Don’t wait until a patient is hospitalized:
Screen for HE today

Because cirrhosis is such a strong risk factor for overt HE, screening for HE is critical in patients with CLD/cirrhosis.1 Diagnosis requires the detection of signs suggestive of HE in a patient with severe liver insufficiency who does not have obvious alternative causes of brain dysfunction.2

You can help patients at risk of overt HE recurrence by screening today

  • As burden of CLD/cirrhosis increases, frequency of HE increases3,4
  • Disrupt the pattern: screen with West Haven Criteria (Conn score)2

How XIFAXAN is believed to work in overt HE

Gut-derived toxins, such as ammonia, are thought to be central to the pathogenesis of HE.5,6 XIFAXAN is believed to modulate gastrointestinal flora, including Gram +/–, aerobic/anaerobic, and enteric bacteria, which may help decrease production of the nitrogenous compounds associated with the pathogenesis of HE.5,7,8

Align with the Guidelines for patients at risk

XIFAXAN earned AASLD/EASL’s highest possible recommendation (GRADE I,A,1) as an add-on therapy to lactulose to reduce the risk of overt HE recurrence after a patient has a recurrence while on lactulose alone2*

  • Lactulose alone may not be sufficient2,4

*Per the GRADE System for Evidence: Grade I=randomized, controlled trials; A=evidence is “high quality,” and further research is very unlikely to change our confidence in the estimated effect; and 1=recommendation is “strong,” with factors influencing strength of recommendation, including the quality of evidence, presumed patient-important outcomes, and costs.2

Connect to AASLD

AASLD/EASL 2014 Guideline Overview

Quickly review some of the recommendations for adult patients with OHE.

Diagnosing and grading severity of OHE

Diagnosing OHE is a clinical decision based on a clinical examination, requiring the detection of signs suggestive of HE in a patient with severe liver insufficiency and/or portosystemic shunts who does not have obvious alternative causes of brain dysfunction. The recognition of precipitating factors for HE (eg, GI bleeding and infections) supports the diagnosis of HE.2

What do the guidelines say about ammonia?

”Increased blood ammonia alone does not add any diagnostic, staging, or prognostic value for HE in patients with chronic liver disease. A normal value calls for diagnostic reevaluation (GRADE II-3,A,1).” –Recommendation 9

Managing OHE

”Secondary prophylaxis after an episode for OHE is recommended (GRADE I,A,1).” –Recommendation 11

Transition from inpatient care to home care

Ongoing management and team awareness post-discharge is recommended, including educating the patient, caregivers, and providers so that everyone on the care team understands how to manage HE and reduce the risk of repeated HE-related hospitalizations.2

HE = hepatic encephalopathy

CLD = chronic liver disease

GI = gastrointestinal

AASLD = American Association for the Study of Liver Diseases

EASL = European Association for the Study of the Liver


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.

  • 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.