Comparison of once a day rifaximin to twice a day dosage in the prevention of recurrence of hepatic encephalopathy in patients with chronic liver disease

Khokhar, Nasir; Qureshi, Muhammad Omar; Ahmad, Shafiq; Ahmad, Aiza; Khan, Hamza; Shafqat, Farzana; Salih, Muhammad

doi:10.1111/jgh.12970

Cited by 17 publications

(12 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Studies have also assessed the effectiveness of different rifaximin treatment regimens when used in addition to lactulose therapy. No significant differences were observed between patients treated with rifaximin-α 550 mg once-daily versus twice daily 25, or between patients treated with rifaximin-α 550 mg twice daily versus rifaximin 400 mg, three times daily; although rifaximin-α 550 mg twice daily was shown to be more cost-effective than the three times daily regimen 27.…”

Section: Resultsmentioning

confidence: 88%

Long-term management of hepatic encephalopathy with lactulose and/or rifaximin: a review of the evidence

Hudson

Schuchmann²

2019

European Journal of Gastroenterology &Amp; Hepatology

View full text Add to dashboard Cite

A consolidated overview of evidence for the effectiveness and safety/tolerability of hepatic encephalopathy (HE) treatment over the long term is currently lacking. We identified and assessed published evidence for the long-term (≥6 months) pharmacological management of HE with lactulose and/or rifaximin. A literature search was conducted in PubMed (cutoff date 05 March 2018) using the search terms ‘hepatic encephalopathy+rifaximin’ and ‘hepatic encephalopathy+lactulose’. All articles containing primary clinical data were manually assessed to identify studies in which long-term (≥6 months) effectiveness and/or safety/tolerability end points were reported for lactulose and/or rifaximin. Long-term effectiveness outcomes were reported in eight articles for treatment with lactulose alone and 19 articles for treatment with rifaximin, alone or in combination with lactulose. Long-term safety/tolerability outcomes were reported in six articles for treatment with lactulose alone and nine articles for treatment with rifaximin, alone or in combination with lactulose. These studies showed that lactulose is effective for the prevention of overt HE recurrence over the long term and that the addition of rifaximin to lactulose significantly reduces the risk of overt HE recurrence and HE-related hospitalization, compared with lactulose therapy alone, without compromising tolerability. Current evidence therefore supports recommendations for the use of lactulose therapy for the prevention of overt HE recurrence over the long term, and for the additional benefit of adding rifaximin to lactulose therapy. Addition of rifaximin to standard lactulose therapy may result in substantial reductions in healthcare resource utilization over the long term, by reducing overt HE recurrence and associated rehospitalization.

show abstract

Section: Resultsmentioning

confidence: 88%

Long-term management of hepatic encephalopathy with lactulose and/or rifaximin: a review of the evidence

Hudson

Schuchmann²

2019

European Journal of Gastroenterology &Amp; Hepatology

View full text Add to dashboard Cite

show abstract

“…Regarding the dosage of rifaximin, Khokhar et al found no significant difference in the efficacy of rifaximin (550 mg) once daily and twice daily (550 mg/day and 1,100 mg/ day, respectively) in the prevention of HE (29). In contrast, however, Sarwar et al reported that the rate of HE development during 6 months of follow-up was similar between a low-dose (400 mg/day) group and a full-dose group (1,100 mg/day) (30).…”

Section: Discussionmentioning

confidence: 99%

Evaluation of the Long-term Administration of Rifaximin for More than Three Years in the Treatment of Repeated and Recurrent Overt Hepatic Encephalopathy

et al. 2021

View full text Add to dashboard Cite

The patient was a 65-year-old man with alcoholic liver cirrhosis who had been admitted to hospital 5 times for repeated and recurrent overt hepatic encephalopathy (HE) despite numerous therapies, including disaccharide, branched-chain amino acid (BCAA) formula, L-carnitine and zinc. After the additional administration of rifaximin (1,200 mg/day orally), his consciousness level was well controlled for 3 years without any adverse effects. The long-term administration of rifaximin may be useful and safe for managing recurrent overt HE, although the maintenance dosage and duration of rifaximin and safety should be evaluated in patients with ameliorated HE.

show abstract

“…As with all medications, efforts to reduce cost are prudent to aid in optimized patient compliance. A recent study by Khokar and colleagues examined the potential utility of rifaximin dosed at 550 mg taken only once daily . When comparing this regimen to the standard 550 mg twice daily regimen, they found no significant difference in their outcome of breakthrough episode of encephalopathy .…”

Section: Discussionmentioning

confidence: 99%

Retrospective cross‐sectional pilot study of rifaximin dosing for the prevention of recurrent hepatic encephalopathy

Lyon

Likar

Martello

et al. 2017

J of Gastro and Hepatol

View full text Add to dashboard Cite

Standard treatment for hepatic encephalopathy (HE) includes medications that reduce ammonia and bacterial translocation in the gut. Rifaximin can be used off-label for the reduction of overt HE. The study purpose was to determine efficacy of traditional rifaximin dosing (400 mg three times daily) compared with newer dosing (550 mg twice daily) via readmission rates for the prevention of recurrent HE. This was a retrospective, observational, cross-sectional pilot study conducted in a tertiary medical center. A total of 226 patients 18-89 years of age with documentation of HE via ICD-9 code who started rifaximin therapy while inpatient between April 2009 and June 2014 were evaluated. Data collected included rifaximin dosing, other medications used to treat HE, duration of therapy, time to readmission, and various laboratory values. There were no differences in readmission rates at 30 days, 60 days, or 6 months between treatment groups. Additionally, there was no difference in the odds of readmission between the treatment groups (OR = 0.77, 95% CI: [0.201, 4.365], P = 0.718). Patients had a low overall probability of readmission over the observational period. Based on average wholesale price data, the cost for a 9-day supply of rifaximin for the 400-mg dosing regimen is $952.56 versus $605.16 for the 550-mg dosing regimen. The rifaximin 550-mg dosing strategy should be utilized in hospitalized patients for the prevention of recurrent HE as there was no difference in readmission rate or time to readmission between dosing groups. The 550-mg regimen had a lower acquisition cost for a 9-day duration of treatment in the studied institution.

show abstract

Comparison of once a day rifaximin to twice a day dosage in the prevention of recurrence of hepatic encephalopathy in patients with chronic liver disease

Abstract: This study suggests that there is no significant difference in rifaximin once a day or twice daily dose in preventing HE.

Cited by 17 publications

References 19 publications

Long-term management of hepatic encephalopathy with lactulose and/or rifaximin: a review of the evidence

Long-term management of hepatic encephalopathy with lactulose and/or rifaximin: a review of the evidence

Evaluation of the Long-term Administration of Rifaximin for More than Three Years in the Treatment of Repeated and Recurrent Overt Hepatic Encephalopathy

Retrospective cross‐sectional pilot study of rifaximin dosing for the prevention of recurrent hepatic encephalopathy

Contact Info

Product

Resources

About