West Haven criteria for HE (including minimal HE)1
image shows and details the West Haven Critera itemized per the stages including minima HE

 

Download The HE Symptom Checklist

Overt HE occurs in up to 45% of patients with cirrhosis at some point during the clinical course of their disease.4 As the burden of chronic liver disease and cirrhosis is increasing, the frequency of HE is also increasing.5,6

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Lactulose

Lactulose is a nonabsorbable disaccharide that works by eliminating fecal waste, including gut toxins.5

The goal of lactulose treatment is to produce 2-3 bowel movements per day, so lactulose dosing must be titrated by the patient to meet that goal consistently.1

Overuse of lactulose can cause complications, including dehydration, which can precipitate an episode of HE.1 Noncompliance with lactulose therapy can also occur because of its gastrointestinal side effects.2

Image shows an icon of a medication bottle

XIFAXAN

XIFAXAN is a minimally absorbed oral antimicrobial medication. It alters the gastrointestinal flora and the AASLD/EASL 2014 Guideline recommends adding XIFAXAN to lactulose for ongoing management after an overt HE recurrence on lactulose alone to reduce the risk of another recurrence.1,7

Adding XIFAXAN to lactulose therapy has been proven to lower the risk of overt HE recurrence   and HE-related hospitalizations.7

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Recurrences may cause persistent neurological dysfunction1

Data has suggested that overt HE is associated with persistent cumulative defects in memory
and learning.1

 

Learn More About The AASLD/EASL 2014 Guideline Recommendations For HE

References: 1. Vilstrup H, Amodio P, Bajaj J, et al. Hepatic encephalopathy in chronic liver disease: 2014 Practice Guideline by the American Association for the Study of Liver Diseases and the European Association for the Study of the Liver. Hepatology. 2014;60(2):715-735.
2. Neff GW, Kemmer N, Duncan C, Alsina A. Update on the management of cirrhosis—focus on cost-effective preventative strategies. Clinicoecon Outcomes Res. 2013;5:143-152. 3. Blei A, Córdoba J; The Practice Parameters Committee of the American College of Gastroenterology. Hepatic encephalopathy. Am J Gastroenterol. 2001;96(70):1968-1976. 4. Leise MD, Poterucha JJ, Kamath PS, Kim WR. Management of hepatic encephalopathy in the hospital. Mayo Clin Proc. 2014; 89(2):241-253.5. Frederick RT. Current concepts in the pathophysiology and management of hepatic encephalopathy. Gastroenterol Hepatol. 2011;7(4):222-233. 6. Peery AF, Crockett SD, Barritt AS, et al. Burden of gastrointestinal, liver, and pancreatic diseases in the United States. Gastroenterology. 2015;147:1731-1741. 7. XIFAXAN [prescribing information]. Bridgewater, NJ: Salix Pharmaceuticals.

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.

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.