Summary of prescribing commonly used medicines in patients with DC
| Therapeutic category | Considered safe with monitoring | Avoid | Caution/modify dose | Notes |
| Gastric acid suppression | Simple antacids, for example, calcium carbonate | Proton pump inhibitors H2 antagonists | Altered gut microbiome may increase risk of infection and disease progression | |
| Analgesics | NSAIDs, COX-2 inhibitors | Paracetamol Opiates | See palliative care section | |
| Antimicrobials | Most antibiotics | Azithromycin Erythromycin Rifampicin Isoniazid | Aminoglycosides antifungals | Monitor renal and liver function |
| Antidiabetic drugs | Insulin GLP-1 agonists SGLT-2 inhibitors | Pioglitazone (in patients with fluid overload) | Metformin Sulphonylureas | Risk of lactic acidosis (metformin) Fluid accumulation |
| Drugs used in cardiovascular disease | Calcium antagonists | ACE-inhibitors ARBs Amiodarone | Beta blockers | Risk of acute kidney injury |
| Lipid lowering agents | Cholestyramine | Statins | Risk of accumulation/DILI | |
| Anticonvulsants | Levetiracetam | Sodium valproate Phenobarbitone | Phenytoin Carbamazepine Lamotrigine | Risk of accumulation and increased toxicity |
| Antidepressants/sedatives | Duloxetine | SSRI Venlafaxine Mirtazepine Benzodiazepines | Limited data in severe disease | |
| DMARDs | TNF inhibitors | Methotrexate Leflunomide Budesonide | Prednisolone | Pre-screen for HBV |
| Drugs affecting clotting | LMWH | DOAC (Child Pugh C) | Warfarin Thrombopoietin Receptor Agonists | Lack of evidence in use of DOACs in DC |
ARB, angiotensin receptor blocker; DC, decompensated cirrhosis; DILI, drug induced liver injury; DOAC, direct oral anticoagulant; HBV, hepatitis B virus; LMWH, low molecular weight heparin; NSAIDs, non-steroidal anti-inflammatory drugs; SSRI, selective serotonin reuptake inhibitor.