Medications for Hepatic Encephalopathy

Hepatic encephalopathy (HE) is a neurologic condition that is caused by a dysfunction of the liver. Yellowing of the skin and loss of muscle are signs of liver dysfunction. Sleep problems may occur prior to development of the neurologic signs, which include involuntary movements of the arms and legs and flapping of hands. Other signs and symptoms include a decrease in mental alertness, disorientation, and speech dysfunction. Typically a specific cause leads to neurologic dysfunction. These neurologic symptoms resolve once the specific cause is identified and addressed. An increase in protein, low potassium, infection, low blood sugar, constipation, or gastrointestinal bleeding can lead to HE in an individual with existing liver dysfunction. An increase in ammonia levels can lead to HE, and all of the specific causes listed above can lead to an increase in ammonia levels.

Treatments to decrease or prevent the production of ammonia can help resolve HE. Lactulose (Enulose) is a synthetic disaccharide that works to decrease the amount of ammonia in the blood. Antibiotics such as metronidazole (Flagyl), vancomycin (Vancocin), rifaximin, and neomycin may be also be prescribed to remove ammonia along with lactulose or for persons who do not tolerate lactulose.