People with Gilbert’s Syndrome should avoid drugs that inhibit the UGT enzyme or that are metabolized in the liver in the same pathway used to process bilirubin. You can read more bout how exactly GS affects your liver function HERE. The main drugs to be avoided include:
- Atazanavir (Reyataz®) and indinavir (Crixivan®), which are both used to treat HIV infection.
- Gemfibrozil (Lopid®), a drug used to lower cholesterol.
- Irinotecan (Camptosar®), a drug used to treat advanced bowel cancer.
- Statins, also used for reducing cholesterol, when taken with gemfibrozil.
- Nilotinib, for the treatment of some blood cancers.
- Paracetamol (acetominophen)
Statins are partly metabolized by UGT enzyme, so one should consult his/her doctor before taking these medications if they have Gilbert’s Syndrome to avoid any adverse effects.
Although paracetamol is also partly metabolised by UGT, some people with Gilbert’s syndrome do remove it more slowly from the body and puts these individuals at a greater risk of developing paracetamol toxicity. So it may be better to use another pain killer when necessary.
Anesthetics like morphine should also be avoided in Gilbert syndrome cases when they are prepared for surgery. Morphine has been known to cause prolonged anesthetic effect on individuals with Gilbert’s Syndrome, since it is also metabolized in liver by glucuronidation, but with different isoform of UGT enzyme. There are still conflicting studies regarding the effects of morphine in Gilbert syndrome cases, so it should be best avoided as a precaution, incase told otherwise.
Other drugs that are processed by glucuronidation include codeine, temazepam and testosterone.
Certain herbal supplements including cranberry, gingko biloba, hawthorn, noni, soy, grape seed, milk thistle, valerian and green tea are rich in chemicals that can modulate UGT enzyme; however, there interaction is not well understood. It is best to consult a doctor before taking any medication or herbal supplements to avoid any side effect or adverse effect.
Gilbert's Syndrome 