Treatment Options for Hepatic Encephalopathy

Thomas D. Schiano, M.D.


Pharmacotherapy. 2010;30(5):16S-21S. 

In This Article


Lactulose remains the first-line agent for both acute episodic and persistent hepatic encephalopathy. Rifaximin is the second-line agent, either when used alone or in combination with lactulose. Results of several clinical studies suggest that rifaximin 400 mg 3 times/day or 550 mg twice/day is suitable for the treatment of hepatic encephalopathy, is very well tolerated, and is at least as effective as other commonly used agents such as lactulose or neomycin. More data are needed to assess the effects of rifaximin alone versus rifaximin combined with lactulose, particularly in patients with MHE. Additional well-controlled clinical trials are being conducted to further define the efficacy and safety of rifaximin for hepatic encephalopathy.