Discover effective medications to treat liver cirrhosis and know its benefits, risks and possible side effects.

Hepatic cirrhosis is a progressive and weakening disease that is characterized by the irreversible healing of liver tissue, which causes a deterioration of liver function. Although the main treatment of liver cirrhosis is to address the underlying cause, medicines play a crucial role in control of symptoms and complications associated with this complex disease.

1. Diuretics: One of the main medications prescribed for liver cirrhosis are diuretics. These medications help reduce the accumulation of fluid in the body, especially in the abdomen and legs, a frequent condition known as ascites. Diuretics increase urine production, thus reducing excess fluid retention. The most common diuretics are Spironolactone and furosemide.

Important information: diuretics should be taken under the supervision of a healthcare professional, since excessive loss of water and electrolytes can have adverse effects. It is necessary to regularly control electrolyte levels, as well as renal function, during diuretics treatment.

• 2. Beta blockers: Another class of medications used in the treatment of liver cirrhosis are beta blockers. These medications help reduce the pressure in the blood vessels of the liver, known as portal hypertension. By reducing this pressure, beta blockers can prevent or minimize the risk of complications such as varicose hemorrhage. Propranolol and carvedilol are beta blockers that are frequently prescribed for liver cirrhosis.

1. Important information: beta blockers can cause side effects such as fatigue, dizziness and low blood pressure. During treatment with beta blockers it is essential to regularly control blood pressure and heart rate. People who take beta blockers must be cautious when performing activities that need to be alert until they know how medication affects them.

Important information: Osmotic laxatives should be used with caution, as excessive use can cause diarrhea and electrolyte imbalances. It is important to follow the recommended dosage instructions and consult a healthcare professional for proper guidance on laxative use.

Treatment options for liver cirrhosis

1. Medications: Medications play a crucial role in the treatment of liver cirrhosis. They are used to address the underlying causes of the disease, manage complications, and relieve symptoms. One of the main goals of drug treatment is to reduce inflammation and prevent further liver damage. The Ul and ol lists can be used to highlight the different types of medications prescribed:

• Antivirals for hepatitis C: Hepatitis C is a common cause of liver cirrhosis. Antiviral medications, such as direct-acting antivirals (DAAs), are used to treat hepatitis C infection and slow the progression of liver cirrhosis caused by the virus.
• Corticosteroids: These anti-inflammatory medications may be prescribed to reduce liver inflammation and control autoimmune reactions that contribute to cirrhosis.

Note: It is important to consult with a healthcare professional before starting any medication, as they can evaluate the individual case and determine the most appropriate treatment plan.

2. Lifestyle changes: Along with pharmacological treatment, the adoption of certain lifestyle changes can significantly improve the treatment of liver cirrhosis. Patients are often advised

1. Avoid alcohol: Alcohol consumption can aggravate liver damage and hinder the liver’s ability to heal. Complete abstinence from alcohol is essential for people with liver cirrhosis.
2. Eat a balanced diet: A healthy diet low in sodium and processed foods can help minimize fluid retention and control weight gain, which are common complications of liver cirrhosis.
3. Exercise regularly: Regular physical activity can improve overall liver function, reduce inflammation, and increase overall well-being.

3. Liver transplant: In some cases where cirrhosis has progressed to the terminal phase of liver disease, a liver transplant may be necessary. This procedure consists of replacing the diseased liver with a healthy liver from a donor. Liver transplant offers a chance of long-term survival to people with advanced liver cirrhosis.

Medications for Reducing Liver Inflammation

1. Nonsteroidal anti-inflammatory drugs (NSAIDs): NSAIDs are a class of commonly prescribed medications that can help reduce liver inflammation. These drugs act by inhibiting the production of chemicals called prostaglandins, which are involved in triggering inflammation. Some examples of NSAIDs commonly used for liver inflammation are ibuprofen, naproxen, and aspirin. It is important to note that prolonged use and high doses of NSAIDs can have adverse effects on the liver and should be used under medical supervision.

Important Note:

Although NSAIDs can help reduce liver inflammation, they should be used with caution in people with preexisting liver disease or other risk factors for liver damage. Long-term or high-dose use of NSAIDs may worsen liver function and increase the risk of complications.

2. Corticosteroids: Corticosteroids are powerful anti-inflammatories that can be very effective in reducing inflammation of the liver. These medications work by suppressing the immune system and reducing the inflammatory response. Prednisone and prednisolone are corticosteroids commonly prescribed for liver inflammation. However, corticosteroids carry the risk of significant side effects, such as weight gain, high blood pressure, and increased susceptibility to infections. Therefore, its use should be carefully monitored and administered under medical supervision.

1. Immunosuppressants: Immunosuppressant medications are prescribed for people with liver inflammation caused by autoimmune diseases. These drugs work by suppressing the body’s immune response, which can help reduce inflammation and prevent further damage to the liver. Some of the most commonly used immunosuppressants are azathioprine, mycophenolate mofetil, and cyclosporine.
2. Antiviral medications: If the inflammation of the liver is caused by a viral infection, such as hepatitis B or C, antiviral medications can be prescribed. These medications are directed to the specific virus that causes the infection and help to suppress its replication, thus reducing the inflammation of the liver and preventing greater liver damage. Some examples of antivirals used for viral hepatitis are alpha interferon and direct action antivirals.

Important Information:

It is essential to consult with a healthcare professional to obtain an accurate diagnosis and determine the most appropriate medication to reduce liver inflammation. Some medications may have interactions or contraindications with other underlying drugs or medical conditions. Compliance with prescribed medication and periodic monitoring evaluations are essential to effectively control liver inflammation and prevent its progression to more serious liver diseases.

Antiviral Drugs for Viral Hepatitis-Induced Cirrhosis

Antivirals are medications specifically aimed at viruses and inhibit their replication. In cirrhosis induced by viral hepatitis, antiviral treatment aims to suppress viral activity, slow down the progression of liver fibrosis and prevent new damage to the liver. The choice of antiviral medication depends on several factors, such as the specific hepatitis virus involved, the severity of liver cirrhosis and the patient’s general health status.

Important: Antiviral therapy for viral hepatitis cirrhosis should be initiated and supervised by health professionals with experience in the treatment of liver diseases. The dose, duration and administration of the antiviral drugs may vary depending on the individual characteristics of the patient and the prescribed specific antiviral regime.

• Antiviral medications for hepatitis B: Antiviral medications for cirrhosis induced by hepatitis B are directed mainly against the hepatitis B (HBV) virus and its objective is to reduce viral replication and hepatic inflammation. Some of the most used antiviral drugs for hepatitis B are Entencavir, Disoproxil Tenofovir Fumarate and Alpha Peginterferón.
• Antiviral drugs against hepatitis C: The antiviral treatment of cirrhosis induced by hepatitis C has experienced significant advances in recent years. The introduction of antiviral drugs of direct action (AAD) has revolutionized the treatment of hepatitis C, since they offer high healing rates with minimal side effects. Some examples of DAA medications for hepatitis C are Sofosbuvir, Ledipasvir and Daclatasvir.

It is important to note that antivirals cannot completely reverse existing liver damage. However, they can help slow or stop the progression of cirrhosis, reduce the risk of complications such as liver cancer, and improve overall liver function. During antiviral treatment, it is essential to closely monitor liver function and viral load to evaluate the response to treatment and adjust the medication regimen if necessary.

Immunosuppressants for Treating Autoimmune Liver Diseases

Immunosuppressive medications play a crucial role in the treatment of autoimmune liver diseases. These diseases, such as autoimmune hepatitis, primary biliary cholangitis, and primary sclerosing cholangitis, result from an abnormal immune response that causes inflammation and damage to the liver. By suppressing the immune system, these medications help reduce the intensity and frequency of liver attacks, slowing disease progression and improving patient outcomes.

There are several classes of immunosuppressants commonly used in the treatment of autoimmune liver diseases. One of the most prescribed medications are corticosteroids, such as prednisone or budesonide. These medications work by inhibiting the production of inflammatory substances in the body, which effectively reduces liver inflammation. However, long-term use of corticosteroids can cause significant side effects, such as osteoporosis and increased susceptibility to infections.

Note: Immunosuppressants should only be prescribed under the supervision of a healthcare professional, as they require careful monitoring and can have significant side effects.

Another class of immunosuppressants often used in the treatment of autoimmune liver diseases is azathioprine. Azathioprine reduces the activity of immune cells involved in the inflammatory process and helps prevent liver damage. It is often used as long-term maintenance therapy to maintain remission in patients with autoimmune hepatitis. However, the full effect of azathioprine may take several months to be seen.

• Drug class: Immunosuppressants
• Commonly used medications: Corticosteroids (e. g., prednisone, budesonide), Azathioprine
• Mechanism of action: Inhibition of the production of inflammatory substances, reduction of the activity of immune cells.

Patients under immunosuppressive treatment for autoimmune liver diseases require close surveillance and periodic monitoring by their health professionals. Blood analysis is often performed to evaluate liver function and detect possible complications associated with medication. It may be necessary to adjust the dose of immunosuppressants depending on the individual response and the side effects. It is important that patients follow the prescribed treatment plan and communicate any questions or change in symptoms to their health team to guarantee an optimal treatment of their disease.

1. Immunosuppressive medications are essential in the treatment of autoimmune liver diseases.
2. Corticosteroids, such as prednisone and Budesonide, are usually prescribed to reduce liver inflammation.
3. Azathioprine is another immunosuppressive that helps prevent liver damage by reducing immune cells.

Fluid Retention Management: Role of Diuretics

Mechanism of action:

Diuretics influence the normal process of urine formation in the kidneys. They act on specific renal structures to increase the excretion of water and electrolytes, which translates into greater urine production. By favoring the elimination of excess fluid, diuretics relieve edema symptoms and help restore the body’s liquid balance.

Diuretics types:

1. ASA diuretics: This group of diuretic medications, such as furosemide and bumetanida, acts on the thick ascending branch of the Henle handle in the kidneys. They inhibit sodium resorption, which causes an increase in the excretion of sodium and water. The diuretics of the ASA are usually considered the most powerful diuretics and are usually prescribed to patients with severe fluid retention.
2. Tiazidic diuretics: thiazides, such as hydrochlorotiazide and chlortalidone, are mainly directed to the distal contoured tubules of the kidneys. They inhibit sodium resorption and favor the excretion of water, potassium and magnesium. Tiazidic diuretics are frequently used as a lon g-term treatment option to control fluid retention.
3. Potassium saving diuretics: these diuretics, such as spironolactone and eplerenone, act by reducing sodium resorption and reducing potassium excretion. They help maintain the balance of sodium and potassium levels. Potassium saving diuretics are usually used in combination with other diuretics to minimize the risk of electrolytic imbalances.

Table: Diuretics for the control of fluid retention

It is crucial to point out that the use of diuretics in the treatment of fluid retention must be carefully evaluated and regulated by health professionals following an individualized approach. Proper dose adjustments, consideration of possible pharmacological interactions and the monitoring of electrolyte levels are essential components to maximize benefits and minimize the risks associated with diuretic treatment in patients with liver cirrhosis.

Beta Blockers for Controlling Portal Hypertension

Beta blockers, also known as betaadrenergic antagonists, act by blocking the effects of catecholamines on betaadrenergic receptors. In doing so, they reduce heart rate and cardiac output, which causes a decrease in venous portal pressure. This effect is especially beneficial in patients with portal hypertension, as it helps prevent the expansion and breakage of fragile esophageal varicose veins.

• Beta blockers are recommended as a firs t-line treatment for the primary prevention of varicose hemorrhage in patrrosis and hig h-risk esophageal varicose veins.
• Propranolol and Nadolol are the two most used beta blockers to control portal hypertension.

It is important to note that beta blockers should be used with caution in patients with asthma, since they can exacerbate bronchospasm. Careful monitoring of blood pressure and heart rate is essential during treatment with beta blockers to prevent adverse effects such as hypotension and bradycardia. In addition, periodic follo w-ups must be performed to reassess the need to continue treatment and adjust the dose as necessary.

Nutritional Supplements for Improving Liver Function

Adequate nutrition plays a vital role in the maintenance and improvement of liver health. In addition to a balanced diet, it has been observed that certain nutritional supplements favor the proper functioning of the liver. These supplements contain specific vitamins, minerals and antioxidants that help prevent liver damage, promote regeneration of liver cells and improve the general function of the liver.

Vitamin E: Vitamin E is a powerful antioxidant that helps protect liver stress cells caused by harmful substances. It also helps reduce inflammation and favors the regeneration of liver cells. Among the foods rich in vitamin E are nuts, seeds, spinach and brécol. Taking a vitamin E supplement can provide additional support to liver health.

• Cardo Mariano: Mariano Cardo, also known as Silybum Marianum, is a herbal supplement usually used to improve liver function. It contains a flavonoid complex called Silimarina, which has antioxidant and ant i-inflammatory properties. Silimarin helps protect the liver cells of damage caused by toxins and favors its regeneration. It can be taken in the form of capsules, tablets or liquid extracts.
• Omega-3 fatty acids: It has been shown that omega-3 fatty acids, present in fish oil and linen seeds, have anti-inflammatory effects and can help reduce the accumulation of fat in the liver. These fatty acids can also improve liver enzyme levels and the general functioning of the liver. Including foods rich in Omega-3 in the diet or taking omega-3 supplements can be beneficial for liver health.
• Vitamins of complex B: Vitamins of complex B, such as B12, B6 and folic acid, contribute to various liver functions, such as fat metabolism, proteins and carbohydrates. These vitamins help convert food into energy and contribute to the detoxification process. Incorporating foods such as whole grains, green leafy vegetables and leaflets into your diet, you can provide a natural source of V vitamins. However, if your diet is poor in these vitamins, it may be necessary to take a supplement of complex B to support healthof the liver.

It is important to keep in mind that, before starting to take any new nutritional supplement, it is recommended to consult with a healthcare professional, especially if a liver disease is suffered or medications that can interact with supplements are being taken.

Table: Nutritional supplements for improving liver function

Medications for Treating Complications of Cirrhosis

1. Diuretics: One of the most common complications of cirrhosis is the accumulation of fluid in the abdomen, a condition known as ascites. Diuretics are medications that help increase urine production and reduce fluid retention in the body. They act by favoring the excretion of salt and water, thus relieving swelling and preventing the appearance of complications such as infections or kidney problems. Among the diuretics that are usually prescribed for this purpose are Spironolactone and Furosemide.

• SPIRONOLACTONA: This medicine is a diuretic potassium saver that helps block the effects of a hormone called aldosterone. It is often used in combination with other diuretics to achieve an optimal balance of liquids and prevent electrolytic imbalances.
• Furosemide: Furosemide belongs to a class of diuretics known as ASA diuretics. It acts by inhibiting sodium and chloride reabsorption in the kidneys, which increases urine production. This helps reduce the accumulation of fluids in the body, including the abdomen.

Note: Diuretics should be used with caution in patrrosis patients, since they can cause imbalances in electrolytes, such as potassium and magnesium. It is necessary to regularly control electrolyte levels to guarantee adequate dosage and prevent complications.

2. Beta blockers: Patients with cirrhosis have a greater risk of developing hemorrhagic varicose veins, which are swollen veins in the esophagus or stomach. Beta blockers can help reduce the risk of hemorrhage by varicose veins by decreasing pressure within these veins. These medications block the effects of adrenaline and other stress hormones on the heart and blood vessels, which reduces blood pressure. Among the beta blockers who are usually prescribed for cirrhosis are propranolol and nadolol.

Note: Beta blockers should be used with caution in patients with certain medical conditions, such as asthma or heart failure. Regular heart rate control and blood pressure is essential when these medications are taken.

3. Antibiotics: In cases of advanced cirrhosis, there is a greater risk of bacterial infections, especially in the presence of ascites. Antibiotics can be prescribed to prevent or treat these infections. The most used antibiotics in this context are fluoroquinolones (for example, cyprophloxacin) or trimetoprim-sulfamethoxazole, which have demonstrated their effectiveness against bacteria that usually appear in infections related to cirrhosis.

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Author of the article

Dr.Greenblatt M.

Medical oncologist at the Robert Larner College of Medicine, MD, at the University of Vermont