Liver enzymes and Depakote

[Kansas Educator]

As many of you know, I was placed on Depakote ER last Oct. after a partial seizure diagnosis. I started out at 500 mg. and eventually went up to 1000 mg. to get me in the therapeutic range. I was doing and feeling great (no seizures at all) until this week when I really started to have some digestive issues (nausea, bloating, etc.). My neurologist ran a CBC, CMP and Depakote level check. The Depakote is fine -- within therapeutic levels but not too high. The CBC showed a slightly high hemoglobin and hematocrit sound and a slightly low platelet count and two of the liver enzymes were elevated about 3X normal on the CMP. I am to go back in after a month for a recheck but, being the worrier I am, it's going to be a long month. I know Depakote can cause elevated liver enzymes. Should I be worried and is a month too long to wait.

[Meetz1064]

no, a month isn't too long a wait.

HOWEVER: IF you start to have a lot of edema, call your doctor, and get in again, ASAP. THAT was why I was pulled off Depakote. I suddenly out of nowhere bloated so badly, I looked like a tree.....edema was HORRIBLE. I couldn't bend my fingers or toes. As soon as I went off, weight started disappearing, and so did the edema.......

[Kansas Educator]

If I end up having to discontinue the Depakote in a month, will my liver enzymes return to normal or is this permanent damage? Thanks.

Roxie

[RobinN]

Listen to your body. "Normal levels" might not be right for your system.
Organic lemon juice in water, helps to flush the liver of toxins.

Here is some information that I found on the liver. It helped me to understand what was happening.
Liver Health

[Kansas Educator]

I will be drinking lots of water with lemon juice for sure -- have some organic juice in the fridge right now and are going to go get it right away.

I'm also contemplating lowering my Depakote dosage to 500 mg. ER from the 1000. I know you're not supposed to do that and my levels supposedly weren't high enough before which is why is was raised. However, I didn't have any seizures on 500 mg. either (although mine are pretty infrequent anyway).

I'm also wondering if some anti-inflammatory medicine I was taking for arthritis (500 mg. nabumetone) might have just put me in overload. I quit taking that too so I guess I'll just hurt. This is a bummer and I thought I was doing so well.

[Kansas Educator]

Well, I went back to have my blood work done again. My neurologist's office called and said that, while my liver enzymes were still elevated, they were "stable," which I guess means they aren't going up higher. So now I am to just hold steady and get my blood taken again the first of May. Do they ever just finally go down eventually and is that what the neurologist is hoping for? I'm still kind of nervous about going another two months with elevated liver enzymes. Can someone give me some reassurance or advice?

[elizabeth2021]

If it helps to ease your mind somewhat my hubby was taking an anti-inflammatory med. long term and had a high hemoglobin and hematocrit level as well as elevated liver enzymes that showed up on his last routine blood work. (other than arthritis) he has no medical issues. He was taken off the med for 2 months. Blood work was re-done and everything was okay. Started a different anti-inflammatory and blood work is fine. I know that your situation is very different but thought this might be of interest to you.(excellent advise from meetz for watch for edema i agree horrible and dangerous). Hope everything turns out ok for you.

[Kansas Educator]

Thanks Elizabeth. That is helpful!.......................... Roxie

[brain]

Never was on Dopey-kote long enough to
experience much of anything except falling
asleep ...



They had me on, then had me off as if they
weren't sure exactly what to do here ...

[skillefer]

Hey Kansas! Just remember, it takes time for your blood to be replaced by your system and that it also takes time for meds to exit your system. Yes, you'd like everything to return to normal immediately, but when dealing with the human body, it usually doesn't. A month is about the right time for all that to take place, and most likely, your levels will return to normal. Just stay away from the 3 o'clock martinis.

[Kansas Educator]

Skilly,

Is this likely to happen even though they are keeping me on the Depakote ER for now? They didn't change meds -- just want me to come back in in early May for another blood test. The stomach upset seems to be going away though.

[drarvindr]

Hi KE,
I'm on depakote 500mg thrice a day and have a similar blood profile. It is to be expected with valproate. Things you should watch out for are:
Key signs of liver failure
1) asterixis : tremors in your hand on flexing your wrist ("flapping" hand tremors)
2)sspider naevi : spider like reddish rashes around your neck and upper chest which blanch when you apply pressure on them
3) menstrual irregularities (if applicable)
4) Jaundice (look at your sclerae {white part of your eye} in the sunlight and see if they are yellowed
5) hepatomegaly : enlarged liver
6) mental changes (hepatic encephalopathy)

Should you have one or more of the following , get yourself checked out earlier or else you can wait the month and repeat the tests

P.S. do you smoke ? increased HB and Hct are also sometimes due to smoking

[Kansas Educator]

Never have smoked or lived in a house with anyone who does. Your information was great Dr. and I thank you for it.