Drug-induced alkaline phosphatase (raised)

There are many drugs (1,2) that may result in a raised alkaline phosphatase. It is important to consider that a medication may be the cause of an isolated raised alkaline phosphatase - but also consider other possible causes as well.

Some examples of drugs that may cause a raised alkaline phosphatase include:

• Antibiotics:
  • penicillin derivatives (1)
  • nitrofurantoin
  • erythromycin
  • aminoglycosides (1)
  • sulfonamides (2)
  • trimethoprim-sulfamethoxazole (2)
    
    
• Antiepileptic drugs:
  • Carbamazepine
  • Phenobarbital
  • Phenytoin
  • Valproic Acid
    
    
• Antihistamines:
  • Cetirizine (1)
    
    
• Cardiovascular drugs:
  • Captopril (1)
  • Diltiazem
  • Felodipine (1)
  • Verapamil (2)
  • Quinidine (2)
  • Flutamide (2)
    
    
• Disease modifying agents:
  • Penicillamine
  • Sulfa drugs (1)
  • Gold salts (2)
    
    
• Polycyclic aromatic hydrocarbons:
  • Oestrogens
  • Anabolic Steroids (2)
  • Steroids (1)
  • Methyltestosterone (2)
    
    
• Psychotropic drugs:
  • Monoamine oxidase inhibitors
  • Phenothiazines e.g. chlorpromazine (1,2)
    
    
• Diabetes drugs:
  • tolbutamide
  • chlorpropamide
  • tolazamide
    
    
• Other drugs:
  • Allopurinol
  • Methimazole
  • Disulfiram
  • Phenylbutazone

Reference:

• Shipman KE et al. Interpreting an isolated raised serum alkaline phosphatase level in an asymptomatic patient.BMJ. 2013 Apr 3;346:f976
• NHS Exeter Clinical Laboratory - Alkaline Phosphatase (Accessed 1/9/19)