Question
I was on Methotrexate w/Plaquenil for about 4 months and was feeling great on it however my ALT, AST, and ALP started to elevate. I was taken off the Plaquenil but they were still abnormal. I was taken off everything and tested again, my ALT and AST are normal but my ALP is still elevated. I am now back to just Plaquenil. Is it really true that I can’t tolerate the Methotrexate ever? Will my ALP return to normal on its own?
Answer
Likely, methotrexate is the cause of the elevated liver tests. Many patients with elevated liver tests on methotrexate will tolerate a lower dose. Of course there are many causes of abnormal liver tests and if it is unclear, it may be worth a another trial of methotrexate with careful monitoring.
