Rifaximin therapy and hepatic encephalopathy:Pros and cons

• Published in: World journal of gastrointestinal pharmacology and therapeutics Vol. 3; no. 4; pp. 62 - 67
• Main Authors: Zullo, Angelo, Hassan, Cesare, Ridola, Lorenzo, Lorenzetti, Roberto, Campo, Salvatore Ma, Riggio, Oliviero
• Format: Journal Article
• Language: English
• Published: United States Baishideng Publishing Group Co., Limited 06-08-2012
• Subjects: encephalopathy;Rifaximin;Therapy;Side-effects;Cirrhosis; Hepatic; Topic Highlight; Cirrhosis; Therapy; Rifaximin; Hepatic encephalopathy; Side-effects
• ISSN: 2150-5349; 2150-5349
• DOI: 10.4292/wjgpt.v3.i4.62

Hepatic encephalopathy(HE) is the second most common major complication in cirrhotics and it significantly impacts quality of life.Therapeutic approaches for HE treatment and prevention mainly continue to rely on ammonia-lowering strategies and non-absorbable disaccharides are currently considered the cornerstone therapy.Non-absorbable antibiotics,such as neomycin and paramomycin,are effective in treatment of acute HE episodes but their prolonged use for recurrence prevention is hampered by possible side-effects.To overcome these limitations,rifaximin use has been proposed.Rifaximin has been shown to be not superior to non-absorbable disaccharides for either HE treatment or prevention,with a similar incidence of side-effects.Cirrhosis significantly increases rifaximin absorption and this could be a cause for concern.Following long-term rifaximin therapy,Clostridium difficile colitis has been observed and Candida albicans has been isolated from 20% of patients.In addition,selection of resistant mutants of both Gram-negative and-positive bacteria in the gastrointestinal tract cannot be definitely ruled out.Electrolyte alterations(sodium and potassium) have been reported during rifaximin therapy,a warning for its long-term use in cirrhotics.Moreover,a potential interference with vitamin K production should be considered which could further impair the already altered clotting status of these patients.The therapeutic cost of rifaximin is markedly higher than non-absorbable disaccharides.While waiting for further safety data,caution should be used to limit the use of rifaximin therapy for a very short-term period in selected HE cirrhotics not responding to nonabsorbable disaccharides.