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

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Saxenda is FDA-approved for the treatment of obesity, while Victoza is approved for the treatment of type 2 diabetes in patients ages ten and older
Tirzepatide is administered as a once-weekly subcutaneous injection, typically starting at 2.5 mg and gradually titrating upward to minimize gastrointestinal side effects