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.
Important information
When Propranolol is first started it may affect your mental alertness and coordination.
If affected, take care when driving or operating heavy machinery.
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.
Important information
- Potassium is an important salt in the body.
- Different diuretics can cause either a loss or gain of potassium.
- Generally, frusemide and bumetanide cause a loss of potassium, while spironolactone and amiloride cause your body to retain potassium your doctor will be monitoring the potassium in your blood and will adjust your medication accordingly.
- You may need to take potassium supplements if your potassium level is low.
- It is very important that you talk to your doctor or pharmacist before taking any dietary supplements, for example vitamins or herbal preparations
- You must also tell your doctor if you use salt substitutes as some of them contain potassium
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.
If this confusion occurs at home, please seek medical advice quickly
Possible side effects
- Severe diarrhoea, if this occurs contact your doctor
- Bloated feeling
- Flatulence or wind
- Stomach cramps and pains
- Nausea
It is important to have an informed discussion with your doctors and pharmacist before your transplant
You should keep a list of your medications, ‘DMR’ Discharge Medication Record with you and bring it to each appointment. The pharmacist can produce new medication lists should changes be made or you lose it.
In this guide:
- Information and contact details for the liver transplant hepatology team
- The liver - its function and anatomy
- Signs of liver disease
- Pre-transplant assessment and evaluation
- The assessment team
- Allied Health Services
- Palliative care
- Pharmacy—medications before your transplant
- Case discussion and assessment presentation
- Will I make the list?
- The liver transplant waiting list
- Model for End stage Liver Disease (MELD)
- Support Through Education Program (STEP)
- The Donor
- What happens when you are notified that a donor liver is available?
- The liver transplant operation
- Intensive Care Unit (ICU) patient information
- The recovery period
- Pharmacy—medications after your transplant
- Rejection
- Donor family correspondence and information
- Glossary
- Previous ( https://www.qld.gov.au/health/services/specialists/queensland-liver-transplant-service/liver-transplant-evaluation-and-assessment-guide/palliative-care )
- Next ( https://www.qld.gov.au/health/services/specialists/queensland-liver-transplant-service/liver-transplant-evaluation-and-assessment-guide/case-discussion-and-assessment-presentation )