Anyone experience a rise in liver enzymes with imuran/azathiaprone?

I have been on Azathioprine for over 3 years, I started on 50mg twice a day. When my doctor increased it by 25mg, I had elevated liver enzymes, so I went back to 50mg twice a day. After a period of time he again tried to increase it by 25mg, and my liver enzymes were elevated. I am currently on 50mg twice a day with no liver issues.
I am being treated for Dermatomyositis which is an autoimmune disease.
Take Care,
Kathryn

Thank you for sharing this; this is really helpful!

Hello humbug, I was diagnosed with autoimmune hepatitis back in July of 2021. I have been on azathioprine since my diagnosis along with prednisone treatments on and off. My doctor just took me off of the azathioprine last week stating that it is not working. He has prescribed budesinide to replace the prednisone and after 3 weeks off the azathioprine he has prescribed mycophenolate to replace the azathioprine. So I guess my answer to your question would be yes, although it is not clear whether or not it is the medication or the disease that is causing the elevated liver tests. I also have celiac disease and find that disease much easier to understand and take control of. I avoid gluten and all is great. However, I find it extremely difficult to wrap my head around autoimmune hepatitis. I just don’t understand why I’m constantly uncomfortable on both sides of my abdomen not just the right side and other than my basic liver enzyme labs being out of range, there are no indications via lab work that anything is wrong. I had a CT scan with contrast and it was marked as unremarkable. I don’t understand how there is no indication of inflammation when I am so uncomfortable. I had an igg4 test done and it too came back normal. Absolutely mind boggling. If my immune system is attacking my liver who’s to say that it can’t be attacking anything else in my body. Not knowing what the trigger is and how to avoid the discomfort is utterly frustrating. It is also difficult to decipher what symptoms are side effects of the medication I’m on and what symptoms are a result of the disease itself. I also have pain in my muscles and joints. Gripping things with a certain strength feels like I am spraining my hands. I find it difficult to get detailed information from my doctor without feeling like I’m a hypochondriac. I’m hoping this support group site can provide some clarity. If this new treatment plan helps I will surely let you know. Good luck to you!

Autoimmune diseases are very common and often complex. Elevation of liver enzymes is a common side effect of Imuran, but also the AI hepatitis. The best way to assess disease vs medicine effect is to compare enzyme levels before treatment to levels after treatment. This can show a fluctuating baseline from the disease during diagnosis testing, the look at the levels a month or more after treatment started. It’s not easy as dates need to be accurate as to when drug was started. Labcorp results show a graph if you look at “trends “ on your Labcorp patient portal. Quest may have the same, i just don’t know.
The inflammation is microscopic and may not be severe enough to show up on imaging like CT scans. I hope that helps you and you feel better.

Hi Nononanette,
I feel exactly like you do in terms of being frustrated in not knowing what my triggers might be for autoimmune hepatitis. As you say, it is difficult to avoid something when you don't know what that something is!
Celiac has been ruled out in my case, however.
Sorry to hear that you have abdominal discomfort; I really hope they are able to figure out exactly where that is coming from. I am completely asymptomatic at this point and always have been, even with a confirmed diagnosis of advanced fibrosis due to autoimmune hepatitis.
My follow up is at the end of March, and given that they upped my Imuran dosage, I suspect at that visit, they should be able to know whether Imuran raised my enzymes which were actually going down rapidly prior to me starting that drug. But, I don't believe my liver specialist would double my dosage of Imuran if he felt that was the cause of the spike. I guess I'll find out in March.
Yes, do share any updates on your medication tweaks!
Wishing you well also, and hope things improve for you!

Thanks, slkanowitz!
I really appreciate your comment!
Yes, this is the issue. Is it the disease or the Imuran.
My enzymes were rapidly trending downwards after three weeks on prednisone alone, but with the addition of 50 mg of Imuran for 5 weeks, they rose. I think I'll know at my follow-up appointment at the end of March whether my liver doesn't like the Imuran, given that they doubled the dose. This, I would think establishes a pretty clear link between Imuran and spiking enzymes. My doctor never mentioned a possible link, and I totally forgot to ask.
I'm hoping it was just a transient spike.

My AST was about 40 higher than the 35 it should be after being on prednisone for a couple years. The doctor added imuran and it went up to 70. Took me off of it after only a couple weeks and it slowly went back down to in the 40s back to just prednisone but remained high. Sent me to a liver doctor and the hepatologist did several noninvasive tests, determined no cirrhosis, but mildly fatty liver. Told to avoid alcohol. I was never a heavy drinker, but I miss my Glass or 2 of wine a week, but every now and then I splurge. Per Dr the steroid caused my liver issue.

I have AIED and Acid Reflux. My liver enzyme labs were normal the day I started taking 50 mg Azathioprine (October 1, 2024). 14 days later, I increased the dosage to 100 mg, 14 days later my labs were ok so I increased to 150 mg. Immediately after increasing to 150mg Azathioprine, my acid reflux became worse, my eczema flared, caught a bad cold it took a month to get rid of, and I began to have stomach discomfort, pain, constipation, gas pains, and amber colored urine. Labs showed elevated liver enzymes after 3 weeks on 150 mg so I immediately stopped Azathioprine for 3 days then started back at 100mg. My stomach discomfort etc went away and my liver enzymes are normal again and have remained normal. After taking Pantoprazole 40 mg for several years for Acid Reflux, my fingers and toes began to tingle and go numb. I switched to Omeprazole 20 mg 2 x day and the numbness went away. After taking Omeprazole for a year, the numbness is coming back so I am trying to reduce the amount of this medicine I take and may try to change to a different acid reflux medicine to see if it helps.