Rifaximin for the treatment of hepatic encephalopathy

Abstract

Hepatic encephalopathy (HE) is a complication of cirrhosis, the severity of which can range from subtle, neurocognitive dysfunction (minimal HE) to more apparent and severe cognitive and motor manifestations with increasing grades of the condition (overt HE). Current treatment options are targeted at reducing the levels of ammonia and other gut-derived toxins, the purported culprits behind the pathogenesis of HE. One of these therapeutic options, the nonsystemic antibiotic rifaximin, is efficacious for the treatment of minimal and overt HE. However, HE may be a cyclic condition in which patients with overt HE enter remission following treatment and then relapse. Thus, safe, effective and well-tolerated treatments are needed to maintain HE remission. Rifaximin maintained HE remission more effectively than placebo in a large, randomized controlled trial. Rifaximin is safe and well-tolerated for the treatment of minimal and overt HE and for the maintenance of HE remission.

Keywords::

• antibiotic
• hepatic encephalopathy
• nonabsorbable antibiotic
• nonsystemic antibiotic
• rifaximin

Financial & competing interests disclosure

Kevin Mullen is a consultant for and has received honoraria from Salix and Ocera Pharmaceuticals. Ravi Prakash has nothing to disclose. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Medical writing and editorial assistance was provided under the direction of the authors by MedThink Communications with support from Salix Pharmaceuticals, Inc.