Nitazoxanide Plus Lactulose Versus Lactulose Alone Treatment of Hepatic Encephalopathy
Nitazoxanide Plus Lactulose Versus Lactulose Alone Treatment of Hepatic Encephalopathy
Hepatic encephalopathy (HE) is a reversible neuropsychiatric syndrome associated with chronic
 and acute liver dysfunction. It is characterized by cognitive and motor deficits of varying
 severity.

 Treatment options include lactulose administered orally or by nasogastric tube or enema,
 non-absorbable antibiotics, and protein-restricted diets.

 Nitazoxanide is an oral agent indicated for the treatment of infectious diarrhea caused by
 Crytpsporidiumparvum and Giardia lamblia. Basu and colleagues presented a pilot prospective
 study at the 2008 American Association for the Study of Liver Diseases meeting showing
 clinical improvement in HE among cirrhotic patients who received nitazoxanide and lactulose.
Hepatic encephalopathy (HE) is a reversible neuropsychiatric syndrome associated with chronic
 and acute liver dysfunction. It is characterized by cognitive and motor deficits of varying
 severity.

 Hepatic encephalopathy is caused by accumulation of nitrogenous substances, primarily
 ammonia, in the blood. In advanced stages it is referred to as hepatic coma which may be
 preceded by seizures. The treatment goal is to reduce nitrogen load from the GI tract and to
 improve central nervous system (CNS) status.

 Treatment options include lactulose administered orally or by nasogastric tube or enema,
 non-absorbable antibiotics, and protein-restricted diets.

 Lactulose is nonabsorbable disaccharides that are currently used as first line agents for the
 treatment of HE. Its action is thought to beconversion to lactic acid and acetic acid
 resulting in acidification of the gut lumen. This favors conversion of ammonia (NH3) to
 ammonium (NH4+), which is relatively membrane impermeable, and inhibits ammoniagenic coliform
 bacteria.

 Nitazoxanide is an oral agent indicated for the treatment of infectious diarrhea caused by
 Crytpsporidiumparvum and Giardia lamblia. Basu and colleagues presented a pilot prospective
 study at the 2008 American Association for the Study of Liver Diseases meeting showing
 clinical improvement in HE among cirrhotic patients who received nitazoxanide and lactulose.

 Mantry and colleagues showed that the number of hospitalizations and the duration of hospital
 stays were shortened for patients receiving combination therapy compared with those receiving
 lactulose monotherapy.
Inclusion Criteria:

 Age 18-70 years

 Cirrhosis, defined by a combination of any of the following:

 -  Laboratory findings

 -  Endoscopic results

 -  Ultrasound

 -  Histology Overt hepatic encephalopathy

 Exclusion Criteria:

 -  • Creatinine>1.5 mg/dl

 -  Alcohol use within prior 4 weeks

 -  Non-hepatic metabolic encephalopathy

 -  Hepatocellular carcinoma

 -  Degenerative CNS disease

 -  Any significant psychiatric illness or other medical comorbidity