The Medical Letter on Drugs and Therapeutics
Rifaximin (Xifaxan 550) for Hepatic Encephalopathy
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The FDA has approved a new 550-mg tablet of rifaximin (Xifaxan – Salix), a minimally absorbed oral antibiotic, to reduce the risk of recurrent hepatic encephalopathy (HE). A 200-mg tablet has been available for treatment of travelers’ diarrhea since 2004.

TREATMENT OF HE — Excess ammonia in the systemic circulation is thought to be a factor in the development of HE. One source of ammonia is urea breakdown by bacteria in the intestinal lumen.1 Antibiotics such as neomycin or metronidazole (Flagyl, and others) reduce ammonia production by eradicating urease-producing bacteria in the gut, but their use has been limited by toxicity, drug-drug interactions, and concerns about selection of resistant bacteria.2 Non-absorbable disaccharides, such as lactulose, are thought to decrease the absorption of ammonia from the gut by lowering the pH of the lumen and by ... more      

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Title: Rifaximin (Xifaxan 550) for Hepatic Encephalopathy
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