Rifaximin for the treatment of hepatic encephalopathy

Abstract

While no randomized, placebo-controlled studies have assessed the efficacy and long-term safety outcomes of rifaximin in the treatment of HE, rifaximin has demonstrated better efficacy and safety profiles compared with lactulose and neomycin. Future studies should assess HE outcomes with more consistent indexes and measurements and should compare the efficacy and safety of rifaximin with those of metronidazole.

Durability of Rifaximin Response in Hepatic Encephalopathy

“…Of 203 patients included in the study, 149 patients (73%) had received rifaximin monotherapy (mean dose, 1125 mg/d; range, 400-1600 mg/d) for an average of 255 days (range, 125-375) and 54 patients (27%) received rifaximin (mean dose, 1050 mg/d; range, 600-1200 mg/d) and lactulose 90 mL/d for a mean of 205 days (range, 110-255). Mean MELD scores during the study period were similar between treatment groups, with a mean MELD score of 12 (range, [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27] in patients who received rifaximin monotherapy compared with 13 (range, 11-26) in patients who received rifaximin and lactulose dual therapy.…”

“…5,[10][11][12] Rifaximin is approved in the United States for the treatment of travelers' diarrhea and for the reduction in risk of HE recurrence and is approved in several other countries for the treatment of HE. 10,12,13 Rifaximin has been demonstrated to be equal or superior to nonabsorbable disaccharides and antimicrobials for the treatment of HE. 5,12 Also, in 2 retrospective studies, rifaximin treatment led to fewer hospitalizations for HE versus lactulose.…”

“…10,12,13 Rifaximin has been demonstrated to be equal or superior to nonabsorbable disaccharides and antimicrobials for the treatment of HE. 5,12 Also, in 2 retrospective studies, rifaximin treatment led to fewer hospitalizations for HE versus lactulose. 14,15 Because rifaximin has an excellent safety profile, 10 it is an ideal drug for the long-term management of HE.…”

The Management of Hospitalized Patients with Cirrhosis: The Mount Sinai Experience and a Guide for Hospitalists

“…Rifaximin shows a general trend toward better efficacy versus lactulose or neomycin. In addition, rifaximin seems to offer a better safety and tolerability profile than that of lactulose and possibly neomycin [108]. It has recently been approved by the FDA at a dose of 550 mg BID [109].…”

A Comparative Study to Determine the Outcome of Hepatic Encephalopathy who Have A Past History of Hepatic Encephalopathy And or Upper Gastrointestinal Bleeding Versus Who Have Not Such Using 7 Days Therapy of RifaximinAnd or Lactulose

“…Hepatic encephalopathy is a potentially reversible neuro-psychiatric and functional syndrome occurring in 50% -70% of patients with advanced liver disease and or porto-systemic shunting [1].It occurs in presence of insufficient hepatic clearance of toxic products absorbed from intestine resulting in neuro-chemical abnormalities after crossing blood brain barrier [2] Although occurrence of an episode of hepatic encephalopathy appears to be unrelated to the cause of cirrhosis [3], increases in frequency and severity of such episode predict an increased risk of death [4,5].Clinical manifestation of HE range from altered mental status to deep coma [6]. Recurrent episodes of hepatic encephalopathy may be triggered by non-compliance to therapy or precipitated by infection, gastrointestinal bleeding , constipation, high protein diet, dyselectrolytaemia.Current treatment strategies are aimed to reduce serum ammonia by rifaximin or lactulose /lactitol and correcting the precipitating factors.…”