A Dutch study estimated that patients with cirrhosis used an average of nine medications to manage their condition in the first year after diagnosis. The most used drugs were proton pump inhibitors (prevalence 53.9 per cent), aldosterone antagonists (43.6 per cent), and sulfonamide diuretics (41.3 per cent).²⁶

However, the researchers warned that almost half (48.3 per cent) of the prescribed drugs required safety recommendations, while as many as 60 per cent of drugs were considered unsafe during the follow-up period (until the patient died, had a liver transplant or transferred out of the database). The top five most used potentially unsafe drugs were pantoprazole, diclofenac, ibuprofen, naproxen and atorvastatin.

NICE guidance on managing complications of cirrhosis includes offering prophylactic intravenous antibiotics for upper gastrointestinal bleeding. Prophylactic oral ciprofloxacin or norfloxacin may be suitable in some cases for ascites.²⁷

Ascites is normally managed with a low sodium diet and diuretics such as spironolactone or furosemide. Some patients will also have fluid drained from their abdomen (paracentesis) every few weeks.²⁸

Viral hepatitis treatment should be initiated by a specialist. Immunisation against hepatitis A and hepatitis B is available but a range of antivirals are available for chronic hepatitis B or C infection.³⁰