Very high liver enzymes

@lisw - Those are very good questions to ask your doctor. I'm not sure what the next step is, but first they will wait for your liver enzymes to drop into the normal range, then restart meds one at a time to see which one caused the increase. There are a number of people here who have had to stop either rifampin/rifabutin or ethambutol due to side effects, and continue treatment with just two drugs.
Sue

I started Azithromycin, Ethambutol and Rifampin in January. My bloodwork in February had elevated liver enzymes along with other elevations which was scary but my Doctors did not take me off anything because by March all bloodwork was back in normal range and has continued to do so. Since these medications are hard on the body it can take a little getting used to.

Just a thought, there are many other drugs or even supplements that can raise liver enzymes especially if taken along with the certain antibiotics. Tylenol and of course alcohol in any form are common ones with that potential. Bill

Thanks for your comments but doc had me immediately stop all meds because of dangerously high levels--not just scary.

Thanks, but I am extremely careful. I don’t touch alcohol, Tylenol or anything that can remotely affect my liver enzymes.

FYI, There is a 2 vs 3 trial ..
https://connect.mayoclinic.org/discussion/are-you-considering-antibiotics-for-a-mac-lung-infection/

Thanks for your suggestion. I considered that prior to beginning treatment. Now don't qualify for the trial since I have begun treatment with three drugs but not precluded from switching to a two drug regimen on my own. Plan to discuss with my physician this coming week after new lab results Tuesday. Sounds like there aren't any good alternative drugs, but will explore that with doc also.

I’m new to this group, but I searched for liver disease and this thread came up. I have bronchiectasis and MAC and multiple myeloma. Many drugs I’ve been prescribed cause my liver enzymes to go very high. About 8 years ago I had a liver biopsy which showed Nodular Regenerative Hyperplasia. It’s extremely rare, and nothing much can be done except to carefully watch my LFTs and stop the offending drug. The Mayo hepatologist told me that I needn’t worry unless my LFTs don’t return to a more acceptable range. I always run 50-100% of the high normal, and I was told the threshold for concern was 3 times high normal (15 times high normal would send me screaming to the ER!). Treatment would be a shunt.

Your liver enzymes include alkaline phosphatase (ALP), alanine transaminase (ALT), aspartate aminotransferase (AST) and gamma-glutamyl transferase (GGT).
My alkaline phosphatase runs mostly high, in your range, for years while the others have been normal so the Dr's are not too concerned. I watch my tylenol intake.