Why There Isn't One 'Best Drug' for Cirrhosis of the Liver

October 14, 2025 •

4 min read

Cirrhosis is irreversible in its advanced stages, but treatment can significantly slow its progression and manage its complications. Instead of a single "best drug for cirrhosis of the liver," successful management depends on a personalized approach tailored to the specific cause and related symptoms.

Quick Summary

Treatment for liver cirrhosis is not based on a single medication but is personalized to address the underlying cause and manage specific complications like fluid retention, confusion, and bleeding risks.

Key Points

Personalized Treatment is Key: There is no single best drug for cirrhosis; treatment is tailored to the individual's underlying cause and specific complications.
Targeting the Root Cause: The primary goal is to address the source of the liver damage, such as using antivirals for hepatitis B and C, or alcohol abstinence for alcoholic liver disease.
Complication Management is Crucial: Medications are used to manage complications like ascites (diuretics), hepatic encephalopathy (lactulose, rifaximin), and portal hypertension (beta-blockers).
Emerging Therapies for MASH: Recent FDA-approved drugs like resmetirom show promise for MASH-related cirrhosis, but are used in combination with lifestyle changes.
Lifestyle Modifications are Foundational: Important measures include a low-sodium diet, complete alcohol abstinence, and careful management of all medications.
Avoid Certain Medications: NSAIDs and other potentially liver-toxic substances should be strictly avoided in patients with cirrhosis.
Transplantation as a Final Option: For advanced, irreversible cirrhosis and liver failure, a liver transplant is often the only remaining option.

Treating the Underlying Cause of Cirrhosis

Because there is no one best drug to reverse the extensive scarring of cirrhosis, the primary medical approach is to target the original cause of the liver damage. This can prevent further harm and may even allow for some liver function improvement in certain cases.

Chronic Viral Hepatitis (Hepatitis B and C): Antiviral medications are highly effective at eliminating or suppressing the virus that is causing liver damage. The specific drug depends on the type of hepatitis present. For example, modern direct-acting antiviral (DAA) medications can cure hepatitis C in most cases. For hepatitis B, drugs like entecavir or tenofovir are used to control the virus and prevent further liver damage.
Alcohol-Associated Liver Disease: For patients with cirrhosis stemming from excessive alcohol consumption, the single most critical intervention is complete and permanent abstinence from alcohol. A doctor may recommend medication-assisted treatment (MAT) with drugs like baclofen or naltrexone to support abstinence, especially in severe cases.
Metabolic Dysfunction-Associated Steatohepatitis (MASH): Previously known as NASH, MASH is increasingly recognized as a cause of cirrhosis. In March 2024, the FDA approved resmetirom (Rezdiffra) as the first drug specifically for MASH, used in conjunction with diet and exercise to reduce liver fat and inflammation in some patients with moderate-to-advanced fibrosis. Other promising drugs, like semaglutide, are also being studied. However, weight loss and managing diabetes and high lipids remain cornerstones of treatment.
Autoimmune Hepatitis: This condition is treated with immunosuppressant medications like corticosteroids (prednisolone) to reduce inflammation and prevent the immune system from attacking the liver.
Genetic or Other Diseases: For rare causes, like Wilson's disease or hemochromatosis, treatment involves managing the specific condition. For example, ursodiol is used for conditions that damage bile ducts, such as primary biliary cholangitis.

Managing the Complications of Cirrhosis

As cirrhosis progresses, managing its complications becomes a central focus of treatment. Medications play a crucial role in controlling these symptoms.

Medications for Specific Complications

Ascites (Fluid Buildup): Diuretics like spironolactone (Aldactone) and furosemide (Lasix) are prescribed to help the body excrete excess fluid and sodium. Spironolactone is a potassium-sparing diuretic that counteracts the fluid-retention mechanisms in cirrhosis. A low-sodium diet is also essential.
Hepatic Encephalopathy (HE): This condition, causing confusion and cognitive issues, results from the liver's inability to clear toxins. Medications used to manage HE include:
- Lactulose: A synthetic sugar that acts as a laxative, it helps remove toxins like ammonia from the body via the gut.
- Rifaximin: A non-absorbable antibiotic that reduces the bacteria in the gut that produce ammonia.
Portal Hypertension and Variceal Bleeding: Beta-blockers, such as propranolol or carvedilol, are used to lower high blood pressure in the portal vein system and reduce the risk of variceal bleeding.
Infections: Patients with cirrhosis have a reduced ability to fight infections. Prophylactic antibiotics may be used in some cases, such as for patients with low protein ascites who are at high risk for spontaneous bacterial peritonitis.

Comparison of Key Cirrhosis Medications


Medication Class	Primary Indication	Common Examples	How It Works	Side Effects
Diuretics	Ascites (fluid buildup)	Spironolactone, Furosemide	Increases urine output to remove excess fluid and sodium	Electrolyte imbalance, kidney injury, dehydration
Antivirals	Hepatitis B & C	Entecavir, Sofosbuvir/Velpatasvir	Stops or suppresses viral replication	Headache, fatigue, nausea, muscle pain
Antibiotics	Hepatic Encephalopathy, SBP prophylaxis	Rifaximin, Norfloxacin	Reduces ammonia-producing gut bacteria	Abdominal pain, nausea, antibiotic resistance
Beta-Blockers	Portal Hypertension, Variceal Prophylaxis	Propranolol, Carvedilol	Lowers blood pressure in the portal vein system	Fatigue, low blood pressure, dizziness
Laxatives	Hepatic Encephalopathy	Lactulose	Removes toxins via the gut, alters gut bacteria	Bloating, gas, diarrhea, dehydration

The Role of Lifestyle and Transplantation

For all patients with cirrhosis, medication is only part of the puzzle. Significant lifestyle changes are necessary to manage the disease effectively. This includes strict adherence to a low-sodium diet, abstinence from alcohol, and vaccinations against infections like hepatitis A and B, and pneumonia. Most importantly, patients must be aware that certain common medications, such as Nonsteroidal Anti-Inflammatory Drugs (NSAIDs), can be harmful and should be avoided.

In cases of advanced, decompensated cirrhosis where medical management is no longer sufficient, a liver transplant may be the only curative option. The criteria for receiving a transplant are strict, and evaluation by a hepatologist is necessary to determine eligibility.

Conclusion

Ultimately, the question, "What is the best drug for cirrhosis of the liver?" has no single answer because the disease's progression and complications are highly individual. Effective pharmacological management relies on a personalized strategy, targeting both the underlying cause and the resulting symptoms. While new drugs like resmetirom offer hope for specific causes like MASH, lifestyle modifications remain foundational. Regular consultation with a hepatologist is critical for navigating the complexities of cirrhosis and optimizing treatment, which may range from antiviral medications and diuretics to, in the most severe cases, liver transplantation.

For more information on the management of chronic liver disease, consult the American College of Gastroenterology guidelines.

Frequently Asked Questions

While some treatments can slow or halt the progression of liver damage and address the underlying cause, the scarring associated with advanced cirrhosis is generally considered irreversible. In some cases, treating the root cause (e.g., curing hepatitis C) can lead to some liver function improvement.

Fluid buildup (ascites) is typically treated with a combination of diuretics, most commonly spironolactone and furosemide, along with a low-sodium diet. These medications help the body get rid of excess fluid.

Hepatic encephalopathy is managed with lactulose, a laxative that removes toxins like ammonia from the gut, and rifaximin, an antibiotic that reduces ammonia-producing bacteria. The goal is to produce two to three soft bowel movements daily.

Acetaminophen is generally considered the safest pain reliever, but it must be used at a lower dose (typically no more than 2 grams per day) and only under a doctor's supervision. NSAIDs like ibuprofen are contraindicated due to the risk of kidney damage and bleeding.

Non-selective beta-blockers, such as propranolol or carvedilol, are used to lower blood pressure in the portal vein system and prevent internal bleeding from enlarged veins (varices).

Yes, resmetirom (Rezdiffra) was recently approved by the FDA for MASH patients with moderate-to-advanced fibrosis. It is the first medication to target this specific cause of liver disease.

A liver transplant is considered for advanced, decompensated cirrhosis when the liver has failed and other treatments are no longer effective. It is a life-saving procedure for many patients.

Patients with cirrhosis should avoid herbal supplements and check with their doctor before taking any other supplements. Some supplements can cause further liver damage.