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Maxwell MA, Muscat GEO

Pens can be kept in fridge or room temperature once opened

Addressing Both Hunger and Digestion Hunger and digestion are two major factors in weight gain

These drugs include ondansetron (small benefit in a small randomized trial), S-adenosyl-methionine (SAMe, small benefit in uncontrolled studies), pentoxifylline (no benefit), modafinil (no benefit), hydroxyzine, zolpidem, trazodone, and melatonin (no benefit for sleep quality and insomnia) ( In conclusion, non-pharmacological therapies that focus on controlling the etiology of liver disease, improving nutrition, increasing muscle mass, mitigating triggers and risk factors, and enhancing coping mechanisms are significantly more effective in combating fatigue in cirrhosis compared to pharmacological treatments (Figure 2) ( Figure 2 3 Cirrhosis-related appetite disorders, restrictive diet, and malnutrition 3.1 Prevalence, risk factors and mechanisms Chronic liver failure in end-stage cirrhosis often leads to low appetite, nutritional deficits, and malnutrition

Exercise Considerations Start with moderate activity you enjoy