Q: My sister has advanced hormone receptive breast cancer with extensive liver mets. We’d like to try DCA, my only concern is as her liver isn’t in a great way is it safe to take? My worry is liver failure. Unfortunately, we can’t get it via IV in the UK. I’d be greateful for any information. Kind regards, Reena T. A: Hello, Reena! Is your sister on Tamoxifen? (If yes, read this article - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5312350/. Tamoxifen + DCA can have a synergistic effect) From our narrow knowledge, we haven't encountered anyone who took DCA and experienced liver problems. However, I would approach this treatment option with relative caution and maybe try lower than medium doses due to existing liver damage. There have been no deaths related to DCA usage and you can find all of the side effects in this article: https://www.dcaguide.org/dca-safety-and-side-effects.This is what we've the article mentions regarding DCA and liver function: ▪ Mild liver enzyme (AST, ALT, GGT) elevation, without symptoms. A majority of medications can cause mild liver enzyme changes in the blood. DCA can cause minimal liver AST,ALT, GGT elevations (about 50 – 60 U/l) for 1 % of the patients. These little alterations should not cause any worries. A more acute and bigger liver enzyme increase can be caused by antibiotics, Tyenol/Paracetamol (acetaminophen), certain types of medicinal herbs and birth control pills. (Ref.) ▪ DCA and the liver. In case of liver failure and severe jaundice don’t use high doses of DCA, because Sodium dichloroacetate is metabolised in the liver. In situations like these, DCA should be administered intravenously and not through the mouth. If the patient experiences AST and ALT or bilirubin elevation by 150% from the upper reference norm, a pause should be made (Ref.)" If I was in your situation, I would check her liver function with liver enzyme blood test. I wouldn't take DCA if AST or ALT were higher than 100 U/l. Elevated Bilirubin can also be a red flag in this situation. All in all, she could use the oral form DCA orally, just in lower quantities, such as 10 - 20 mg/kg DCA daily. I/V DCA injections are difficult to find in the UK and are mostly given in Canada and Germany. We hope we shed some light on your question.