Medications for liver failure

By Mayo Clinic Staff

When the liver begins to fail, the body loses an important tool for staying healthy. That can feel frightening and overwhelming — especially when treatment involves complex medicines or a liver transplant.

Medications play an important role in managing liver failure. They can help the liver work better, manage symptoms, prevent infections and support recovery after transplant. Understanding what these medicines do and how they affect your body can help you feel more confident and involved in your care or in supporting someone you love.

Medications for liver failure

Many medicines can help manage liver failure symptoms and improve quality of life, though some people with severe or end-stage liver disease may eventually need a liver transplant. For those who do, medicines play an important role in supporting liver function and easing symptoms while they wait.

Acute liver failure

Acute liver failure is loss of liver function that happens quickly — in days or weeks — usually in a person who has no preexisting liver disease. It's most often caused by a hepatitis virus or medications, such as acetaminophen. This condition is quite rare.

Medicines given to manage acute liver failure complications include:

• Medicine for the underlying causes. If liver failure is caused by another condition, such as hepatitis B or autoimmune hepatitis, specific antiviral or immune-based medicines may be prescribed.
• N-acetylcysteine (NAC). NAC is the main treatment for liver damage caused by an acetaminophen (Tylenol, others) overdose. It also may help protect the liver in other forms of drug-induced liver injury (DILI) and nonacetaminophen-induced acute liver failure.
• Medicines for infections. Because people with liver failure are more likely to develop infections, antibiotics or antiviral medicines may be prescribed to treat or prevent them.

Chronic liver failure

Chronic liver failure is a life-threatening condition that develops slowly over time as liver damage worsens. Treatment focuses on managing symptoms and underlying causes.

Medicines used to manage complications of chronic liver failure may include:

• Diuretics. These medicines, including furosemide, torsemide and spironolactone, help remove extra fluid from the body and reduce swelling or fluid buildup. Diuretics are sometimes called water pills.
• Blood pressure medicines. Certain blood pressure medicines, including beta blockers, can help control increased pressure in the veins that supply the liver, called portal hypertension, and help prevent severe bleeding. Beta blockers include propranolol and carvedilol.
• Antibiotics. These medicines may be used to prevent infection. An antibiotic called rifaximin can reduce certain gut bacteria and lower the risk of confusion or drowsiness caused by toxin buildup, called hepatic encephalopathy.
• Medicines to lower ammonia levels. Laxatives, including lactulose and polyethylene glycol (PEG) laxatives, can increase bowel movements to help remove toxins, including ammonia, from the body.

Your healthcare team also may recommend vitamins or supplements to help manage chronic liver failure.

• Zinc supplements. Zinc may help the body process and get rid of ammonia more effectively.
• Vitamin K1. Researchers are studying whether Vitamin K1 may reduce risk of death in patients with chronic liver failure. More research is needed.

Medications given after liver transplant

After a liver transplant, medicines are needed to help the body accept the new liver and prevent infection. They include:

• Antirejection medicines, also called immunosuppressants. These medicines prevent the body's immune system from attacking the new liver. These medicines are usually taken for the rest of your life. Common antirejection medicines include prednisone, mycophenolate mofetil (CellCept), tacrolimus (Prograf) and others.
• Medicines to prevent infection. Because antirejection medicines can weaken the immune system, people who've had liver transplants are at higher risk of infections. To prevent infection, antiviral, antibacterial or antifungal medicines may be prescribed.
• Experimental medicines and emerging medicines. Researchers are developing new treatments to improve transplant outcomes and prevent liver damage.

What to know about medication side effects

All medicines — including those used to manage liver failure — can cause side effects. Many side effects are mild and improve with time. Others may require changing the dose or switching to a different medicine.

Here are examples of possible side effects connected to medicines used in liver failure or after liver transplant:

• Corticosteroids. These medications may be used as antirejection medicines after transplant. Common side effects include increased appetite, weight gain, high blood sugar, high blood pressure and roundness of the face, referred to as moon face. Other common side effects include bone thinning, called osteoporosis, and sleep problems.
• Immunosuppressants. These medications are used for antirejection after liver transplant. The side effects of immunosuppressants vary depending on the amount and kind taken. Some common side effects include diabetes, high blood pressure, high cholesterol, increased risk of infection and stomach issues.
• Diuretics. Diuretics are used to manage fluid buildup in liver failure. Side effects depend on the amount and kind taken. Generally, common side effects may include dehydration, headache, frequent urination, a change in potassium or sodium levels, skin reactions, stomach issues, restlessness, and fatigue.

While side effects can be uncomfortable, many can be prevented or managed. Never stop or change any medicines on your own. If a side effect becomes hard to manage or affects your daily life, tell your healthcare team. Your care team can help balance treatment effectiveness with safety and comfort.

And talk with your healthcare team about every medicine you take — including medications available without a prescription and supplements. Your care team can help you understand the possible side effects and manage them. Your healthcare professional can adjust your overall treatment plan if needed.