Pharmaceutical Treatments for Cirrhosis
As the liver becomes more and more inflamed by hepatitis viruses, hormone imbalances or toxins like drugs, and alcohol , scar tissue gradually replaces healthy tissue. When the majority of a patient's liver is replaced by this scar tissue, the condition is known as cirrhosis.
There are no drugs that can reverse and treat liver cirrhosis.1 However, pharmaceuticals are prescribed to manage the numerous complications of cirrhosis, such as tricyclic antidepressants, pain relief medications, antibiotics, and anticonvulsants2 to manage pain, and complications like spontaneous bacterial peritonitis (SBP).
How do cirrhosis pharmaceuticals relieve symptoms?
As with any medical procedure, results will vary from patient to patient depending on age, genetics, general health, condition severity, follow-up care, and environmental factors. The following pharmaceutical treatments may present contraindications with one another, and/or with other medical conditions. Consult your healthcare provider before embarking on your treatment journey.
Non-steroidal anti-inflammatory drugs (NSAIDs) should be avoided because they can cause renal impairment and gastrointestinal bleeding. Most opioids too can increase the risk of liver toxicity. Instead, cirrhosis patients are usually prescribed the following:
Analgesics (pain killers)
These drugs are prescribed strictly for pain management. Opioid (narcotic) analgesics work by binding to receptors on cells mainly in the brain, spinal cord, and gastrointestinal system. Researchers aren't quite sure yet how anticonvulsants work to relieve nerve pain.
- acetaminophen: may reduce the production of inflammation-causing prostaglandins in the brain; safe in small doses for short durations to alleviate organ and musculoskeletal pain2; not recommended for alcohol drinkers3; side effects include: nausea, stomach pain, loss of appetite, headache, and jaundice
- hydromorphone: this addictive opioid is prescribed in low doses; not for patients with progressive kidney failure3; side effects include: vomiting, constipation, lightheadedness, drowsiness, sweating, flushing, and dry mouth
- gabapentin: an anticonvulsant that doesn't metabolize in the liver; used to manage pain in the somatosensory nervous system3; side effects include dizziness, loss of coordination, fatigue, blurred or double vision, unusual eye movements, or tremors.
Antidepressants affect certain brain circuits and neurotransmitters that pass along signals from one nerve cell to another in the brain. In low doses, TCAs can be used to manage pain from somatosensory nervous system damage. The following antidepressants are less potent and don't cause as much of an increased heart rate:3
- nortriptyline: believed to work by affecting the balance of neurotransmitters in the brain;not to be taken with amitriptyline or nortriptyline. Side effects include drowsiness: dizziness, dry mouth, blurred vision, constipation, weight gain, or urinating trouble
- desipramine: inhibits the recycling of serotonin and norepinephrine; side effects include a headache, nausea, dizziness, drowsiness, nervousness, sleeping trouble, blurred vision, increased appetite, weight gain, constipation, and dry mouth
Fluoroquinolones are prescribed to prevent recurrent bacterial infection in the membrane that covers the abdominal organs (peritoneum) called SBP.2 Cirrhosis can cause fluid to accumulate in your abdomen (ascites); when this fluid becomes infected, SBP occurs.
Do not take fluoroquinolones if you have any heart disorders that can cause an arrhythmia. Side effects include headaches, drowsiness, insomnia, dizziness, mood alteration, peripheral neuropathy, tendinopathy, abnormal heart rhythms, and pseudomembranous colitis.
Medications used to treat cirrhosis may interact with other medications, like:
- thyroid supplements
- belladonna alkaloids
- high blood pressure medications
- MAO inhibitors
- gabapentin enacarbil
Do not take these medications if you are breastfeeding or have:
- low blood potassium levels (hypokalemia)
- abnormally slow heart action (bradycardia)
- low magnesium levels (hypokalemia)
- a history of heart attack
- brain disorders
- breathing problems
- stomach issues (constipation, diarrhea)
- kidney disease
- enlarged thyroid
- bipolar disorder
- eating disorders
There are several drugs that should not be taken by cirrhosis patients:
- NSAIDs: they increase the risk of causing renal (kidney) failure and inducing or worsening gastrointestinal bleeding2
- benzodiazepines: these may cause brain disease (encephalopathy), and can last longer in cirrhosis patients than in those without cirrhosis2
- narcotics: these may also cause encephalopathy and last longer in cirrhosis patients2
- proton pump inhibitors: this has been linked to an increased risk of SBP2
- acid-suppressive agents: these have also been linked to an increased risk of SBP2
- meperidine: this has been linked to an increased risk of seizures3
- lidocaine: this drug may be toxic for cirrhosis patients and is only recommend for localized pain only3
- TCAs: these can cause involuntary muscle movements and constipation, the later which can also cause a loss of brain function from toxins in the blood (hepatic encephalopathy)3
- carbamazepine: this anticonvulsant is associated with hepatotoxicity3
Reserve your appointment
While no synthetic drug has yet been developed that can reverse cirrhosis, many medications can help manage pain and prevent cirrhosis complications like SBP. To learn what medications can help you manage your cirrhosis in San Antonio, call (813) 536-3212 or contact Evolution online.
1. Ansari, Rais. "Drugs Needed for Treatment of Liver Cirrhosis." Journal of Drug Metabolism & Toxicology 4.117 (2013): n. pag. Web. 14 Sept. 2018.
2. Lewis, J. H., and J. G. Stine. "Review article: prescribing medications in patients with cirrhosis - a practical guide." Alimentary Pharmacology and Therapeutics 37.12 (2013): 1132-1156. Web. 12 Oct. 2018.
3. Wehrer, Megan. "Pain Management Considerations in Cirrhosis." U.S. Pharmacist - The Pharmacist's Resource for Clinical Excellence (2015). Web. 15 Oct. 2018.
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