Hepatic Encephalopathy and Rifaximin

 What is hepatic encephalopathy?

Hepatic Encephalopathy is a condition that develops in individuals with cirrhosis who have a damaged liver, which usually cannot eliminate toxins as a healthy liver would. These toxins move through the body until they reach the brain and then they damage the brain and cause Hepatic Encephalopathy.

What are the hepatic encephalopathy symptoms? 

Signs and symptoms of moderate HE (Hepatic Encephalopathy) are:

• Difficulty thinking
• Personality changes
• Lack of concentration
• Confusion
• Forgetfulness
• Lack of judgment
• Sweet breath odor

The severe hepatic encephalopathy symptoms may include:

• Confusion
• Drowsiness
• Lethargy
• Anxiety
• Seizures
• Fatigue
• Confused speech
• Shaky hands
• Slow movements
• Severe changes in personality

Seek emergency medical assistance right away in case you develop signs of severe hepatic encephalopathy. These signs may lead to a coma in case left untreated for a longer period of time.

What is the most serious sign of hepatic encephalopathy?

In most individuals with severe hepatic encephalopathy, confusion or disorientation, amnesia, stupor or coma may develop. 

What are the stages of hepatic encephalopathy?

The four hepatic encephalopathy stages are listed as follows:

• Stage 1: (Mild HE): Patients may experience sleep problems, trouble concentrating and may have mood swings. 
• Stage 2: (Moderate HE): Patients may feel exhausted, have problems with basic math, and may react strangely. Hands might be shaking, and have difficulty writing.
• Stage 3: (Severe HE): Patients may be very sleepy and sometimes pass out. They are unable to do basic math at all. They may act strange and may be very fearful as well as jumpy.
• Stage 4: (Coma): The last stage of hepatic encephalopathy is coma, means the patient is unconscious.

How is hepatic encephalopathy diagnosed?

By performing blood tests can help in order to identify complications such as infections as well as bleeding associated with liver disease. Your healthcare practitioner may prescribe a few other tests in order to rule out conditions responsible for causing identical symptoms, such as strokes and brain tumors.

These tests include MRI, CT scans and EEG.

Generally, your healthcare practitioner makes a diagnosis on behalf of your Medical history, Symptoms and Office exam.

How is hepatic encephalopathy treated?

The hepatic encephalopathy treatment varies depending on your symptoms, overall health and how severe the disease is. Treatment is able to slow, and sometimes stop, the disease from getting worse. In order to treat HE, your healthcare practitioner may prescribe rifaximin (Xifaxan), or Laxatives. 

Rifaximin (Xifaxan): Inside the body, bacteria makes natural toxins from the digested foods. As an antibiotic, Rifaximin for hepatic encephalopathy helps stop the bacterial growth. As an outcome, the body starts producing fewer toxins.

Although the evidence is still lacking, rifaximin (Xifaxan) appears to be comparatively more effective than other existing treatments for HE. 

Eligibility criteria: To be suitable/eligible for treatment with Rifaximin the patient must:

• be established, with an appropriate therapeutic trial (at least 30 days), on a dose of lactulose (up to a maximum dose of 30 mL QID) that achieves 2 to 3 semi-formed stools daily, unless not tolerated. 

• be aged 18 years or older. 

• have experienced, in the last 6 months, at least 2 episodes of overt hepatic encephalopathy (Conn score ≥ 2) related to hepatic cirrhosis. 

• be in remission of Hepatic Encephalopathy (Conn score ≤1) with a MELD or Model for End-Stage Liver Disease score ≤ 25.

Exclusion criteria: Patients should be excluded from the treatment with rifaximin if:

• liver transplant is awaited within 30 days. 

• lactulose has not been appropriately trialled because of non-compliance. 

• an ongoing infection or active spontaneous bacterial peritonitis or

• Hepatic Encephalopathy is caused by a reversible precipitating cause.

Treatment: 

Should all the patients fulfil the requirements mentioned above, rifaximin treatment may be commenced at 550 mg twice in day, with or without meals, either as an inpatient or outpatient. 

Treatment with lactulose should continue as tolerated, maintaining a response of 2 to 3 semi-formed stools daily. 

Treatment may only be begun by an experienced Consultant Hepatologist. Rifaximin therapy needs to be reviewed on a regular basis at least every 3 months (90 days); where there is establishment of disease progression or no evidence of clinical benefit has been seen within a six month time-span treatment needs to be ceased.

Side Effects of Rifaximin: The rifaximin side effects are generally mild, fewer as well as uncommon. These are:

• Dizziness
• Hands
• Gas
• Headache
• Low Energy
• Nausea
• Stomach Cramps

What dosage form and strength Rifaximin is available? 

This medication comes in the form of tablets as following strength:

• rifaximin 200 mg
• rifaximin 550 mg
• rifaximin Rifagut 400 mg

How to take it: The recommended dose for HE is rifaximin 550 mg, which is consumed orally two times daily. know about indication of rifaximin tablets

NOTE: The piece of information provided about hepatic encephalopathy and rifaximin in this article is only for the informational purposes and is not served as a substitute for the medical treatment, consultation, diagnosis of an experienced healthcare practitioner.