Posted by Rick on June 22, 2001, at 0:00:07
In reply to Provigil (modafinil), posted by University on June 21, 2001, at 1:16:24
Were you taking anything else with the Provigil? (Getting at possible interactions here with CYP2C19 inhibitors like Celexa).
Also, were you at 200 mg all along?
I'm overdue for a liver-function test, taking not only Provigil (usually 100 mg/day), but also Serzone which is known as a strong inhibitor of certain CYP 450 liver enzymes.
There's always a chance (unless you already know otherwise) that you're a poor metabolizer of CYP2C19.
It's not uncommon for AD's and other psychotropics to cause slight elevations in liver enzymes, and infrequently substantial elevations (the latter being a problem, of course). I'm not sure where your "slightly-but noticeable" increases fits in here.
Anyway, the following Medline abstract on bupropion (Wellbutrin) liver effects in one individual -- while an extreme case -- provides food for thought:
Dig Dis Sci 2000 Sep;45(9):1872-3 Related Articles, Books
Acute hepatitis induced by bupropion.Hu KQ, Tiyyagura L, Kanel G, Redeker AG.
Department of Pathology, University of Southern California School of Medicine, Downey, USA.
As an antidepressant, bupropion is considered to be a safe agent that usually causes infrequent and mild increase of serum liver enzymes. Asymptomatic elevation of serum transaminases was previously reported only in a single case. We describe a patient who developed typical acute hepatitis after receiving six weeks of bupropion for depression. His presentation was characterized with acute onset of symptoms associated with significantly elevated ALT, AST, and LDH and acute hepatic inflammation. The clinical course of our patient, including incubation period, pattern of liver enzyme elevation, and time of recovery, was similar to, but much more severe than, the case reported by Oslin and Duffy. Discontinuation of bupropion was followed by a rapid resolution of clinical symptoms and liver enzymes. The incidence of bupropion-induced hepatitis remains to be defined even though it appears to be relatively low. Since the clinical application of bupropion is broader, we must be aware of the clinical entity of bupropion-induced hepatitis.
> FYI, I have been taking Provigil (about 2oomg/prn) for about a year.
>
> Recently, I had a complete physical exam for a new job I took--and my liver enzymes were slightly--but noticably--elavated. Both sgot and alt.
>
> I abstained from Provigil, had a hep C test, which was negative, and retested my enzymes in a month. Both readings were back to normal.
>
> Modafinil was hailed as the first new antinarcoleptic in decades--and one that wasn't hard on the liver.
>
> Anyone taking it would do well to have periodic liver function bloodwork done. Pemoline was supposed to be easy on the liver too...
>
> JM
poster:Rick
thread:67329
URL: http://www.dr-bob.org/babble/20010618/msgs/67438.html