▁and ▁death . ▁Based ▁on ▁the ▁number ▁of ▁pres cri ptions ▁written ▁and ▁the ▁number ▁of ▁cases ▁reported ▁in ▁the ▁Med Watch ▁database , ▁the ▁rate ▁of ▁serious ▁he pat ot ox icity ▁associated ▁with ▁fl ut am ide ▁treatment ▁was ▁estimated ▁in ▁ 1 9 9 6 ▁as ▁approximately ▁ 0 . 0 3 % ▁( 3 ▁per ▁ 1 0 , 0 0 0 ). ▁However , ▁other ▁research ▁has ▁suggested ▁that ▁the ▁true ▁inc idence ▁of ▁significant ▁he pat ot ox icity ▁with ▁fl ut am ide ▁may ▁be ▁much ▁greater , ▁as ▁high ▁as ▁ 0 . 1 8 ▁to ▁ 1 0 %. ▁ ▁Fl ut am ide ▁is ▁also ▁associated ▁with ▁li ver ▁en zym e ▁elev ations ▁in ▁up ▁to ▁ 4 2 ▁to ▁ 6 2 % ▁of ▁patients , ▁although ▁marked ▁elev ations ▁in ▁li ver ▁en zym es ▁( above ▁ 5   times ▁upper ▁normal ▁limit ) ▁occur ▁only ▁in ▁ 3 ▁to ▁ 5 %. ▁The ▁risk ▁of ▁he pat ot ox icity ▁with ▁fl ut am ide ▁treatment ▁is ▁far ▁higher ▁than ▁with ▁nil ut am ide ▁or ▁b ical ut am ide . ▁Lower ▁dos ages ▁of ▁the ▁medic ation ▁appear ▁to ▁have ▁a ▁reduced ▁but ▁still ▁significant ▁risk . ▁Liver ▁function ▁should ▁be ▁monitor ed ▁regularly ▁with ▁li ver ▁function ▁tests ▁during ▁fl ut am ide ▁treatment . ▁In ▁addition , ▁due ▁to ▁the ▁high ▁risk ▁of ▁serious ▁he pat ot ox icity , ▁fl ut am ide