From the Guidelines
No, you should not stop rifaximin (Xifaxan) even if ammonia levels are normal, especially if it was prescribed for hepatic encephalopathy. Rifaximin is typically used as a long-term maintenance therapy to prevent recurrence of hepatic encephalopathy, regardless of current ammonia levels 1. The standard dosage is usually 550 mg taken twice daily. The medication works by reducing ammonia-producing bacteria in the intestines, which helps prevent the buildup of toxins that can affect brain function in liver disease patients.
Key Considerations
- Even when ammonia levels normalize, the underlying liver disease typically remains, and stopping rifaximin prematurely could lead to a recurrence of encephalopathy symptoms, which may include confusion, disorientation, and in severe cases, coma.
- According to the 2022 EASL clinical practice guidelines on the management of hepatic encephalopathy, rifaximin as an adjunct to lactulose is recommended as secondary prophylaxis following more than one additional episode of overt HE within 6 months of the first one 1.
- Any decision to discontinue rifaximin should be made only after consulting with your healthcare provider, who can evaluate your specific clinical situation, liver function, and risk factors for recurrence.
Clinical Decision Making
- The healthcare provider should consider the patient's overall liver function, body habitus, and presence of precipitating factors that may influence the risk of recurrence 1.
- In patients with suspected HE, alternative or additional causes of neuropsychiatric impairment should be identified to improve prognostic accuracy and the results of treatment 1.
- The patient's response to treatment and any changes in their clinical condition should be closely monitored to determine the best course of action.
From the Research
Rifaxan (Rifaximin) Discontinuation
- The decision to discontinue Rifaxan (Rifaximin) in patients with ammonia levels within normal limits is a complex one, and the available evidence does not provide a clear answer 2, 3, 4, 5, 6.
Studies on Rifaximin Discontinuation
- A study published in the World Journal of Hepatology found that rifaximin discontinuation during broad-spectrum antibiotic therapy did not negatively impact the clinical status of critically ill liver patients, with a similar safety profile and significant cost savings 2.
- Another study published in Pharmacotherapy noted that rifaximin is effective in improving behavioral, laboratory, mental, and intellectual abnormalities in patients with hepatic encephalopathy, but did not address the issue of discontinuation 3.
- A study published in Therapeutic Advances in Gastroenterology found that rifaximin reduced the risk of recurrent hepatic encephalopathy in patients with a history of at least two bouts of acute hepatic encephalopathy in the previous 6 months, but did not provide guidance on discontinuation 4.
- A double-blind, randomized trial published in Current Medical Research and Opinion found that rifaximin was effective in the treatment of hepatic encephalopathy, but did not address the issue of discontinuation 5.
- A review published in the World Journal of Gastrointestinal Pharmacology and Therapeutics noted that rifaximin therapy has several potential drawbacks, including the risk of Clostridium difficile colitis and selection of resistant mutants, but did not provide guidance on discontinuation 6.
Key Findings
- The available evidence suggests that rifaximin is effective in the treatment and prevention of hepatic encephalopathy, but does not provide clear guidance on discontinuation 2, 3, 4, 5, 6.
- The decision to discontinue rifaximin should be made on a case-by-case basis, taking into account the individual patient's clinical status and medical history.