Warning about a low probability event: adverse liver reaction to GLP-1 drug

[rsmith]

What am I missing? Why are you surprised by your lipids increasing when you stopped a lipid lowering medication?

Since starting GLPs and the like (e.g., cagri), I've been taken off of 2 hypertensives and had another one reduced by 2/3. Blood pressure has dropped and labs are improving dramatically as well. So the triple increase in LDL was somewhat of a surprise although it's likely a "rebound" effect rather than anything to worry about. The Survo I'm titrating up at present will hopefully bring that back down via the glucagon component.

 

[keangkong]

Am I correct that the blood testing results below, along with the dates of drug stops and starts, indicates that reta is likely causing liver problems? By the way, I don't plan on resuming Lipitor (atorvastatin) since I already had elevated enzymes while on it. I intend to speak with my cardiologist about pitavastatin, a statin that is less likely to cause liver problems. The rapid decline in liver enzymes after I stopped taking reta and Lipitor looks good. However, the rapid rise in liver enzymes after I resumed reta (at a tiny dose) look bad. These results are troubling since tirz alone was not getting me to a weight that I wanted to be. Still a slightly heavier me is better than a messed up liver.

 

[rsmith]

Am I correct that the blood testing results below, along with the dates of drug stops and starts, indicates that reta is likely causing liver problems? By the way, I don't plan on resuming Lipitor (atorvastatin) since I already had elevated enzymes while on it. I intend to speak with my cardiologist about pitavastatin, a statin that is less likely to cause liver problems. The rapid decline in liver enzymes after I stopped taking reta and Lipitor looks good. However, the rapid rise in liver enzymes after I resumed reta (at a tiny dose) look bad. These results are troubling since tirz alone was not getting me to a weight that I wanted to be. Still a slightly heavier me is better than a messed up liver.

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It's too early to tell if Reta is your problem. Take it for at least 3 more weeks.

Also and importantly, since you're also still taking Tirz, it might be the Tirz X Reta interaction that is causing the liver enzymes to go up. Only way to know it to stop the Tirz, continue the Reta solo and see what happens over at least 1 month. Please keep us up to date.

 

[keangkong]

It's too early to tell if Reta is your problem. Take it for at least 3 more weeks.

Also and importantly, since you're also still taking Tirz, it might be the Tirz X Reta interaction that is causing the liver enzymes to go up. Only way to know it to stop the Tirz, continue the Reta solo and see what happens over at least 1 month. Please keep us up to date.

I didn't follow your good advice. Instead I stopped reta again.

After reading some of the case reports from LiverTox after I spoke to you and had again stopped reta, I realized that there is a weirdness and almost randomness to how liver enzyme values change. To know whether the changes are significant enough to show that something is or is not a likely or probable cause of liver injury, I need to use the RUCAM calculator, the tool most often employed by researchers in determining whether something has caused a drug induced liver injury.

The reason I didn't follow your advice and keep taking the retatrutide is that I was worried about my liver. If I had a doctor advising me who would say that it would be fine to keep taking reta, I would have done so. But my hepatologist is not such a person even though he previously (with less data that I showed you) concluded that reta is probably not the cause of the elevated enzymes. I plan on staying off the retatrutide and the Lipitor until my liver enzyme levels are completely within the normal zone. That might not ever happen since my liver enzymes have been at least somewhat elevated since 2011, when my record of liver enzyme tests begins. However, I suspect being off of both Lipitor and retatrutide, there is at least a 50% chance of obtaining normal liver enzymes. If the liver enzymes return completely to normal, I'll restart reta. I'd stay on it unless any liver enzymes rose to a level of three times the upper limit of normal or higher, or unless I experienced sustained elevated liver enzymes even if below three times the upper limit of normal. In this post, I used the term "liver enzymes" to mean actual liver enzymes or bilirubin, which is not a liver enzyme, I think.

The technical information I provided may convince some that I know what I'm talking about. I am an excellent researcher. However, my Achille's heel is that I know very little about the hard sciences. Without a background in what I write about, it's quite easy for me to make mistakes when writing about things about which I do not know.

 

[MsGizmo]

Am I correct that the blood testing results below, along with the dates of drug stops and starts, indicates that reta is likely causing liver problems? By the way, I don't plan on resuming Lipitor (atorvastatin) since I already had elevated enzymes while on it. I intend to speak with my cardiologist about pitavastatin, a statin that is less likely to cause liver problems. The rapid decline in liver enzymes after I stopped taking reta and Lipitor looks good. However, the rapid rise in liver enzymes after I resumed reta (at a tiny dose) look bad. These results are troubling since tirz alone was not getting me to a weight that I wanted to be. Still a slightly heavier me is better than a messed up liver.

I assume that all those tests happened in conjunction to doctor visit .. is it possible that there might be matching weigh-ins to see how your weight loss plays into it?

* For the record I am absolutely NOT trying to imply that you are making the wrong choice in stopping reta or down playing the seriousness of potential liver damage. As a person who is also taking reta I want a more complete picture of the risks I might be taking.