Drugs for Liver Disease

Hepatobiliary Infections (Antibiotics)

Ceftriaxone - GRAM-VE bacteria

Metronidazole - ANAEROBIC bacterial coverage!!!

Hepatitis B (Nucleoside Analogues)

Tenofovir (TDF, TAF), Entecavir

Hepatitis C (Direct-Acting Antivirals)

Sofosbuvir/Velpatasvir (Epclusa)

Glecaprevir/Pibrentasvir (Mavyret)

Acute Liver Failure

N-acetylcysteine

Drug-Induced Liver Injury

N-acetylcysteine

Metabolic Dysfunction–Associated Steatohepatitis (MASH)

Pioglitazone, SGLT2 inhibitors, GLP-1 receptor agonists, Resmetirom

SGLT2 Inhibitors

Dapagliflozin, Empagliflozin

GLP-1 Receptor Agonists

Liraglutide, Dulaglutide, Semaglutide

Anti-fibrotic Agents (MASH)

Resmetirom

Hepatic Encephalopathy

Lactulose (1st line)

Rifaximin

Ascites (Aldosterone Antagonists)

Spironolactone (1st line)

Ascites (Loop Diuretics)

Furosemide

Variceal Bleeding (Somatostatin Analogues)

Somatostatin

*note: only somatostatin can be used, other statins are to be avoided!

Variceal Bleeding (Non-selective Beta Blockers)

Propranolol, Carvedilol

Drugs to be Caution in Cirrhosis

Analgesics: Paracetamol 2g/day

AVOID in Cirrhosis

NSAIDs: Diclofenac, Mefenamic acid

Caution in Decompensated Cirrhosis

Antidiabetic Drugs: Metformin

Statins: Simvastatin, Atorvastatin, Rosuvastatin

N-acetylcysteine AE

CAUTION: in patients who need fluid restriction: large volumes of intravenous infusion needed in the setting of liver failure

Hep C: NOT used in Decompensated Liver Disease

Glecaprevir/ Pibrentasvir (Mavyret)

MASH - SGLT2 inhibitors AE

UTI due to

Selective inhibitors of SGLT2 glucose transporters in the kidney, which is responsible for 90% of the filtered glucose reabsorption

Induces glucose urinary excretion

MASH - GLP-1 receptor agonists AE

delayed gastric emptying leading to nausea and vomiting

MASH - Pioglitazone AE

Cardiac side effects are the MAIN concern: cardiac failure