Adjunctive therapies

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Below is an excerpt from one of the eMedicine websites. The itching

post from Qoya made me think of posting it.

MaC

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Adjunctive therapies

Zinc deficiency commonly is observed in patients with cirrhosis.

Treatment with zinc sulfate at 220 mg orally twice daily may improve

dysgeusia and can stimulate appetite. Furthermore, zinc is effective

in the treatment of muscle cramps and is adjunctive therapy for

hepatic encephalopathy.

Pruritus is a common complaint in both cholestatic liver diseases (eg,

primary biliary cirrhosis) and in noncholestatic chronic liver

diseases (eg, hepatitis C). Although increased serum bile acid levels

once were thought to be the cause of pruritus, endogenous opioids are

more likely to be the culprit pruritogens. Mild itching complaints may

respond to treatment with antihistamines.

Cholestyramine is the mainstay of therapy for the pruritus of liver

disease. Care should be taken to avoid coadministration of this

organic anion binder with any other medication, to avoid compromising

GI absorption. Other medications that may provide relief against

pruritus include ursodeoxycholic acid, ammonium lactate 12% skin cream

(Lac-Hydrin, Westwood-Squibb Pharmaceuticals, Inc, Princeton, NJ),

naltrexone (an opioid antagonist), rifampin, gabapentin, and

ondansetron. Patients with severe pruritus may require institution of

ultraviolet light therapy or plasmapheresis.

Some male patients suffer from hypogonadism. Patients with severe

symptoms may undergo therapy with topical testosterone preparations,

although their safety and efficacy is not well studied. Similarly, the

utility and safety of growth hormone therapy remains unclear.

Patients with cirrhosis may develop osteoporosis. Supplementation with

calcium and vitamin D is important in patients at high risk for

osteoporosis, especially patients with chronic cholestasis, patients

with primary biliary cirrhosis, and patients receiving corticosteroids

for autoimmune hepatitis. The discovery of decreased bone

mineralization upon bone densitometry studies also may prompt

institution of therapy with an aminobisphosphonate (eg, alendronate

sodium).

Regular exercise, including walking and even swimming, should be

encouraged in patients with cirrhosis, lest the patient slip into a

vicious cycle of inactivity and muscle wasting. Debilitated patients

frequently benefit from formal exercise programs supervised by a

physical therapist. Patients with chronic liver disease should receive

vaccination to protect them against hepatitis A. Other protective

measures include vaccination against hepatitis B, pneumococci, and

influenza.