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Non-Lactulose Medication Therapies for the Management of Hepatic Encephalopathy: A Literature Review
Justin P Reinert1, Kevin Burnham1
1Ben and Maytee Fisch College of Pharmacy, 12347The University of Texas at Tyler, TX, USA.
Insights
The optimal treatment for hepatic encephalopathy is still unclear. This review summarizes alternative therapies like probiotics and rifaximin for patients not responding to lactulose.
Area of Science:
- Gastroenterology
- Hepatology
- Pharmacology
Background:
- Hepatic encephalopathy (HE) management remains challenging, with lactulose as a traditional therapy.
- Optimal medication regimens to mitigate HE consequences are not definitively established.
- Identifying effective alternatives for refractory or intolerant patients is crucial.
Purpose of the Study:
- To review current clinical trials on alternative therapies for hepatic encephalopathy.
- To provide clinicians with a reference for guiding HE treatment decisions.
- To summarize safety and efficacy data for various HE management agents.
Main Methods:
- Comprehensive literature search from August 2018 to April 2019.
- Inclusion of randomized clinical and double-blind cross-over trials.
- Evaluation of agents including probiotics, zinc, polyethylene glycol, rifaximin, and flumazenil.
Main Results:
- Sixteen clinical trials were analyzed for safety and efficacy.
- Data on statistical and clinical outcomes were summarized.
- Alternative agents offer options for patients unresponsive or intolerant to lactulose.
Conclusions:
- The ideal regimen for hepatic encephalopathy is still under investigation.
- Alternative agents discussed provide valuable options for specific patient populations.
- This review serves as a resource for clinical decision-making in HE management.
Objective:
The most appropriate medication regimen to mitigate the consequences hepatic encephalopathy remains inconclusive. This review seeks to serve as a reference for clinicians to help guide therapy decisions with regard to hepatic encephalopathy.
Methods:
A comprehensive literature review between August 2018 and April 2019 was accomplished with the assistance of a medical librarian. Sources of literature review include PubMed, MEDLINE, SCOPUS, ProQuest Central, CINAHL, and ProQuest Dissertations. The authors selected randomized clinical and double-blind cross-over trials evaluating probiotics, zinc, polyethylene glycol, rifaximin, and flumazenil. Sixteen clinical trials are discussed in this review. Pertinent safety, efficacy, and statistical and clinical outcomes are summarized by the authors.
Conclusions:
The most appropriate regimen to mitigate the consequences of hepatic encephalopathy remains elusive; however, the agents discussed within this review offer alternative options for patients unresponsive to or intolerant of traditional lactulose therapy. This review seeks to serve as a repository for relevant clinical trials, and as a reference for clinicians to help guide therapy decisions.
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