Frailty in end-stage liver disease: Understanding pathophysiology, tools for assessment, and strategies for management

Table 3 Comparison of different frailty suggested medications in cirrhotic patients

Suggested medication	Target of action	Side effects	Dose used in clinical trials	Clinical trial results
Metformin	Insulin resistance; Proinflammatory cytokines	Gastrointestinal upset; Non responders[209]	-	-
Rifaximin	Gut dysbiosis	-	1200 mg daily for 24 wk	No significant changes in skeletal muscle index[186]
Myostatin antagonists	Hyperammonemia; Muscle mass inhibition	Spontaneous bone fractures[210]; Vascular (nasal and gum bleeding, telangiectasia)[211]	-	-
L-Carnitine	Hyperammonemia; Proinflammatory cytokines (antioxidant)	Gastrointestinal upset	(1000 mg/d) + exercise for 6 mo[201]	No significant changes in muscle mass, leg, and handgrip strength[201]
L-ornithine L-aspartate	Hyperammonemia	Gastrointestinal upset	6 g three times daily for 2 wk[207]	No significant increase in prealbumin level after use[207]
Testosterone therapy	Testosterone deficiency	Cardiovascular diseases; Prostate cancer; Erythrocytosis[212]	Intramuscular injection of testosterone undecanoate 1000 mg at 0, 6, 18, 30, 42 wk[172]	The intervention group had increased muscle and bone mass with lower fat mass[172]