So a bit has happened since last time I posted. My primary care physician ordered liver blood testing after seeing my blood test from a few weeks prior and a liver ultrasound. Everything is normal! Alkaline Phosphate has went back down ( although higher then when I started ).
I attached all the liver blood work I have had done for reference, in case anyone wants more detail.
I had the second blood test a few days after going up to 40mg, it seems it took a few weeks for my liver to adapt to the increase. The first, bottom most blood test is from a few days prior to treatment and the last one was taken around a week ago.
During my meeting with the dermatologist he increased my dosage to 60 mg and switched me to a mail order pharmacy called Direct Success, sounds kind of ghetto, but as long as it works. The "pharmacy" sent me Zenatane, a drug manufactured in India. From my research, there have been many quality control issues from various drugs manufactured in India last year, I hope the manufacture is trustworthy.