Having liver disease over a long period of time may damage the liver and eventually lead to its soft, healthy tissue being replaced by hard scar tissue. This condition is called cirrhosis.

When your liver is damaged, it cannot filter toxins out of the blood the way that a healthy liver can. These toxins can build up and travel through your body until they reach your brain. It’s the buildup of these toxins in your brain that can lead to the symptoms of HE.

The symptoms of HE can be mental and physical and can vary in degree:

• “Covert” HE symptoms can go unnoticed, even by a doctor
• “Overt” HE symptoms are more noticeable to other people

Symptoms of overt HE can include:

Mental

• Lack of energy or interest
• Confusion
• Not knowing where you are or where you’re going
• Inappropriate behavior
• Severe personality changes

Physical

• Sleepiness or change in sleep patterns
• Worsening of handwriting
• Loss of small hand movements
• Tremors or shaking of hands or arms
• Breath with a musty or sweet odor

These symptoms may also be found in older people with Alzheimer’s or dementia, but when they occur in people with liver disease, it may be HE.

If you have some form of liver disease and you start to develop any of these symptoms, it is important that you talk about them with your doctor.

When HE symptoms become more severe, the condition is called “overt HE.” If you have overt HE, you may have experienced what is called an “episode” of overt HE.

During an episode, your symptoms can become more obvious. There may be a change in your behavior or personality. You may not understand what is happening, and people around you may notice that you are acting strangely.

Many episodes of overt HE end at the hospital, where you may be taken by a friend or loved one for medical attention.

If you have experienced an episode of overt HE, you also have a higher risk of having another overt HE episode in the future. But there are ways to help reduce the risk of additional overt HE episodes.

Helping care for someone with overt HE can be difficult. You may feel frightened, frustrated, or sad, but you are not alone. Your loved one’s doctors can help develop a plan to manage HE, and you can help play a vital role. If you’re just starting out, here are 3 suggestions:

• Learn more about overt HE and how it might affect your loved one.
• Make a plan to manage overt HE with your loved one and their doctors.
• Support your loved one and find ways to care for yourself, too.

Some of the most commonly used medicines are lactulose and XIFAXAN.

Lactulose is an artificial sugar. It comes as a very sweet liquid that is taken by mouth. Lactulose works by helping to cause more bowel movements. This helps to flush out toxins that may travel through your blood to your brain.

XIFAXAN is a nonsystemic antibiotic that slows the growth of bacteria in the gut that are believed to be linked to symptoms of overt HE. XIFAXAN is the only FDA-approved medicine indicated for the reduction in risk of overt HE recurrence in adults. It was also proven to help reduce the risk of HE-related hospitalizations.

Expert guidelines recommend using both lactulose and XIFAXAN together to help reduce the risk of overt HE recurrence.

Talk to your healthcare provider before taking XIFAXAN if you have severe hepatic (liver) impairment, as this may cause increased effects of the medicine.

Learn more about XIFAXAN.

There is no known medicine that can cure HE. While there are no medicines that can completely prevent an overt HE episode, XIFAXAN is a medicine that can help reduce the risk of additional episodes of overt HE.

Read all the ways XIFAXAN was proven to help adults with overt HE.

XIFAXAN was studied to see how it impacted adults with overt HE. In this study of 299 adults with a recent history of overt HE, those who took XIFAXAN had a lower risk of having an overt HE episode compared to those who did not take XIFAXAN. People taking XIFAXAN also had a lower risk of having an HE-related hospitalization compared to those who did not take XIFAXAN.

Click here to look at the data.

The most common side effects reported by patients taking XIFAXAN (occurring in at least 10% of them and at a higher rate than in patients taking placebo) were:

• Peripheral edema (swelling, usually in the ankles or lower legs)
• Nausea (feeling sick to one’s stomach)
• Dizziness
• Fatigue (feeling tired)
• Ascites (a buildup of fluid in the abdomen)

Please see additional Important Safety Information below and click here for full Prescribing Information.

XIFAXAN is a nonsystemic antibiotic that slows the growth of bacteria in the gut that are believed to be linked to symptoms of overt HE.

Talk to your healthcare provider before taking XIFAXAN if you have severe hepatic (liver) impairment, as this may cause increased effects of the medicine.

Learn more about XIFAXAN.

Yes, the most common side effects reported by patients taking XIFAXAN (occurring in at least 10% of them and at a higher rate than in patients taking placebo) were:

• Peripheral edema (swelling, usually in the ankles or lower legs)
• Nausea (feeling sick to one’s stomach)
• Dizziness
• Fatigue (feeling tired)
• Ascites (a buildup of fluid in the abdomen)

XIFAXAN is not for everyone. Do not take XIFAXAN if you have a known hypersensitivity to rifaximin, any of the rifamycin antimicrobial agents, or any of the components in XIFAXAN.

These are not all of the possible side effects of XIFAXAN. Call your doctor for medical advice about XIFAXAN side effects.

If you are prescribed XIFAXAN, the recommended dose is 1 tablet of XIFAXAN by mouth 2 times a day (1 in the morning and 1 at night) to help reduce the risk of additional overt HE episodes. You can take XIFAXAN with or without food.

You should keep taking XIFAXAN for as long as your doctor recommends. Continuing to take your medicine is an important part of any plan to manage overt HE.

If you miss a dose, please contact your healthcare provider.

Tell your doctor if you are taking drugs called P-glycoprotein and/or OATPs inhibitors (such as cyclosporine), because using these drugs while taking XIFAXAN may lead to an increase in the amount of XIFAXAN absorbed by your body.

XIFAXAN may affect warfarin activity when taken together. Tell your doctor if you are taking warfarin because the dose of warfarin may need to be adjusted to maintain proper blood-thinning effect.

Tell your doctor about all of the medicines you take including prescription medicines, over-the-counter medicines, vitamins/supplements, or herbal medicines.

Because overt HE involves your liver, your gut, and your overall health, you can talk to several doctors about how to manage overt HE.

• Your regular doctor (called your primary care physician) may be able to help you create a plan to manage overt HE
• You may be seeing a doctor for your liver disease (often a hepatologist) or a doctor who focuses on the digestive system (called a gastroenterologist). Both of these doctors may be able to help you manage your overt HE

The most important thing to remember is that it will take teamwork among you, your loved ones, and your doctors to help manage HE. Be honest with your doctors about your symptoms, experiences, and challenges you may be having.

Your doctor may already have prescribed medicine as part of your plan to manage overt HE, but you should ask how you can help reduce your risk for additional overt HE episodes with XIFAXAN.

There are guidelines that advise doctors on how to create a plan based on the latest evidence from medical studies. XIFAXAN is recommended in those guidelines for certain patients, so if your management plan doesn’t include XIFAXAN, ask your doctor if you are doing all you can to help reduce your risk.

Remember, keep a positive attitude and be sure to see your doctors regularly. Be honest with your doctors about your symptoms, experiences, and challenges you may be having. Write down any symptoms you may have noticed and bring the list to your next appointment. Ask questions if you do not understand something. They can help explain things and make you feel more prepared for the future.