However; this study provides a safe and highly effective drug for muscle cramps in cirrhotic patients. In conclusion, orphenadrine is considered a safe and effective drug in the treatment of muscle cramps in patients with liver cirrhosis.
Methocarbamol is a commonly used, centrally acting muscle relaxant and has not been linked to instances of liver injury.
Summary. Patients with cirrhosis often exhibit a resistance to muscle relaxants. This phenomenon can be explained by an increase in the initial volume of distribution of the relaxant.
Cyclobenzaprine is a centrally acting muscle relaxant closely related to the tricyclic antidepressants. Despite its similarity to tricyclic antidepressants, there is little evidence that cyclobenzaprine causes liver injury.
Taurine, BCAAs, orphenadrine, and baclofen are safe and well-tolerated treatment options for muscle cramps in cirrhosis.
Our findings suggest that muscle cramps occur more frequently in patients with liver cirrhosis due to their decreased liver function and poorer nutritional status.
Patients with cirrhosis who experience muscle cramps report that they are extremely painful and that they often occur at rest and frequently during sleep. 8 Cramps predominantly affect the hands, legs and the feet but may also affect the neck, back and the sides.
Metaxalone
Taken as 800 mg tablets 3 to 4 times a day, metaxalone (Skelaxin) has the fewest reported side effects. It's also the least likely of the muscle relaxants to make you sleepy. It may work better for chronic lower back pain that is flaring up, rather than for pain that is new.
Rare cases of drug induced jaundice have occurred with some, but not all of the muscle relaxants. Agents that have been fairly clearly linked to clinically apparent acute liver injury include chlorzoxazone, dantrolene, and tizanidine.
In general, acetaminophen at reduced dosing is a safe option. In patients with cirrhosis, nonsteroidal anti-inflammatory drugs should be avoided to avert renal failure, and opiates should be avoided or used sparingly, with low and infrequent dosing, to prevent encephalopathy.
Other medications that should be avoided include abacavir, COX-2 inhibitors, nonsteroidal anti-inflammatory drugs, direct oral anticoagulant agents, sertraline, and tacrolimus. Herbal supplements have been shown to induce liver injury.
For instance, nonsteroidal, anti-inflammatory drugs such as ibuprofen and naproxen, they should be avoided in patients with cirrhosis, because when the liver is scarred, there's a greater chance of hurting the kidneys with these types of medications.
Angiotensin-converting enzyme inhibitors and angiotensin receptor blockers should be avoided in patients with cirrhosis and ascites even in low doses as they can induce arterial hypotension and renal failure [60, 61].
Among sedatives, propofol has good safety profile in liver disease (though predominantly cleared by liver, dose adjustments are not required in liver disease).
Ibuprofen has the highest liver safety profile among NSAIDs and showed no severe liver injury in larger studies. Along with paracetamol and aspirin, it is considered one of the most common over the counter NSAIDs sold in the world. Coxibs have currently replaced several NSAIDs due to safer GI profile.
As a rule, any type of long-acting local anesthetic in patients with cirrhosis should be avoided. Fentanyl from narcotics, lorazepam and oxazepam from sedatives along with some volatile anesthetic agent such as Sevoflurane or intravenous anesthetics such as propofol, are recommended in these patients (18-20).
Baclofen is a centrally acting muscle relaxant commonly prescribed for spasticity in patients with multiple sclerosis. Baclofen has not been linked to rare instances of mild, self-limited, clinically apparent liver injury.
Serious side effects associated with their use include dizziness, falls, fractures, car accidents, dependence and overdose. Muscle relaxants pose a significant risk to people over 65, and the American Geriatrics Society advises against their use in this age group.
Stage 3: Cirrhosis
During this stage of disease, symptoms become more noticeable: pain and discomfort, fatigue, appetite loss, fluid retention, jaundice, and an itchy feeling around the liver.
Swelling in the legs and abdomen.
The increased pressure in the portal vein can cause fluid to accumulate in the legs, called edema, and in the abdomen, called ascites. Edema and ascites also may happen if the liver can't make enough of certain blood proteins, such as albumin.