My comments are in bold. You may share any or all of my comments with your dr. I am not a physician but I don't think she would have an issue with my opinions.
"So I am now taking 20 mg of Buspar 3x a day. It works about 85%. I have days where I have to take a valium (2-6mg) just to hold it together. Once I am established at the 3x a day we are going to increase the Buspar dose."
All of those doses seem fine except the buspar dose. The 20 mg at 3 times per day is the maximum recommended dose and should not be raised above that.
"My thyroid levels are now perfect but my liver enzymes are continuing to rise. I now have to go get an ultrasound of my liver. Could the fatty liver be a result of the Cymbalta? I am sure the hypoT is, as I didn't have it at all until I weaned off Cymbalta. "
First of all I am glad the thyroid levels have returned to normal and this is typical after getting the Cymbalta out of your system.
Secondly, Cymbalta does not cause fatty liver. The most common cause of fatty liver is excessive alcohol consumption or elevated levels of cholesterol and/or triglycerides. The most likely senerio is that Cymbalta is fat soluble and would collect to higher concentrations in a fatty liver thereby increasing the risk of Cymbalta related damage to the liver. See research and warnings below on the dangers of Cymbalta to the liver.
https://www.ncbi.nlm...les/PMC4607169/
"Our findings, while not statistically significant, may suggest a higher incidence of hepatic injury other than hepatic-related death or liver failure among duloxetine initiators compared to venlafaxine and possibly SSRIs, but not untreated patients. These differences remain consistent with chance, and an elevated risk cannot be ruled in or out."
Translation - Cymbalta can effect the liver but no indication of it causing death or liver failure. This would be a typical result for many meds.
https://www.ncbi.nlm...les/PMC3773985/
"Duloxetine hepatotoxicity developed within 2 months of drug intake and led to clinically significant liver injury. A spectrum of laboratory, histological, and extra-hepatic features were noted at presentation."
Note a more serious finding compared to the above research.
http://www.fda.gov/S...n/ucm319241.htm
Note 2012 warning from FDA...
"Hepatotoxicity
⦁ Patients should be informed that severe liver problems, sometimes fatal, have been reported in patients treated with Cymbalta… "
Cymbalta is fat soluble...
From:
http://www.drugs.com/pro/cymbalta.html
"Duloxetine hydrochloride is a white to slightly brownish white solid, which is slightly soluble in water."
Note - From the structure we can see that the compound is primarily non-polar and therefore should be fat soluble.
From:
http://www.drugbank.ca/drugs/DB00476
Water Solubility = 0.00296 mg/mL (Vertually insoluble)
Note - If it is not water suluble (polar (has a negative or positive charge)) then it is non-polar (not charged) and would be lipid soluble.
From:
http://www.selleckch...l-cymbalta.html
Chemical Information
Solubility (25°C) * In vitro DMSO 67 mg/mL (200.67 mM)
Water <1 mg/mL (<1 mM)
Ethanol <1 mg/mL (<1 mM)
Note - Dissolves well in DMSO a relatively nonpolar solvent.
From:
http://toxwiki.wikis....com/Duloxetine
Soluble in dimethylformamide (nonpolar) and water.
From:
https://www.ncbi.nlm...les/PMC3299448/
Table I
Amount of Solid Lipid (fat) Required to Solubilize 20 mg of DLX and Percent Partitioning of DLX in Lipid vs Water
Solid lipid Amount (mg) % Partitioning
Glyceryl monostearates 400 92
Glyceryl behenate 700 33
Glyceryl palmitostearate 650 60
Geleol 450 60
Gelucire 44/14 800 –
From 33% to 92% lipid (fat) soluble.
Note - have you been diagnosed with fatty liver and if so to what extent? What is the results from your last lipid panel (cholesterol/triglycerides)? If you have fatty liver it is important you know these values.
"Any information you have on a connection between Cym and fatty liver would be very helpful to show my Dr. She wants me to exercise 30-60 min a day, start taking Vit E, and change to a low carb/low sugar diet. The diet is going to be next to impossible. I am allergic to a lot and with my spectrum disorder I don't like a lot of foods. I also have to eat for my gut (so things stay happy). "
Your dr suspects either cholesterol or triglyceride problems as these are typical responses to those conditions. There are various medications (with their own set of medical issues) for treating these issues. I have suffered my whole life from triglyceride levels of 1000 to 2000 (suppose to be below 200). I have lived of the low carb/low sugar high exercise diet since I was 13 and still had those numbers. In 2015 it was determined that my pancreas was 95% fat infiltrated and I had to get drastic or risk pancreatitis. I further tightened up my diet and now run 200 to 300 on triglycerides. I have considerable info on diets for this purpose. These diets for me are very difficult also as I am vegetable intolerant to many things. I have a summary of what I have been through and will post it later to give you some dietary ideas. First we need to establish you do have fatty liver and what your lipid profile is.
"My appetite is way down as well. I have increased the amount of avocado since my last blood check on my liver and my levels increased. Avocado is supposed to help lower it. So not sure about that."
"I will update again after my ultrasound."
Avacado. No medical research done on avacados on fatty liver however the monounsaturated fat in them has been shown to reduce cholesterol/triglycerides. Olive oil and safflower oil have the highest level of these good oils and are more effective at lowering cholesterol/triglycerides than the oil in avacados. Please be sure and remember that the skin and seeds of an avacado are poisonous.