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Rifaximin: A Review of Its Use in Reducing Recurrence of Overt Hepatic Encephalopathy Episodes

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Abstract

Oral rifaximin 550 mg (Refero®; Targaxan®; Tixteller®; Xifaxan®) twice daily, either alone or more commonly with medicines containing lactulose, is approved in several countries, including the UK, EU and USA, for use in adults with liver disease to reduce the recurrence of episodes of overt hepatic encephalopathy (HE). Rifaximin is a broad-spectrum antibacterial that acts locally in the gut to reduce intestinal flora, including ammonia-producing species, with hyperammonaemia considered to play a central role in the pathogenesis of HE. In a 6-month, multinational trial in patients with liver disease, rifaximin 550 mg twice daily (± lactulose) was an effective and well tolerated treatment for reducing the recurrence of HE episodes. At study end, rifaximin therapy significantly prolonged the time to the first breakthrough HE episode compared with placebo (± lactulose), irrespective of geographical region or baseline patient and disease characteristics. Rifaximin treatment also significantly reduced HE-related hospitalizations and improved health-related quality of life compared with placebo. Furthermore, the efficacy of rifaximin with or without lactulose in reducing the recurrence of overt HE episodes was maintained after up to 2.5 years of treatment, with no new safety signals arising during this period. This article reviews the pharmacology and therapeutic efficacy of rifaximin 550 mg twice daily in reducing the recurrence of overt HE episodes in adults with liver disease.

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Disclosure

The preparation of this review was not supported by any external funding. During the peer review process, the manufacturer of the agent under review was offered an opportunity to comment on this article. Changes resulting from comments received were made by the authors on the basis of scientific and editorial merit. Lesley Scott is a salaried employee of Adis/Springer.

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Correspondence to Lesley J. Scott.

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The manuscript was reviewed by: N. Bass, Department of Medicine, UCSF, San Francisco, CA, USA; G. Bertino, University of Catania, Hepatology Unit, Regional Reference Centre for the Treatment of Hepatitis C, Department of Medical and Paediatric Science, Catania, Italy; F. Bessone, Department of Gastroenterology and Hepatology, University of Rosario School of Medicine, Urquiza, Rosario, Argentina; J. Chang, Department of Gastroenterology and Hepatology, Singapore General Hospital, Singapore; E. Giangreco, School of Specialization of Gastroenterology, University of Catania, Catania, Italy; K. J. Simpson, Hepatology, University of Edinburgh, Edinburgh, UK.

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Scott, L.J. Rifaximin: A Review of Its Use in Reducing Recurrence of Overt Hepatic Encephalopathy Episodes. Drugs 74, 2153–2160 (2014). https://doi.org/10.1007/s40265-014-0300-y

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