Medications for Cirrhosis

Antiviral Medications

Common names include:

• Alpha-Interferon]]> (Alferon N, Roferon-A, Intron A)
• ]]>Ribavirin]]> (Virazole)
• ]]>Lamivudine]]> (Epivir, Epivir-HBV)

Chronic viral hepatitis B and C may respond to treatment with antiviral medications. These may include interferon (for hepatitis B and C) or a combination of interferon and ribavirin (hepatitis C).

For hepatitis C, combination therapy consistently yields higher rates of sustained response than treatment with just one drug. At present, use of interferon alone is generally reserved for people who should not use ribavirin. Interferon is given subcutaneously (injected beneath the skin) once every week. Treatment of hepatitis C usually lasts for 24-48 weeks depending on the HCV genotype. Ribavirin is an oral antiviral agent that is given twice a day.

Lamivudine is 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 lamivudine is combined with interferon.

Possible side effects associated with antiviral use 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 (fever, body aches, chills)

Anti-inflammatory Medications (Corticosteroids)

Common names include:

• Prednisone]]> (Prednisone Intensol, Pred-Pak 45)
• Prednisone and ]]>azathioprine]]> (Imuran)

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 medicines that also suppress immune responses. This helps reduce liver inflammation, thereby helping to prevent the progression of cirrhosis. 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 associated with corticosteroid use include:

• Hypertension
• Glucose intolerance
• Bone thinning

Metal Chelating Agents

Common names include:

• Penicillamine]]> (Cuprimine, Depen)
• ]]>Trientine]]> (Syprine)
• ]]>Deferoxamine]]> (Desferal)

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 Wilson’s 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. The dose of these medicines will be different for different patients. Follow your doctor's orders or the directions on the label. 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
• Lesions on the face, neck, scalp, and/or trunk
• Skin rash, hives, or itching
• Swollen and/or painful glands
• Ulcers, sores, or white spots on lips or in mouth
• Bluish fingernails, lips, or skin
• Blurred vision or other problems with vision
• Convulsions (seizures)
• Difficulty breathing (wheezing), or fast breathing
• Fast heartbeat
• Redness or flushing of skin
• Nausea, vomiting, or diarrhea
• Blood in the urine

Vitamin K

Common names include:

• Phytonadione]]> (AquaMEPHYTON, Mephyton)

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, and thereby alter clotting ability. Your doctor may prescribe vitamin K to help prevent excessive bleeding. The dose of these medicines 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 use include:

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

Diuretics

• “Loop” diuretics:
  • Bumetanide]]> (Bumex)
  • ]]>Furosemide]]> (Lasix)
• Thiazide diuretics:
  • ]]>Hydrochlorothiazide]]> (HydroDIURIL, Esidrix)
  • ]]>Chlorothiazide]]> (Diuril)
• Potassium-sparing diuretics:
  • ]]>Amiloride]]> (Midamor)
  • ]]>Triamterene]]> (Dyrenium)

Diuretics are used to treat the buildup of excess fluid in the body that occurs with cirrhosis (as well as other diseases). These drugs act on the kidneys to increase urine output, which 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
• Dizziness
• Headache
• Lethargy
• Low or high blood potassium level
• Low sodium level

Antihypertensives (Beta-Blockers)

Common names include:

• Atenolol]]> (Tenormin)
• ]]>Metoprolol]]> (Lopressor)
• ]]>Nadolol]]> (Corgard)
• ]]>Propranolol]]> (Inderal)
• ]]>Timolol]]> (Blocadren)

In cirrhosis, these are used to reduce venous blood pressure in the abdomen (called portal hypertension) and thereby reduce 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 dizziness
• Cold sensitivity
• Sleep disorders

Laxatives

Common names include:

• Beta-galactosidofructose (Lactulose)

Although laxatives are usually prescribed to treat constipation, they can help treat cirrhosis by absorbing or binding toxins, such as ammonia, in the intestine and remove them from the body. Not all laxatives are equally effective, and 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