| Drug | Class | Adult | Paediatric | Notes |
|---|---|---|---|---|
| Carvedilol or propranolol (variceal prophylaxis)[1] | Non-selective beta-blocker | Carvedilol 6.25 mg PO daily start, titrate to 12.5 mg/day; propranolol 20 mg PO BD start, titrate to maximum tolerated to HR 55–60 | — | Primary and secondary variceal prophylaxis; carvedilol preferred per AASLD 2024 — additional alpha-1 antagonism reduces portal pressure more; hold for SBP <90 or refractory ascites with hyponatraemia |
| Spironolactone ± furosemide (ascites)[1] | Mineralocorticoid receptor antagonist + loop diuretic | Spironolactone 100 mg PO daily start, titrate every 3–5 days to 400 mg max; combine with furosemide 40 mg PO daily, titrate to 160 mg max — keep 100:40 ratio | — | Standard combination; monitor sodium, potassium, creatinine; gynaecomastia from spironolactone — consider eplerenone or amiloride |
| Lactulose[1] | Non-absorbable disaccharide laxative | 30–45 mL PO TDS-QDS titrated to 2–3 soft stools/day | — | First-line for hepatic encephalopathy; reduces gut ammonia; hypokalaemia and dehydration with overdose; rectal route in obtunded patients (300 mL in 700 mL water) |
| Rifaximin[1] | Non-absorbable rifamycin antibiotic | 550 mg PO BD | — | Add-on to lactulose for recurrent HE; reduces hospital admission; minimal systemic absorption; expensive |
| Ceftriaxone (SBP / variceal bleed prophylaxis)[1] | Third-generation cephalosporin | 1–2 g IV daily × 5–7 days | — | Empirical for SBP and prophylactic in variceal bleed; switch to oral norfloxacin after stabilisation; SBP recurrence prevention with daily norfloxacin |
| Terlipressin (acute variceal bleed)[1] | Synthetic vasopressin analogue | 2 mg IV every 4 h × 24 h then 1 mg every 4 h × 2–5 days | — | Reduces splanchnic blood flow and portal pressure; alternative octreotide 50 µg IV bolus then 50 µg/h infusion; cardiac monitoring (myocardial ischaemia) |
Diagnosis, complications surveillance, and aetiology-driven management of compensated and decompensated liver cirrhosis in adults.