Hepatic Encephalopathy
Prophylaxis of hepatic encephalopathy
Lactulose
Lactulose 3.1-3.7g/5ml oral solution
Adjusted according to response to 30–50ml 3 times a day, subsequently adjusted to produce 2–3 soft stools per day.
Rifaximin
Rifaximin 550mg tablets
550mg twice daily.
Prescribing Notes:
- Lactulose is included for specialist initiation in hepatic encephalopathy.
- Rifaximin initiated by specialist for prophylaxis of hepatic encephalopathy, should be continued by primary care in the absence of side effects, efficacy will be reviewed by specialist team. If there is no improvement in encephalopathy, then rifaximin will be stopped by the specialist hospital team. If there is an improvement in symptoms, then rifaximin supply from primary care should continue long term with ongoing review from specialist hospital team.
History Notes
22/10/2024
Pathway title and position updated, ERWG Sept 24.