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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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Stem Cell Res Ther 9:12 Ghallab NA, Hamdy E, Shaker OG (2016) Malondialdehyde, superoxide dismutase and melatonin levels in gingival crevicular fluid of aggressive and chronic periodontitis patients

The atypical antipsychotic Paliperidone regulates endogenous antioxidant/anti-inflammatory pathways in rat models of acute and chronic restraint stress