Can a Doctor Decline Your Valtrex Prescription?

Long story short, my doc thinks my elevated liver enzymes might have something to do with my daily Valtrex prescription and mentioned something about taking me off Valtrex if the blood test results come back high.

Needless to say, this is not something I want. I like to be able to take prevantive Valtrex.

I've done research and I can't find anything that would link high liver enzyme issues with Valtrex. Is the doctor really allowed to do this? What can I do if the doc decides to cut melt Valtrex prescription?

I've found several websites stating that Valtrex can cause issues with the liver. I've included just one of them... And yes, doctors are definitely allowed to do that. Maybe talk with the doctor and find out if there are other options?

http://justherpes.com/commercial-remedies/valtrex-side-effects-valocyclovir/

"The dosage for daily suppressive therapy is one gram per day. Two grams are taken only when there is an active outbreak. However, daily use is too much for some people who are concerned about the effect of such a heavy dose on the liver, since that is where Valtrex is processed. Therefore they only take it when they have an outbreak. Liver damage can show up as inflammation of the liver, abnormal enzymes, or hepatitis. (It’s generally agreed that no one should take Valtrex forever, especially not in high doses.)"

That link doesn't provide any studies that show a direct link between liver damage and Valtrex usage.

Show me the study that demonstrates a direct link between Valtrex and Liver damage. Just because you take something everyday doesn't meant it is guaranteed to damage your liver. I've been on Valtrex for a couple years and it didn't elevate my liver levels before. I believe there are others here who have the same experience.

https://livertox.nih.gov/Valacyclovir.htm

Here is a link that has a study that showed:

"No instances of acute liver failure or chronic liver injury have been linked to valacyclovir use. The liver injury associated with valacyclovir is usually mild and resolves rapidly. There is no information on possible cross sensivity of hepatic injury among the various nucleoside analogues used to treat herpes virus infections."

Here's another link that tackles the question of Valtrex and the liver head on. It says that Valtrex can affect some readings of liver levels but not damage it:

http://projectaccept.org/how-to-read-your-patient-medication-labels/

“Is Valtrex Bad for my Liver?”

Let’s face it. Technical stuff can be a bit confusing. Medical technical stuff can be even worse. Many people have a hard time deciphering their medicine labels and much misinformation and is spread as a result. We’ve dissected the entire US Valtrex manual, including the patient label, so that you can better understand it.

We often hear claims on the Internet that Valtrex can cause “severe liver damage”. This is untrue. That isn’t an opinion; it’s a proven fact. Not only has it not been shown to cause “severe liver damage”, but with dozens of millions patients worldwide, it hasn’t shown to be the cause severe liver damage or liver failure in anyone. The only thing it has been shown to do is:

A: raise ALT levels temporarily in certain populations (the elderly, small children and HIV+ patients)

B: alter the readings of liver and kidney tests, as Valtrex does have a numerical impact on the very same markers which liver and kidney tests use to determine function.

That said, people who have existing kidney disease, or are in high-risk groups for kidney disease, should speak with their doctor about whether or not Valtrex is right for them. There is no such recommendation for those with liver issues. In fact, no adjustment in dosage is recommend for anyone , even those with existing liver disease. (Please read the full article to see detailed reasons and precautions regarding Valtrex)

How about getting a second opinion from another doctor about the cause of the elevated liver enzymes? Maybe that doc would be willing to write you a prescription. Or, if that doesn't work out, maybe compromise and agree to go off Valtrex for one month and retest to see if there's a change?

I understand what you're saying, @hippyherpy. There's no guarantee that the medication is what's causing the rise in liver enzymes. There's also no guarantee that it isn't. Usually, when there aren't enough people who experience certain adverse effects, they see no need to conduct studies. This could be why there aren't any to be found. @HikingGirl has some good suggestions. If I were you, I'd be asking my doctor to explore other possible reasons for the elevated liver enzymes. And if they won't, find another doctor that will. Even if the medication had been proven to cause it, that doesn't mean it *is* the medication causing it...

Seeking a second opinion with a doctor of your choosing is a very common thing for patients with complicated issues.

It would be completely reasonable for you to seek a doctor who might try cycling you onto different brands of antiviral medicine, or cycling you off to do further tests, like @HikingGirl said.

However, it is known that antivirals (like many other medications) are somewhat taxing on the liver. Lots of factors effect a healthy liver and can make it unhealthy, especially medication and diet. The most common cause of liver problems while taking medication is alcohol consumption.

Alcohol is very hard on the liver and when consumed while on a treatment plan of medication, can cause serious problems.

If you tend to drink regularly, or occasionally have a few, take your elevated liver enzymes as fair warning to cut back or abstain. Life doesn't offer fair warnings very often, and your doctor probably wants to protect you from a potentially life threatening problem. Even if you don't drink, take your liver seriously.

Good luck, and expect that any doctor you choose should be friendly, take the time to hear your concerns, and answer your questions completely. Patients are meant to walk away from a doctor's appointment feeling like they know the factors effecting them, and that the doctor has the ability to treat them.

@hippyherpy Have you heard from your doctor about your test results?