Rational use of drugs to relieve liver disturbances: a guide to medication for liver cirrhosis

Author: Chi Chunsheng, The Fifth Medical Center, PLA General Hospital

Reviewer: Jin Bo, Chief Physician, Fifth Medical Center, PLA General Hospital

Cirrhosis, this invisible killer, is quietly threatening the health of many people. It not only erodes the vitality of the liver, but may also trigger a series of chain reactions, affecting the patient's overall quality of life. Faced with this challenge, rational medication treatment has become an important part of the patient's road to recovery. However, in the complex world of drugs, patients are often full of confusion and confusion-when is the best time to take the medicine? Do you need to take medicine for life? What medicine can you take and what medicine can't you take? If these questions are not answered correctly, not only will they not help recovery, but they may put a heavier burden on the body due to improper medication, and even accelerate the deterioration of the disease. Today, we will answer various common questions about the use of drugs for cirrhosis in an easy-to-understand way, striving to enable every patient to achieve safe and effective treatment and jointly protect liver health.

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1. For different drugs, when is the best time for patients with cirrhosis to take the medicine?

The time to take commonly used drugs for patients with cirrhosis should follow the instructions of the drug or the requirements of the attending physician. In order to ensure the best efficacy of the drug or avoid the interaction between different drugs, some drugs have specific time requirements for taking, while some drugs have no special requirements. For example, patients with chronic hepatitis B (abbreviated as "chronic hepatitis B")-related cirrhosis take the anti-hepatitis B virus drug entecavir between meals.

Since many patients with cirrhosis also have other chronic diseases, such as hypertension, diabetes, etc., they need to take other medications at the same time. Here is a brief introduction to the requirements for medications required for common concomitant diseases.

1. Antihypertensive drugs: Human blood pressure mostly fluctuates in a state of "two peaks and one valley" within 24 hours, that is, it is highest between 9:00-11:00 and 16:00-18:00, and starts to slowly decline at 18:00, reaching the lowest between 2:00-3:00 the next day. Therefore, it is best for hypertensive patients to take the drug 30 minutes before the two peaks of natural blood pressure increase.

2. Anti-peptic ulcer drugs: H2 receptor antagonists such as ranitidine and famotidine can be taken before or after meals; proton pump inhibitors such as omeprazole, pantoprazole, and rabeprazole should be taken before meals or on an empty stomach; bismuth agents such as potassium bismuth citrate should be taken between meals or before going to bed at night; aluminum phosphate gel should be taken 30 minutes before meals for the treatment of gastric ulcers, and 3 hours after meals for duodenal ulcers and when pain occurs.

3. Lipid-regulating drugs: The therapeutic effect of lipid-regulating drugs is better when administered before bedtime at night than when administered during the day, such as simvastatin, pravastatin, etc.

4. Astringent drugs: Astringent drugs have astringent, protective and adsorbent effects. Taking them before meals is helpful to improve symptoms. Such drugs include tannic acid protein and montmorillonite powder.

5. Antiemetics: Antiemetics can be taken before meals to exert their efficacy and relieve symptoms, such as scopolamine, promethazine, metoclopramide, etc.

6. Drugs that promote gastrointestinal motility: When using drugs that promote gastrointestinal motility, it is advisable to take them before meals to increase gastrointestinal motility, such as domperidone, mosapride, etc.

7. Iron supplements: The absorption rate of iron supplements taken in the evening is 2 times higher than that in the morning. Iron salts are irritating to the gastrointestinal tract and are only easily absorbed under the action of gastric acid. Therefore, it is best to take them orally 30 minutes after dinner.

2. Does liver cirrhosis require lifelong medication?

Drug treatment is a long-term process. Many patients do not have enough psychological expectations. Over time, their compliance with medication decreases, and they may even stop taking medication on their own. Taking the diagnosis and treatment of liver cirrhosis caused by chronic hepatitis B as an example, it has been reported that when patients stop taking antiviral drugs on their own, it will lead to a rapid increase in viral replication, and even drug resistance, inducing excessive immune response and severe liver cell damage, leading to liver failure. Therefore, patients need to understand the risks that may result from stopping medication at will, strictly follow the doctor's orders to take medication, and do not change or stop medication without authorization for liver cirrhosis caused by chronic hepatitis B.

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3. Which drugs are likely to cause drug-induced liver injury?

Most oral drugs need to be metabolized by the liver. Long-term use or blind use of one or several drugs may cause drug-induced liver damage. It is commonly found in various prescription or over-the-counter chemical drugs, biological preparations, traditional Chinese medicines, natural medicines, health products, dietary supplements and their metabolites and even excipients, such as antibiotics, antipyretic analgesics, Chinese medicines, health products, weight loss drugs, etc.

Therefore, medications must be taken under the guidance of a physician and random medications should be avoided as much as possible to prevent interactions between different drugs, which could seriously affect the liver's ability to metabolize the drugs.

4. Can patients with cirrhosis take Ganoderma lucidum, soft-shelled turtle, ginseng, etc.?

Patients with cirrhosis (except autoimmune liver disease) can take Ganoderma lucidum appropriately. Ganoderma lucidum has the functions of regulating immunity, nourishing the heart and calming the nerves. It can promote the liver's metabolism of drugs and toxins, and can also eliminate symptoms such as dizziness, fatigue, nausea, and discomfort in the liver area. However, patients with liver disease should avoid eating foods such as ginseng, red ginseng, and soft-shelled turtle, because these foods are hot tonics and have the effect of activating blood circulation, which will lead to increased alanine aminotransferase and fluctuations in liver function.