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Medications for Cirrhosis

One or more medicines may be used for cirrhosis. They may be used to control the cause and prevent more damage. They may also be used to treat symptoms and related health problems.

Here are the basics about each of the medicines below. Only common problems with them are listed.

Prescription Medicines

Medicines to Treat the Causes

Alcohol-related

  • Disulfiram
  • Naltrexone
  • Acamprosate

Antiviral medicines

  • Interferons
  • Protease inhibitors
  • Reverse transcriptase inhibitors

Corticosteroids

  • Prednisone
  • Prednisone and Azathioprine

Chelating Agents

  • Penicillamine
  • Trientine
  • Deferoxamine

Medicines to Treat Complications

Antibiotics

  • Ciprofloxacin
  • Norofloxacin
  • Ceftriaxone
  • Rifaximin
  • 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
  • Carvedilol

Laxatives

  • Beta-galactosidofructose

Over-the-Counter Medicines

Multivitamin and Mineral Supplements

Prescription Medicines

Medicines to Treat the Causes

 

Alcohol-related

Common names are:

  • Disulfiram
  • Naltrexone
  • Acamprosate

These medicines treat alcohol use disorder. A person who drinks while taking disulfiram will have hangover symptoms that are much worse than normal. Problems may be headache, nausea, confusion, and uneasiness. Naltrexone lowers the craving for alcohol. Acamprosate lowers both the physical and emotional unrest that happens from quitting drinking, such as sweating, sleep problems, and unease.

Some problems may be:

 

Antiviral Medicines

Common ones are:

  • Interferons
  • Protease inhibitors
  • Reverse transcriptase inhibitors

Chronic viral hepatitis B and C may get better with antiviral medicines. These may be interferon for hepatitis B and C. Taking both interferon and ribavirin may be more helpful for hepatitis C than taking one alone.

Lamivudine, tenofivir, adefovir, entecavir, and telbivudine are used to treat hepatitis B infection. They are often taken by mouth once a day for a year or more. Sometimes these drugs are taken with interferon.

Some problems may be:

  • Belly pain
  • A feeling of fullness
  • Nausea
  • Peripheral neuropathy
  • Flu-like symptoms, such as fever, body aches, and chills
 

Corticosteroids

Common names are:

  • Prednisone
  • Prednisone and azathioprine

Some forms of hepatitis are caused by the body's immune system attacking normal, healthy tissue. Corticosteroids can help suppress the attack. This helps ease liver inflammation, which helps prevent cirrhosis from getting worse. High doses of prednisone taken for a long time may cause serious side effects. Lower doses of prednisone may be used when taken with azathioprine.

Some problems may be:

  • Stomach upset
  • Glucose intolerance
  • Bone thinning
  • A higher risk of infection
  • Changes in behavior
 

Chelating Agents

Common names are:

  • Penicillamine
  • Trientine
  • Deferoxamine

Chelating agents are drugs that draw toxic metals from the blood. This lets them pass more easily in urine or stool. Chelating agents are used to rid the body of excess copper in a person with Wilson disease or excess iron in a person with hemochromatosis. These are rare inherited problems can cause liver damage that leads to cirrhosis.

Penicillamine and trientine are used to treat Wilson disease. Deferoxamine is used to treat iron overload from hemochromatosis. It is given as an injection. Chelating agents are strong medicines that can cause serious side effects.

Some problems may be:

  • Fever
  • Joint pain
  • Skin rash
  • Blurry eyesight or other sight problems
  • Problems breathing
  • Fast heartbeat
  • Nausea and vomiting
  • Diarrhea

Medicines to Treat Complications

 

Antibiotics

Common names are:

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

Antibiotics may be used to prevent bacterial infection in people who have cirrhosis and gastrointestinal bleeding.

Some problems may be:

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

Vitamin K

Common names are:

  • Phytonadione

Bleeding problems are common in cirrhosis. Vitamin K plays helps with blood clotting. Problems with the liver can make it hard to get enough. Vitamin K supplements may need to be taken to help prevent excessive bleeding.

Some problems may be:

  • Flushing of the face
  • Redness, pain, or swelling at the site a vitamin K injection
  • Changes in taste
 

Blood Coagulation

This process changes blood from a liquid to a thickened gel. This helps the body control blood loss. A blood transfusion may be needed to help people who have a lot of bleeding or bleeding that does not get better with treatment. Blood transfusions use one or more of these:

  • Frozen fresh plasma
  • Platelets
  • Specific clotting factors

Problems are rare, but may be:

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

Desmopressin (DDAVP) is used to help release von Willebrand factor. This is a protein in the blood linked to blood coagulation. It is often given by IV.

Problems may be:

  • Headache
  • Fluid buildup, 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 fluid in the body from cirrhosis. They act on the kidneys to help the body make more urine. This lowers the amount of fluid in the blood. This can help lower blood pressure in the portal veins. This can ease some of the problems from cirrhosis, such as swelling in the belly and legs.

Problems may be:

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

Bleeding in the Esophagus

Common names are:

  • Octreotide

Cirrhosis causes higher pressure in the liver. This can cause blood to back up and cause swelling in the blood vessels in the esophagus and digestive tract. This can cause serious bleeding. Medicines can help ease pressure and lower the risk of bleeding.

Some problems may be:

  • Belly cramps
  • Nausea and vomiting
  • Diarrhea
  • Slow heart rate
  • Greasy stools
  • Upset stomach
 

Beta-blockers

Common names are:

  • Atenolol
  • Metoprolol
  • Nadolol
  • Propranolol
  • Timolol
  • Carvedilol

Cirrhosis can raise blood pressure in the belly. This can cause blood to back up and cause swelling in the blood vessels in the esophagus and digestive tract. This can cause serious bleeding. Medicines can help ease pressure and lower the risk of bleeding. These may be given by mouth or by injection.

Some problems may be:

  • Drowsiness and lightheadedness
  • Cold sensitivity
  • Problems sleeping
 

Laxatives

Common names are:

  • Beta-galactosidofructose (Lactulose)
  • Senna
  • Polyethylene glycol

Laxatives are usually taken to treat constipation. They can also help treat cirrhosis by helping to remove toxins from the body.

Some problems may be:

  • Diarrhea
  • Belly cramping, gas, and bloating
  • Dehydration and weakness

Over the Counter Medicines

 

Multivitamin/Mineral Supplements

A multivitamin and mineral supplement can be taken to replace nutrients that are lowered because of liver disease. In a person with alcohol use disorder, thiamine and folate (two B vitamins) may also be needed.

REFERENCES:

Cirrhosis. American Liver Foundation website. Available at: http://www.liverfoundation.org/abouttheliver/info/cirrhosis. Accessed January 6, 2021.

Cirrhosis. National Institute of Diabetes and Digestive and Kidney Diseases website. Available at: https://www.niddk.nih.gov/health-information/liver-disease/cirrhosis. Accessed January 6, 2021.

Cirrhosis of the liver. EBSCO DynaMed website. Available at: https://www.dynamed.com/condition/cirrhosis-of-the-liver-31. Accessed January 6, 2021.

Ge PS, Runyon BA. Treatment of Patients with Cirrhosis. N Engl J Med. 2016 Aug 25;375(8):767-777.

Last reviewed December 2020 by EBSCO Medical Review Board Daniel A. Ostrovsky, MD  Last Updated: 1/6/2021