What is HE?

HE is a brain dysfunction caused by liver insufficiency and/or portal systemic shunting.1 In patients with cirrhosis and decreased hepatic function, toxins from the gut can enter the bloodstream and reach the brain, where they affect neurotransmission.1-3 This can cause episodes of HE, which may present as alterations in consciousness, cognition, and behavior that range from minimal to severe.1-3

HE is a problem hiding in plain sight

Recognizing patients at risk. The risk of HE is higher in patients with cirrhosis/chronic liver disease and4:

  • Portal hypertension
  • Ascites
  • Variceal bleeding
  • Medications, such as opioids

The risk of HE recurrence is high1,9

Once overt HE occurs, patients have a high risk of recurrence1,9:

  • Cumulative risk of an overt HE recurrence at 1 year: 40%
  • 40% cumulative risk of another overt HE recurrence within 6 months, despite standard-of-care treatment

HE and overt HE can be a burden for patients and families

  • Each overt HE episode may cause irreversible trauma1,10,11
  • HE-related hospitalizations rose 325% from 2005 to 201412
  • Other costs: disability, lost productivity, stress on caregivers1

Did you know?

Up to 80% of patients with cirrhosis develop HE1,5-8

Screen cirrhosis patients
 

Align with the Guidelines
for patients at risk

See what is recommended
 

See what to look for:

Use these symptoms to screen for HE

West Haven Criteria for HE
 
INDICATIONS

XIFAXAN® (rifaximin) 550 mg tablets are indicated for the reduction in risk of overt hepatic encephalopathy (HE) recurrence in adults and for the treatment of irritable bowel syndrome with diarrhea (IBS-D) in adults.

IMPORTANT SAFETY INFORMATION
  • XIFAXAN is contraindicated in patients with a hypersensitivity to rifaximin, 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. If CDAD is suspected or confirmed, ongoing antibiotic use not directed against C. difficile may need to be discontinued.
  • There is an increased systemic exposure in patients with severe (Child-Pugh Class C) hepatic impairment. Caution should be exercised when administering XIFAXAN to these patients.
  • Caution should be exercised when concomitant use of XIFAXAN and P-glycoprotein (P-gp) and/or OATPs inhibitors is needed. Concomitant administration of cyclosporine, an inhibitor of P-gp and OATPs, significantly increased the systemic exposure of rifaximin. In patients with hepatic impairment, a potential additive effect of reduced metabolism and concomitant P-gp inhibitors may further increase the systemic exposure to rifaximin.
  • In clinical studies, the most common adverse reactions for XIFAXAN were:
    • –HE (≥10%): Peripheral edema (15%), nausea (14%), dizziness (13%), fatigue (12%), and ascites (11%)
    • –IBS-D (≥2%): Nausea (3%), ALT increased (2%)
  • INR changes have been reported in patients receiving rifaximin and warfarin concomitantly. Monitor INR and prothrombin time. Dose adjustment of warfarin may be required.
  • XIFAXAN may cause fetal harm. Advise pregnant women of the potential risk to a fetus.

To report SUSPECTED ADVERSE REACTIONS, contact Salix Pharmaceuticals at 1-800-321-4576 or FDA at 1-800-FDA-1088 or www.fda.gov/medwatch.

Please click here for full Prescribing Information.

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INDICATIONS

XIFAXAN® (rifaximin) 550 mg tablets are indicated for the reduction in risk of overt hepatic encephalopathy (HE) recurrence in adults and for the treatment of irritable bowel syndrome with diarrhea (IBS-D) in adults.

IMPORTANT SAFETY INFORMATION
  • XIFAXAN is contraindicated in patients with a hypersensitivity to rifaximin, rifamycin antimicrobial agents, or any of the components in XIFAXAN. Hypersensitivity reactions have included exfoliative dermatitis, angioneurotic edema, and anaphylaxis.