Help Them Create A Management Plan
Proper medical care and lifestyle changes can help manage your loved ones overt hepatic encephalopathy. Managing overt HE may require medical care, lifestyle changes, and a whole team of different doctors.
Here are some tips to keep in mind:
Help your loved one follow diet changes or recommendations
Make sure your loved one is able to pick up their medicine have it delivered or arrange to have it mailed so they dont miss taking their medicine as prescribed by their doctor
Monitor to make sure your loved one is taking his or her medicine the way the doctor recommends
Monitor your loved one to help avoid greater harm, including the risk of falling
Talk about any concerns you have with a doctor, nurse, or other members of your loved ones healthcare team
What Other Drugs Could Interact With This Medication
There may be an interaction between rifaximin and any of the following:
If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:
- stop taking one of the medications,
- change one of the medications to another,
- change how you are taking one or both of the medications, or
- leave everything as is.
An interaction between two medications does not always mean that you must stop taking one of them. Speak to your doctor about how any drug interactions are being managed or should be managed.
Medications other than those listed above may interact with this medication. Tell your doctor or prescriber about all prescription, over-the-counter , and herbal medications you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them.
All material copyright MediResource Inc. 1996 2022. Terms and conditions of use. The contents herein are for informational purposes only. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Source: www.medbroadcast.com/drug/getdrug/Zaxine
Xifaxan Dosage For Adults
Xifaxan, a non-absorbable oral antibiotic, is FDA approved to treat travelers diarrhea caused by E. coli bacteria, help relieve the symptoms of irritable bowel syndrome with diarrhea , and help prevent overt hepatic encephalopathy. Some healthcare providers may prescribe Xifaxan off-label to treat recurrent Clostridium difficile infection, active Crohns disease, small intestinal bacterial overgrowth , or to prevent travelers diarrhea.
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How Many Can You Take In A Day
Your doctor will provide you with the daily dosage of Rifaximin you should take. This can help to provide the best results. There are various factors that will help to determine the particular dosage including the condition youre treating. Its important to avoid taking more than youre required to take per day. That can help to avoid certain side-effects.
This medicine is usually taken 2x per day to help prevent HE. However, you should talk to your doctor about the number of times you should take the medicine per day.
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Assessment Of The Need For Long
Patients with cirrhosis are at risk of developing new episodes of encephalopathy. Several factors need to be considered:
Diet and Nutrition
Low-protein diets are often erroneously recommended for patients with cirrhosis, in hopes of decreasing intestinal ammonia production and of preventing exacerbations of HE. An obvious consequence was the worsening of preexisting protein-energy malnutrition. Protein restriction may be appropriate in some patients immediately following a severe flare of symptoms . However, protein restriction is rarely justified in patients with cirrhosis and persistent HE. Indeed, malnutrition is a more serious clinical problem than HE for many of these patients.
It is the infrequent patient who is intolerant of a diet high in protein. Most patients with mild chronic HE tolerate more than 60 to 80 g of protein per day.
Diets containing vegetable proteins appear to be better tolerated than diets rich in animal protein. This may be because of increased content of dietary fiber, a natural cathartic, and decreased levels of AAA. AAA, as precursors for the false neurotransmitters tyramine and octopamine, are thought to inhibit dopaminergic neurotransmission and worsen HE. Ingestion of red meat protein should be discouraged.
Control of Potential Precipitating Factors
Higher Likelihood of Recurrent Encephalopathy
Patient Education
Assessment of the Need for Liver Transplantation
Hepatic Encephalopathy and Fitness to Drive
Specific Measures
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What Side Effects Are Possible With This Medication
Many medications can cause side effects. A side effect is an unwanted response to a medication when it is taken in normal doses. Side effects can be mild or severe, temporary or permanent.
The side effects listed below are not experienced by everyone who takes this medication. If you are concerned about side effects, discuss the risks and benefits of this medication with your doctor.
The following side effects have been reported by at least 1% of people taking this medication. Many of these side effects can be managed, and some may go away on their own over time.
Contact your doctor if you experience these side effects and they are severe or bothersome. Your pharmacist may be able to advise you on managing side effects.
- reddish colour to sweat, urine, or tears
Although most of the side effects listed below don’t happen very often, they could lead to serious problems if you do not check with your doctor or seek medical attention.
Check with your doctor as soon as possible if any of the following side effects occur:
- signs of depression
Stop taking the medication and seek immediate medical attention if any of the following occur:
- signs of bowel inflammation
- signs of a severe allergic reaction
Some people may experience side effects other than those listed. Check with your doctor if you notice any symptom that worries you while you are taking this medication.
Inclusion And Exclusion Criteria
According to PICOS criteria, two reviewers independently selected and evaluated the studies through different databases. The studies were included if they met the following criteria: : Participant: adults with an age of at least 18 years Intervention: assessment of the efficacy and safety of rifaximin on patients with liver cirrhosis and overt, minimal, or recurrent HE Comparator: rifaximin compared with other interventions, such as placebo and other active drugs Outcomes: primary outcomes, including OHE improvement, MHE reversal, prevention of recurrent HE, mortality, and adverse effects secondary outcomes, including blood ammonia level, mental state, flapping tremor, rehospitalization, and portosystemic encephalopathy index Study design: RCTs with either multicentre or single-centre design. Exclusion criteria were: : trials conducted among children patients non-controlled clinical trials and phase I clinical trials trials that assessed the efficacy and safety of rifaximin combined with other active drugs trials including patients with psychiatric illness, with undercurrent infections, with hypersensitivity to rifaximin or intolerance to other active drugs.
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Are There Any Other Precautions Or Warnings For This Medication
Before you begin using a medication, be sure to inform your doctor of any medical conditions or allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should use this medication.
Antibiotic-related diarrhea: As with other antibacterial medications, rifaximin can cause a severe form of diarrhea associated with a condition known as pseudomembranous colitis. If you develop severe diarrhea while taking this medication, contact your doctor.
Liver function: Liver disease or reduced liver function may cause this medication to build up in the body, causing side effects. If you have liver problems, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed. Your doctor may want to test your liver function regularly with blood tests while you are taking this medication.
Pregnancy: This medication should not be used during pregnancy unless the benefits outweigh the risks. If you become pregnant while taking this medication, contact your doctor immediately.
Breast-feeding: It is not known if rifaximin passes into breast milk. If you are a breast-feeding mother and are taking this medication, it may affect your baby. Talk to your doctor about whether you should continue breast-feeding.
Comparison With Other Systematic Reviews
To date, several meta-analyses have assessed the therapeutic effects of rifaximin vs. control interventions on patients with HE . These systematic reviews included 319 trials that were published between 1985 and 2017. In contrast, our meta-analysis had the largest sample size on this topic that included 28 RCTs with 2,979 patients and comprehensively evaluated the efficacy and safety of rifaximin treatment for different types of HE. Moreover, we involved a variety of outcomes in terms of clinical efficacy and safety. Similar to the findings of three previous reviews, we found that rifaximin can significantly reverse MHE and prevent recurrent HE compared with placebo . Unlike the findings of other three meta-analyses , our results showed that rifaximin was superior to other active drugs in improving HE clinical syndrome . By contrast, they concluded that clinical efficacy of rifaximin was equivalent to that of other oral drugs . Kimer reported that rifaximin could significantly reduce the mortality of patients with HE compared with nonabsorbable disaccharides . By contrast, we did not find statistically significant difference in mortality between the two groups. Furthermore, we assessed the risk of bias, GRADE evidence, and publication bias for all included studies, which indicated that our results were stable and reliable. By contrast, most of the previous meta-analyses did not conduct these analyses to evaluate the quality of evidence.
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How Should This Medicine Be Used
Rifaximin comes as a tablet to take by mouth with or without food. When rifaximin is used to treat traveler’s diarrhea, it is usually taken three times a day for 3 days. When rifaximin is used to prevent episodes of hepatic encephalopathy, it is usually taken twice a day. When rifaximin is used to treat irritable bowel syndrome, it is usually taken three times a day for 14 days. To help you remember to take rifaximin, take it around the same times every day. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take rifaximin exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor.
If you are taking rifaximin to treat traveler’s diarrhea, your symptoms should improve within 24 to 48 hours after you start taking the medication. If your symptoms do not go away or they get worse, or if you develop a fever or bloody diarrhea, call your doctor.
If you are taking rifamaxin to treat irritable bowel syndrome and your symptoms return after you have finished your treatment, call your doctor.
Dosage: How Much Xifaxan Should I Take
The dose of this medicine will be different for different patients. Follow your doctor’s orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so.
The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.
- For oral dosage form :
- For treatment of irritable bowel syndrome with diarrhea:
- Adults550 milligrams three times a day for 14 days.
- ChildrenUse and dose must be determined by your doctor.
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What Other Information Should I Know
Keep all appointments with your doctor.
Do not let anyone else take your medication. Ask your pharmacist if you have any questions about refilling your prescription.
It is important for you to keep a written list of all of the prescription and nonprescription medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies.
Xifaxan Dosage For Children
Xifaxan is FDA approved for use in adolescents 12 years of age and older for the treatment of travelers diarrhea due to noninvasive strains of E. coli. However, some healthcare providers may prescribe Xifaxan off-label as an add-on treatment for recurrent C. difficile infections. Because very little rifaximin, the active ingredient in Xifaxan, is absorbed into the bloodstream, dose reductions are not necessary for younger patients.
-
Standard dosage for treatment of uncomplicated travelers diarrhea due to E. coli infection in children 12 years of age and older: 200 mg tablet taken three times a day for three days
-
Maximum dosage for treatment of uncomplicated travelers diarrhea due to E. coli infection in children 12 years of age and older: 600 mg per day
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Direction For Use And Caution
Before taking this medicine its important to know about possible side-effects and risks. For example, you shouldnt take Xifaxan if youre allergic to certain medicines. You should also inform your doctor if you have liver disease or diarrhea with fever before you start taking the medicine.
Xifaxan might help to improve symptoms before the infection clears up completely. Its important to note that this medicine wont treat certain conditions. They include virus-caused diarrhea, common cold, and flu. You should also inform your doctor if your symptoms arent reduced within 24 hours.
Its also important to know about the possible side-effects of this medicine. Some possible ones include hives, breathing problems, and swelling . These could be allergic reactions to the medicine.
You should also inform your doctor of any medicines/supplements youre taking now. He/She can determine if Xifaxan might cause any interactions when combined with them. These can cause unwanted side-effects and its important to know about them before you start treating HE or other conditions with Xifaxan.
Xifaxan Dosage For Treatment Of Travelers Diarrhea Due To E Coli Infection
Xifaxan is FDA approved to treat travelers diarrhea due to infection by noninvasive strains of Escherichia coli as long as there are no complications such as fever or blood in the stools. Travelers diarrhea is a common medical condition experienced by up to half or more of people who travel to resource-limited areas. Many types of microbes can be the culprit, including bacteria, viruses, or parasites. However, Escherichia coli, a type of bacteria, is the most common cause, responsible for around 30% of all cases. For cases caused by other pathogens, Xifaxan is not an appropriate treatment for travelers diarrhea.
To treat the underlying E. coli infection, a healthcare professional will prescribe a low dose of Xifaxan three times a day for three days.
-
Standard dosage for treatment of uncomplicated travelers diarrhea due to noninvasive E. coli infection: 200 mg tablet taken three times a day for three days
-
Maximum dosage for treatment of uncomplicated travelers diarrhea due to noninvasive E. coli infection: 600 mg per day
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Symptoms Of Hepatic Encephalopathy Occur During Overt Heepisodes
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.
These episodes can get worse over time and may result in:
Clinical Scales For Grading He
A number of scales have been devised for the diagnosis of HE the first of its kind was proposed by Parsonsmith and colleagues in 1957. For patients with moderate to severe HE, the Glasgow Coma scale can also be employed.
Table 1: West-Haven Criteria for Hepatic Encephalopathy
| Stage |
|---|
MHE, minimal hepatic encephalopathy.
The West-Haven Classification Table
Stage 0. MHE . Lack of detectable changes in personality or behavior. Minimal changes in memory, concentration, intellectual function, and coordination. Asterixis is absent.
Stage 1. Trivial lack of awareness. Shortened attention span. Impaired addition or subtraction. Hypersomnia, insomnia, or inversion of sleep pattern. Euphoria, depression, or irritability. Mild confusion. Slowing of ability to perform mental tasks. Asterixis can be detected.
Stage 2. Lethargy or apathy. Minimal disorientation. Inappropriate behavior. Slurred speech. Obvious asterixis. Drowsiness, lethargy, gross deficits in ability to perform mental tasks, obvious personality changes, inappropriate behavior, and intermittent disorientation, usually regarding time.
Stage 3. Somnolent but can be aroused, unable to perform mental tasks, gross disorientation about time and place, marked confusion, amnesia, occasional fits of rage, present but incomprehensible speech.
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Influence Of Rifaximin On Economic Burden Of Hepatic Encephalopathy
Approximately 5.5 million persons in the US have hepatic cirrhosis, and most of them have a lifetime risk of developing an episode of hepatic encephalopathy. Although the total direct and indirect costs of hepatic encephalopathy have not been formally quantified, data from the Healthcare Cost and Utilization Project suggest that hepatic encephalopathy-related hospitalizations are associated with substantial health care costs. In 2003, there were over 40,000 patients hospitalized in the US for a primary diagnosis of hepatic encephalopathy, resulting in total charges of approximately US$932 million. Furthermore, trends over the past 10 years suggest that the burden of hepatic encephalopathy is increasing, as indicated by increases in hospital admissions and higher charges per stay. Moreover, hepatic encephalopathy imposes a formidable burden on families, because patients are incapable of selfcare.1,4,5557