Q. I am a 53-year-old female who has had elevated liver enzyme levels for several years.

A recent liver biopsy came back "steatohepatitis," and my doctor said I have "a mild fatty infiltration of the liver."

Can you tell me in layperson's terms what this means?

Should I be concerned?

A. Your doctor gave you a rough translation of the Latin steatohepatitis, meaning fat (steato) deposition and an inflammation of the liver (hepatitis).

A liver can become inflamed (that is, injured and irritated) for a number of reasons, commonly from alcohol, viruses (such as hepatitis A), and, in your case, an abnormal metabolism of sugar and cholesterol. While the exact cause of steatohepatitis is not clear, obesity and diabetes can be instigators.

Physician Walter Hogan, a professor of gastroenterology at the Medical College of Wisconsin, tells me that steatohepatitis is one of the most rapidly growing liver problems in the country.

Yet he said most people with steatohepatitis do not develop frank liver failure and, in particular, the results of your liver biopsy are reassuring because you did not describe structural abnormalities of the liver, only the inflammation. Still, steatohepatitis progresses to cirrhosis in quite a few people (about 10% to 20% over the course of seven years).

The treatment for steatohepatitis is a gradual weight loss to normal weight, physical activity, and control of diabetes (if present) and high cholesterol. Weight loss does improve liver function and reduce further liver injury.

Q. My dentist told me to get an "over-the-counter" brand-name pain reliever for a toothache. But when I compared the store brand to the brand-name, the price was better and all the ingredients and the dose were exactly the same. My daughter says I should have gotten the brand name.

Does it really make any difference?

A. No. Generic medications, whether prescription or non- prescription, must pass the same safety and efficacy standards issued by the FDA. By law, the generic product must be the same dose and deliver the same amount of active ingredient in the same amount of time as the brand-name product this is called "bioequivalence."

In a recent study comparing more than 270 medications, the average difference in bioequivalence between generic and brand- names was 3.5%, about the same difference between batches of brand- name products.

Generic products are cheaper because manufacturers of brand-name medications pass on their cost of research, development, marketing and promotion.

Once a medication is off-patent or on the market about 17 years a competing pharmaceutical company can copy the medication with comparatively little effort.

Brand-name products do differ from generics in pill shape, color, taste and inactive ingredients.

But the active ingredient, the important piece, is the same.

Q. For years, I had been on enalapril for my blood pressure.

Recently, I needed a second medication, so my doctor instead prescribed the combination medication Benicar HCT 40/25mg.

This medication seemed to give me leg cramps, so my doctor changed it to two tablets of Diovan HCT 160/12.5mg. I still had leg cramps.

On studying these medications, I noted they have the same amount of hydrochlorothiazide, so I tried taking one tablet of the Diovan HCT. But still I am troubled with leg cramps.

Any suggestions?

A. Hydrochlorothiazide, often abbreviated HCTZ, can cause leg cramps by depleting potassium stores.

The first thing to do would be to check your potassium and look for other (non-drug-related) causes of leg cramps. If the HCTZ is the culprit, you can either supplement your diet with potassium- rich foods such as tomato or orange juice, take a potassium tablet, or switch to another kind of blood pressure medication.

It's easier to sort out whether a medication is causing an adverse effect, such as leg cramps, if only one new medication is started at a time.

I'm not sure why your doctor substituted your enalapril, which is a generic medication, for the more expensive brand names of Benicar and Diovan, which are not in the same medication class as enalapril but are close cousins.

Sometimes it's more convenient to take a combination medication, instead of two different pills. In that case, a logical choice for a new prescription for you would have been enalapril-HCTZ.

There are literally dozens of blood pressure medications.

I'm sure you can work with your doctor to find the right prescription for you.

Julie Mitchell is an assistant professor of medicine at the Medical College of Wisconsin. Send questions to her at: Medical College of Wisconsin Physicians & Clinics, 9200 W. Wisconsin Ave., Milwaukee, WI 53226 or via e-mail at drjulie@mcw.edu.

Medical College of Wisconsin

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Copyright 2005 Journal Sentinel Inc. Note: This notice does not apply to those news items already copyrighted and received through wire services or other media
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