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Medications for Cirrhosis

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Main Page | Risk Factors | Symptoms | Diagnosis | Treatment | Screening | Reducing Your Risk | Talking to Your Doctor | Living With Cirrhosis | Resource Guide

The information provided here is meant to give you a general idea about each of the medications listed below. Only the most general side effects are included. Ask your doctor if you need to take any special precautions. Use each of these medications as recommended by your doctor, or according to the instructions provided. If you have further questions about usage or side effects, contact your doctor.

Although cirrhosis cannot be cured, your doctor may prescribe several medications to treat your cirrhosis. These drugs may help control the cause of the cirrhosis and prevent additional liver damage. Or they may be aimed at treating symptoms and complications.

Prescription Medications

Medications to Treat the Causes of Cirrhosis

Alcohol-related

  • Disulfiram
  • Naltrexone
  • Acamprosate

Antiviral Medications

Corticosteroids

  • Prednisone
  • Prednisone and Azathioprine

Metal Chelating Agents

  • Penicillamine
  • Trientine
  • Deferoxamine

Medications to Treat the Complications of Cirrhosis

Antibiotics

  • Ciprofloxacin
  • Norofloxacin
  • Ceftriaxone
  • Ofloxacin
  • Amoxicillin-clavulanate

Vitamin K

  • Phytonadione

Blood Coagulation

  • Fresh frozen plasma
  • Platelet transfusion
  • Blood clotting factors
  • Desmopressin (DDAVP)

Diuretics

  • Bumetanide
  • Furosemide
  • Hydrochlorothiazide
  • Chlorothiazide
  • Amiloride
  • Triamterene
  • Spironolactone

Bleeding from Varices

  • Octreotide

Beta Blockers

  • Atenolol
  • Metoprolol
  • Nadolol
  • Propranolol
  • Timolol

Laxatives

  • Beta-galactosidofructose

Over-the-Counter Medications

Multivitamin and Mineral Supplements

Prescription Medications

Medications to Treat the Causes of Cirrhosis

Alcohol-related

Common names include:

  • Disulfiram
  • Naltrexone
  • Acamprosate

These three drugs are FDA approved for the treatment of alcohol abuse. If you drink while on disulfiram, you will experience a negative reaction or hangover symptoms which are far worse than the usual hangover symptoms. These symptoms might include headache, nausea, confusion, and uneasiness. Naltrexone reduces the craving for alcohol. Acamprosate reduces both the physical and emotional distress associated with quitting drinking, such as less sweating, sleep disturbance, and anxiety.

Possible side effects include:

  • Drowsiness
  • Erectile dysfunction
  • Headache
  • Mood changes
  • Peripheral neuropathy
  • Psychosis
  • Abdominal cramps
  • Dermatitis
  • Insomnia
  • Muscle pain
  • Rash
  • Vomiting
  • Diarrhea
  • Intense itching

Antiviral Medications

Examples of antiviral medications include:

  • Interferons
  • Protease inhibitors
  • Reverse transcriptase inhibitors

Chronic viral hepatitis B and C may respond to treatment with antiviral medications. These may include interferon for hepatitis B and C. A combination of interferon and ribavirin is used for hepatitis C.

For hepatitis C, combination therapy consistently yields higher rates of sustained response compared to treatment with just one drug. For example, interferon is given subcutaneously once every week. Ribavirin is an oral antiviral agent that is given twice a day. The US Food and Drug Administration is in the process of investigating several new hepatitis treatments. If you have any questions about them, call your doctor to discuss them.

Lamivudine, tenofivir, adefovir, entecavir, and telbivudine are used to treat hepatitis B infection. It is usually provided in an oral form that is taken once a day for a year or more. Sometimes these drugs are combined with interferon.

Possible side effects include:

  • Abdominal or stomach pain (severe)
  • Feeling of fullness
  • Nausea
  • Tingling, burning, numbness, or pain in the hands, arms, feet, or legs
  • Flu-like symptoms, such as fever, body aches, and chills

Corticosteroids

Common names include:

  • Prednisone
  • Prednisone and Azathioprine

Some forms of hepatitis are caused by autoimmune reactions, in which the body’s own immune system attacks normal, healthy tissue. Corticosteroids are anti-inflammatory medications that also suppress immune responses. This helps reduce liver inflammation, which helps prevent cirrhosis from progressing. High doses of prednisone given long-term are associated with an increase in serious side effects. Lower doses of prednisone may be used when combined with azathioprine.

Possible side effects include:

  • Indigestion
  • Glucose intolerance
  • Bone thinning
  • Increased risk of infection
  • Behavior changes

Metal Chelating Agents

Common names include:

  • Penicillamine
  • Trientine
  • Deferoxamine

Metal chelating agents are drugs that draw toxic metals from the bloodstream so that the body can pass them more effectively in urine or feces. Chelating agents are used to rid the body of excess copper in Wilsons disease or excess iron in hemochromatosis. Both of these rare inherited diseases can produce liver damage resulting in cirrhosis.

Penicillamine and trientine are used to treat Wilson's disease. Deferoxamine is used to treat iron overload associated with hemochromatosis. It is provided as an injection. Chelating agents are very powerful drugs that can have important, serious side effects. Be sure to report these to your healthcare provider.

Possible side effects associated with chelating agents include:

  • Fever
  • Joint pain
  • Skin rash
  • Blurred vision or other problems with vision
  • Difficulty breathing, wheezing, or rapid breathing
  • Fast heartbeat
  • Nausea, vomiting, or diarrhea

Medications to Treat the Complications of Cirrhosis

Antibiotics

Common names include:

  • Ciprofloxacin
  • Norofloxacin
  • Ceftriaxone
  • Ofloxacin
  • Amoxicillin-clavulanate

Prophylactic antibiotics may used to prevent bacterial infection in people who have cirrhosis and gastrointestinal bleeding.

Common side effects include:

  • Nausea or vomiting
  • Diarrhea
  • Abdominal pain
  • Headache
  • Rash or hives

Vitamin K

Common names include:

  • Phytonadione

Bleeding abnormalities are common in cirrhosis. Vitamin K plays an important role in blood clotting. Because your liver metabolizes this vitamin, liver diseases can affect vitamin K levels and its ability to function. This alters your clotting ability. Your doctor may prescribe vitamin K to help prevent excessive bleeding. The dose of these medications will be different for different people. Follow your doctor's orders. Do not change your dose unless your doctor tells you.

Possible side effects associated with vitamin K include:

  • Flushing of the face
  • Redness, pain, or swelling at the site of injection
  • Unusual taste

Blood Coagulation

Blood coagulation is a complex reaction of proteins and factors that changes blood from a liquid to a thickened gel. This process helps the body control blood loss. For people who have persistent bleeding, or bleeding that does not respond to treatment, a blood transfusion may be needed. Blood transfusions use one or more components of coagulation to help stop bleeding. Compents include:

  • Frozen fresh plasma
  • Platelets
  • Specific clotting factors

Possible side effects associated with blood product transfusions are rare, but may include:

  • Allergic reaction
  • Fever
  • Infection
  • Iron overload
  • Lung injury
  • Immune reaction

Desmopressin (DDAVP) is used to help release von Willebrand factor, a specific protein in the blood associated with blood coagulation. It is generally given by IV.

Possible side effects associated with DDAVP use include:

  • Headache
  • Water retention, which may increase weight
  • Flushing of the face
  • Nausea
  • Seizures
  • Low sodium level—hyponatremia

Diuretics

Loop diuretics:

  • Bumetanide
  • Furosemide

Thiazide diuretics:

  • Hydrochlorothiazide
  • Chlorothiazide

Potassium-sparing diuretics:

  • Amiloride
  • Triamterene

Diuretics are used to treat the buildup of excess fluid in the body that occurs with cirrhosis and other diseases. These drugs act on the kidneys to increase urine output. This reduces the amount of fluid in the bloodstream. This can help reduce portal vein hypertension and help alleviate some of the symptoms of cirrhosis, such as fluid accumulation in the abdomen and legs.

Possible side effects associated with diuretic use include:

  • Loss of appetite
  • Nausea and vomiting
  • Lightheadedness
  • Headache
  • Lack of energy
  • Low or high blood potassium level
  • Low sodium level

Bleeding in Esophagus

Common names include:

  • Octreotide

Cirrhosis can lead to bleeding from the esophageal vessels. You may have to take medication to reduce the pressure in the vessels.

Possible side effects associated with the use of this drug include:

  • Abdominal cramps
  • Nausea
  • Vomiting
  • Diarrhea
  • Slow heart rate
  • Greasy stools
  • Upset stomach

Beta Blockers

Common names include:

  • Atenolol
  • Metoprolol
  • Nadolol
  • Propranolol
  • Timolol

In cirrhosis, these are used to reduce venous blood pressure in the abdomen (called portal hypertension). This reduces the risk of esophageal variceal bleeding and other complications. These drugs come in capsule, tablet, liquid, and injectable forms.

Possible side effects associated with beta-blocker use include:

  • Drowsiness and lightheadedness
  • Cold sensitivity
  • Sleep disorders

Laxatives

Common names include:

  • Beta-galactosidofructose
  • Senna

Laxatives are usually prescribed to treat constipation. However, they can help treat cirrhosis by absorbing or binding toxins, such as ammonia, in the intestine and removing them from the body. Not all laxatives are equally effective. Your doctor may be more likely to prescribe beta-galactosidofructose (Lactulose).

Possible side effects associated with laxative use include:

  • Diarrhea
  • Abdominal cramping, flatulence, and bloating
  • Dehydration and weakness

Over-the-Counter Medications

Multivitamin/Mineral Supplements

Your doctor may recommend that you take a multivitamin and mineral supplement. This will help correct any nutrient deficiencies you may have developed if your dietary intake was reduced because of liver disease.

If you were consuming alcohol regularly, you may need additional thiamine and folate (two B vitamins) as well. Ask your healthcare provider or a registered dietitian for guidance in choosing an appropriate supplement.

Special Considerations

If you are taking medications, follow these general guidelines:

  • Take your medications as directed. Do not change the amount or the schedule.
  • Ask what side effects could occur. Discuss them with your doctor.
  • Talk to your doctor before you stop taking the medication.
  • Plan ahead for refills if you need them.
  • Do not share your medication with anyone.
  • Drugs can be dangerous when mixed. Talk to your doctor if you are taking more than one drug, including over-the-counter products and supplements.
 

References:

  • Cales P, Masliah C, Bernard B, et al. Early Administration of Vapreotide for variceal Bleeding in Patients with Cirrhosis. New E J Med. 2001;344:23-28 .
  • Cirrhosis. American Liver Foundation website. Available at: http://www.liverfoundation.org/abouttheliver/info/cirrhosis. Updated December 3, 2012. Accessed February 27, 2014.
  • Cirrhosis. National Institute of Diabetes and Digestive and Kidney Diseases website. Available at: http://digestive.niddk.nih.gov/ddiseases/pubs/cirrhosis/index.aspx. Updated February 21, 2012. Accessed February 27, 2014.
  • Cirrhosis of the liver. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated October 3, 2013. Accessed February 27, 2014.
  • Heidelbaugh JJ, Sherbondy M. Cirrhosis and Chronic Liver Failure: Part II. Complications and Treatment. Am Fam Phys. 2006;74:767-76.
  • Peginterferon alfa. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated January 10, 2014. Accessed February 27, 2014.
  • Tenofovir. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated January 18, 2013. Accessed February 27, 2014.
  • Transfusion reactions. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated September 15, 2013. Accessed February 27, 2014.

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