even at doses as low as 3-4 gm/day, as noted in the 2005 Hepatology study 1, it's crucial to avoid any potential liver stress. The fact that acetaminophen hepatotoxicity can lead to acute liver failure (ALF) and is the leading cause of ALF in the United States and Europe, as mentioned in the same study 1, further supports the decision to avoid Tylenol in this scenario.
When considering pain relief, it's essential to explore alternative options that are safer for the liver. Some NSAIDs or other medications might be recommended by a healthcare provider, depending on the individual's specific medical situation. The primary concern should be to investigate and address the underlying cause of the elevated liver enzymes before considering any medication that could potentially worsen liver function.
Key considerations include:
- Elevated AST/ALT levels indicate liver inflammation or injury
- Acetaminophen can cause severe liver injury even at relatively low doses
- Alternative pain relief options should be explored under healthcare provider guidance
- The cause of elevated liver enzymes must be investigated and addressed before considering acetaminophen use, as suggested by the principles outlined in the management of acute liver failure 1.
From the Research
Liver Enzyme Levels and Tylenol Use
- The provided liver enzyme levels are AST 79 and ALT 93, which are elevated but not severely so 2.
- According to the study published in the American journal of gastroenterology, a true healthy normal ALT level ranges from 29 to 33 IU/l for males, 19 to 25 IU/l for females, and levels above this should be assessed 2.
- The degree of elevation of ALT and or AST in the clinical setting helps guide the evaluation, and the presence of an elevated ALT has been associated with increased liver-related mortality 2.
Tylenol and Liver Damage
- Acetaminophen (APAP) toxicity can cause liver damage, and elevations in AST and ALT levels indicate hepatic toxicity 3, 4.
- A case report published in the American journal of therapeutics describes a patient who developed moderate liver enzyme elevation after an acute APAP overdose, despite an initial undetectable APAP level and normal liver enzymes 3.
- The AST/ALT ratio can indicate recovery after acute paracetamol poisoning, with an AST/ALT ratio less than or equal to 0.4 being highly predictive of recovery in patients treated with N-acetylcysteine 4.
Guidance on Tylenol Use with Elevated Liver Enzymes
- There is no direct evidence in the provided studies to suggest that Tylenol can be safely taken with AST/ALT levels of 79 and 93.
- However, the studies suggest that patients with elevated liver enzymes should be evaluated for underlying liver disease and that the use of APAP should be approached with caution in these patients 5, 2.
- It is recommended that patients with abnormal liver chemistries should be assessed by a clinician to determine the underlying cause and to guide treatment decisions 2.