Liver Transplant Evaluation and Assessment Guide

Pharmacy—medications before your transplant

The pharmacist works with your doctors and nurses to ensure you receive the correct medication. The pharmacist is available to discuss your medications with you. If you have any questions about your medications, just ask!

It is very important that you keep taking your medications, exactly as prescribed. If you forget to take your medicine, your symptoms will become worse. Please make sure you have enough medication to last until your next clinic visit and keep your repeat prescriptions in a safe place.

Do not take any other medications or supplements without asking your doctor or pharmacist first. Many medications, alternative therapies and supplements are toxic to the liver or may interact with your prescription medications. This includes medications bought from the pharmacy or supermarket, dietary supplements, for example vitamins and minerals and herbal or natural remedies.

Three of the most common medications used to treat the complications of liver disease are discussed below.

Propranolol (Inderal®, Deralin®)

Propranolol is a medication used to lower blood pressure and belongs to a group of drugs called beta-blockers. In liver disease the pressure in the blood vessels around the liver can be high. This is called portal hypertension and can lead to or worsen other complications of liver disease such as ascites and oesophageal varices, swollen veins in the oesophagus). Propranolol treats portal hypertension by reducing the pressure in these portal veins and varices.

Possible side effects

  • Fainting or severe dizziness, slow or irregular heartbeat - seek medical advice
  • Feeling dizzy, drowsy or depressed
  • Cold hands and feet
  • Difficulty with erectile function

Diuretics

Frusemide (Lasix®, Uremide®, Urex®, Frusid®, Frusehexal®), Bumetanide (Burinex®), Spironolactone (Aldactone®, Spiractin®), Amiloride (Midamor®, Kaluril®)

In liver disease excess fluid can build up in the abdomen and is called ascites. Diuretics are used to help remove this fluid and any fluid which may build up in the legs or lungs. Diuretics work by increasing the amount of salt and water you urinate and therefore increase the number of times you have to go to the toilet. Do not stop taking your diuretics without talking to your doctor.


Possible side effects

  • Skin rash, hives or itching - seek medical advice
  • Dizziness or light-headedness, rise slowly after lying down or sitting
  • Upset stomach or diarrhoea
  • Ringing in the ears with frusemide and bumetanide - seek medical advice
  • Breast tenderness in women with spironolactone only
  • Breast swelling and tenderness in men - spironolactone

Lactulose (Duphalac®, Actilax®, Genlac®, Lac-Dol®)

Hepatic encephalopathy is a disorder of brain function that can result in drowsiness and confusion. It is thought to be caused by a build up of ammonia and other toxins in the body. Lactulose can prevent and reduce the symptoms of hepatic encephalopathy.

The dose of lactulose is normally 10 to 20mls, 2 to 3 times a day. The dose is adjusted to produce 2 to 3 soft bowel motions each day. Lactulose may be mixed with half a glass of water, milk or fruit juice to make it taste better.

If severe hepatic encephalopathy happens it may be necessary for you to have the lactulose as an enema.

Possible side effects

  • Severe diarrhoea, if this occurs contact your doctor
  • Bloated feeling
  • Flatulence or wind
  • Stomach cramps and pains
  • Nausea

In this guide:

  1. Information and contact details for the liver transplant hepatology team
  2. The liver - its function and anatomy
  3. Signs of liver disease
  4. Pre-transplant assessment and evaluation
  5. The assessment team
  6. Allied Health Services
  7. Palliative care
  8. Pharmacy—medications before your transplant
  9. Case discussion and assessment presentation
  10. Will I make the list?
  11. The liver transplant waiting list
  12. Model for End stage Liver Disease (MELD)
  13. Support Through Education Program (STEP)
  14. The Donor
  15. What happens when you are notified that a donor liver is available?
  16. The liver transplant operation
  17. Intensive Care Unit (ICU) patient information
  18. The recovery period
  19. Pharmacy—medications after your transplant
  20. Rejection
  21. Donor family correspondence and information
  22. Glossary

Print entire guide