Alcohol-Related Liver Disease Drug Summary

Drug	Dosage	Remarks
Branched-chain amino acids  (L-isoleucine, L-leucine, L-valine)1	4.15 g sachet, take 1 sachet with a glass of water PO 8 hourly after meals	Adverse Reactions GI effects (abdominal distension or pain, queasy, diarrhea, constipation, vomiting); Other effects (malaise, edema, rash, itching, increased BUN and serum creatinine, increased blood ammonia, increased serum AST and ALT, increased total bilirubin) Special Instructions Not to be reconstituted with water or other fluids Use with caution in elderly patients Avoid in patients with congenital branched-chain amino acid metabolic abnormality or patients with markedly advanced hepatic cirrhosis
L-ornithine-L-aspartate	3 g or 5 g sachet, take 1-2 sachet dissolved in liquid PO up to 8 hourly or 20 g/day IV infusion	Adverse Reactions Granules: Nausea/vomiting, stomachache, flatulence; rare diarrhea, limb pain Infusion concentrate: Nausea/vomiting Special Instructions Use with caution in patients with fructose intolerance Avoid in patients with severe renal insufficiency
Metadoxine	1,000 mg PO 24 hourly or 500 mg PO 8 hourly	Special Instructions May be taken with or without food Use with caution in patients with parkinsonism treated with Levodopa Avoid in pregnancy, lactation
Phospholipids1 (Essential phospholipids)	600 mg PO 8 hourly	Adverse Reactions Occasionally stomach complaints, soft stool, diarrhea Special Instructions Take unchewed with meals with plenty of liquid Use with caution in patients with chronic hepatitis Avoid in patients with hypersensitivity to soya bean prep Not a substitute for the avoidance of the noxious agents causing liver damage eg alcohol
Silymarin1	150-200 mg PO 12-24 hourly or Initially for severe disease: 140 mg PO 8 hourly for 3-6 months Maintenance dose: 70 mg PO 8 hourly or 140 mg PO 12 hourly	Adverse Reactions Diarrhea Special Instructions Should be taken with food
Ursodeoxycholic acid	Individualize dose	Adverse Reactions GI effects (nausea/vomiting, GI disturbances); Other effects (headache, insomnia, bronchitis, URTI, arthralgia, myalgia, pruritus)  Special Instructions Should be taken with food Contraindicated in patients with allergy to bile acids, with calcified cholesterol stones, radiopaque stones or radiolucent bile pigment stones, chronic liver disease

¹Various combination preparations are available. Please see the latest MIMS for specific formulations and prescribing information.

Drug	Dosage	Remarks
Betamethasone	1.5-5 mg PO 24 hourly for 1-3 weeks, then reduce dose until effective minimum dose is reached	Adverse Reactions CV effects (hypertension, myocardial rupture following recent MI); Other effects (adrenal suppression, visual disturbances, immunosuppression with prolonged use, myopathy, psychiatric disturbances, electrolyte disturbances, fluid retention, hypersensitivity) Special Instructions Increase dose in patients subjected to any unusual stress; gradually reduce dose to minimize drug-induced secondary adrenocortical insufficiency May mask some signs of infection, may activate latent amoebiasis or TB Use with caution in patients with left ventricular free wall rupture after recent MI, women of childbearing potential

Drug	Dosage	Remarks
S-adenosyl-L-methionine	400-1,200 mg PO 24 hourly in divided doses for 6 months	Special Instructions Should be taken on an empty stomach, do not chew or crush Use with caution during pregnancy and lactation

All dosage recommendations are for non-elderly adults with normal renal and hepatic function unless otherwise stated.   
Not all products are available or approved for above use in all countries.  
Products listed in the Drug Summary are based on indications stated in the locally approved product monographs.   
Please refer to local product monographs in Related MIMS Drugs for country-specific prescribing information.