Liver Shrinkage (Cirrhosis): Prevention

To prevent liver cirrhosis (liver shrinkage), attention must be paid to reducing individual risk factors. Behavioral risk factors

• Consumption of stimulants
  • Alcohol – (woman: > 40 g/day; man: > 60 g/day).
  • Tobacco (smoking, passive smoking) – smoking promotes fibrosis of the liver in the presence of cirrhosis.
• Drug use
  • Ecstasy (also XTC and others) – collective name for a variety of phenylethylamines.
  • Cocaine

Drugs (hepatotoxic: hepatotoxic drugs/hepatoxic drugs) [list is not exhaustive].

• Anabolic steroids (anabolic steroids).
• Analgesics (including NSAIDs) – acetylsalicylic acid (ASA), diclofenac, ibuprofen, indometacin, metamizole, paracetamol (acetaminophen), sulindac.
• Antiarrhythmic drugs – amiodarone
• Antibiotics
  • Aminopenicillins (amoxicillin)
  • Clavulanic acid
  • Gyrase inhibitors (quinolones: ciprofloxacin)
  • Isoxazolylpenicillins (so-called staphylococcal penicillins) – oxacillin.
  • Ketolides
  • Lincosamide antibiotics (lincosamides) – clindamycin
  • Macrolide antibiotics (macrolides) – erythromycin)
  • Nitrofurantoin
  • Penicillins (flucloxacillin)
  • Sulfonamides
  • Tetracyclines (doxycycline, minocycline
  • Trimethoprim/sulfamethoxazole)
• Antidepressants
  • Dual-serotonergic antidepressants (DSAs) – nefazodone
  • Selective serotonin reuptake inhibitors (SSRIs) – fluoxetine, paroxetine, sertraline, trazodone.
  • Selective dopamine and norepinephrine (slightly also serotonin) reuptake inhibitors (NDRI) – bupropion.
  • Tetracyclic antidepressants – mirtazapine
  • Tricyclic antidepressants – amitriptyline
• Antiepileptic drugs – carbamazepine, valproate.
• Antihypertensives – alphamethyldopa, nifedipine, diltiazem, lisinopril, fosinopril, captopril, enalapril,verapamil, losartan, irbesartan.
• Anticoagulants – phenprocoumon (product names: Marcumar, Falithrom), clopidogrel.
• Anticonvulsants – valproic acid, carbamazepine, phenopbarbital, phenytoin.
• Antifungals
  • Allylamines (terbinafine)
  • Ketoconazole (Ketoconazole)
  • Polyene macrolactone (amphotericin)
• Antipsychotics (neuroleptics) – carbamazepine, chlorpromazine, phenobarbital, phenytoin, valproic acid, risperidone.
• Antituberculostatics – isoniazid, pyrazinamide, rifampicin, rifabutin.
• Α-Methyldopa
• EGFR tyrosine kinase inhibitor – lapatinib
• Endothelin receptor antagonists (endothelin receptor antagonists) – ambrisentan, bosentan.
• HMG-CoA reductase inhibitors (statins), unspecified.
• Hormones
  • Antiestrogens (tamoxifen)
  • Oral anticonceptives, unspecified.
  • Estrogens
• Immunosuppressants – azathioprine, ciclosporin (cyclosporin A), mercaptopurine.
• Motilin agonist
• Anesthetic (halothane)
• Oral antidiabetic agents – acarbose
• Orlistat
• Antivirals – nevirapine, abacavir, amprenavir, fialuridine, ritonavir.
• Cytostatic drugs – cytarabine, flutamine, isoniazid, methotrexate.
• Other – disulfiram, hypertonic saline, vitamin A intoxication, pyrrole cidine alkaloids, Thorotrast, allopurinol, cyproheptadine.

Environmental pollution – intoxications (poisonings).

• Arsenic
• Formaldehyde

Prevention factors (protective factors)

• Genetic load
  • Genes/SNPs (single nucleotide polymorphism; English : single nucleotide polymorphism):
    • Gene: HSD17B13
      • SNP: rs72613567 in gene HSD17B13
        • Allele constellation: AA (73% lower risk for alcoholic cirrhosis; 49% for nonalcoholic cirrhosis).
        • Allele constellation: AT (42% lower risk for alcoholic cirrhosis; 26% for nonalcoholic cirrhosis).
• Coffee consumption
  • Studies show that daily coffee consumption of two or more cups reduces mortality (death) from non-viral cirrhosis of the liver. Researchers attribute this protective (protective) effect to the bioactive compounds found in coffee.
  • The risk of developing cirrhosis of the liver can also be reduced by half by drinking two cups of coffee a day.Similar observations have been made for alcohol-related cirrhosis.