Hepatic Insufficiency: Drug Therapy

Therapeutic target

Avoidance of complications

Therapy recommendations

• Therapy for liver failure varies according to the exact cause, the form of liver failure and other concomitant diseases, and the age of the affected individual. Therapeutic measures range from pharmacotherapy to liver transplantation (LTx).

Diseases

Acute hepatitis B

• See under hepatitis B/pharmacotherapy.

Herpes simplex hepatitis

• Antiviral therapy with aciclovir (antiviral; drugs that inhibit the action of viruses).

Autoimmune hepatitis (AIH; autoimmune hepatitis)

• Treatment with prednisolone (glucocorticoids).

Helpp/AFLP (acute fatty liver of pregnancy)

• Therapy: delivery by sectio (cesarean section).

Budd-Chiari syndrome

• Therapy: transjugular intrahepatic portosystemic (stent) shunt (TIPSS)/surgical shunt.

Intoxications (poisonings)

Paracetamoline intoxication

• Use of the antidote/counteragent to poisons acetylcysteine (ACC); for primary detoxification before i. v. therapy with ACC, administration of activated charcoal.
• Notice: While the liver usually regenerates itself after acute damage, the regeneration of hepatocytes fails in acetaminophen poisoning, i.e. in severe acetaminophen poisoning threatens acute liver failure.
• In addition, a general intensive therapy must be performed. In case of failure of therapy with ACC liver transplantation as ultima ratio.

Tuber leaf fungus intoxication

• Administration of the antidote silibinin; prior primary detoxification with activated charcoal.

Hepatic insufficiency and diabetes therapy

• In advanced liver disease, there is a contraindication (contraindications) to all oral antidiabetic agents! Thus, insulin therapy is the only option!