Other HE treatment options
Nonabsorbable disaccharides
Lactulose has been considered the standard of treatment for HE, with clinical studies
showing about 50% of patients experiencing improvement.1,2
- However, even with lactulose treatment, 75% of patients have been shown to develop
HE recurrences3
- Lactulose has a very sweet taste and may cause gas, bloating, and diarrhea, making
it difficult for some patients to tolerate1,2
- Lactulose may also lead to dehydration in some patients, which may be a trigger
for HE1
Antibiotics
Several antibiotics that have activity in the small bowel, although not all approved
for HE, have been shown to reduce symptoms of encephalopathy.4
- Despite poor absorption, neomycin is potentially associated with hearing loss and
renal failure4
- Metronidazole has a high rate of adverse events, the most serious being neurotoxicity,
which can be severe in cirrhotic patients with impaired intestinal motility4
Learn more about Xifaxan
550 mg.
See
how Xifaxan 550 mg may reduce hospitalizations.
IMPORTANT SAFETY INFORMATION
XIFAXAN 550 mg is indicated for reduction in risk of overt hepatic encephalopathy (HE) recurrence in patients ≥18 years of age. In the trials of XIFAXAN for HE, 91% of the patients were using lactulose concomitantly. XIFAXAN has not been studied in patients with MELD scores >25, and only 8.6% of patients in the controlled trial had MELD scores over 19. There is increased systemic exposure in patients with more severe hepatic dysfunction. Therefore, caution should be exercised when administering XIFAXAN to patients with severe hepatic impairment (Child-Pugh C).
XIFAXAN is contraindicated in patients with a hypersensitivity to rifaximin, any of the rifamycin antimicrobial agents, or any of the components in XIFAXAN. Hypersensitivity reactions have included exfoliative dermatitis, angioneurotic edema, and anaphylaxis.
Clostridium difficile-associated diarrhea (CDAD) has been reported with use of nearly all antibacterial agents, including XIFAXAN, and may range in severity from mild diarrhea to fatal colitis. Treatment with antibacterial agents alters the normal flora of the colon which may lead to overgrowth of C. difficile. If CDAD is suspected or confirmed, ongoing antibiotic use not directed against C. difficile may need to be discontinued.
The most common adverse reactions occurring in >8% of patients in the clinical study were edema peripheral (15%), nausea (14%), dizziness (13%), fatigue (12%), ascites (11%), muscle spasms (9%), pruritus (9%), and abdominal pain (9%).
Xifaxan550 is not available for sale outside the U.S.
Xifaxan550 is licensed by Alfa Wassermann S.p.A. to Salix Pharmaceuticals, Inc.
Complete Prescribing Information.
You are encouraged to report negative side effects to the FDA. Visit www.fda.gov/safety/medwatch/ or call 1-800-FDA-1088.
For product information, adverse event reports, and product complaint reports, please contact:
Salix Product Information Call Center
Phone: 1-800-508-0024
Fax: 1-510-595-8183
E-mail: Salix@medcomsol.com
References: 1. Muñoz SJ. Hepatic encephalopathy. Med Clin
North Am. 2008;92(4):795-812. 2. Als-Nielsen B, Gluud
LL, Gluud C. Non-absorbable disaccharides for hepatic encephalopathy: systematic
review of randomised trials. Br Med J. 2004;328(7447):1046. 3.
Bajaj JS, Sanyal AJ, Bell D, Gilles H, Heuman DM. Predictors of the recurrence of
hepatic encephalopathy in lactulose-treated patients. Aliment Pharmacol Ther.
2010; 31(9):1012-1017. 4. Blei AT, Cordoba J, Practice Parameters
Committee of the American College of Gastroenterology. Practice guidelines: hepatic
encephalopathy. Am J Gastroenterol. 2001;96(7):1968-1976.