Pharmacological Management of Hepatic Disorders
Treatment modalities and drug selection for hepatic encephalopathy
Hepatic encephalopathy management involves reducing ammonia levels and enhancing cognitive function. First-line drugs include lactulose and rifaximin, with adjunctive support from probiotics and amino acids.
Pharmacological Management of Hepatic Disorders
Treatment Modalities and Drug Selection for Hepatic Encephalopathy
Hepatic encephalopathy (HE) is a neuropsychiatric condition resulting from liver dysfunction, primarily due to cirrhosis. Effective pharmacological management is crucial for improving patient outcomes.
Primary Treatment Goals
- Reduce ammonia levels in the blood
- Enhance cognitive function
- Prevent recurrence and manage complications
First-Line Pharmacological Interventions
Lactulose
Lactulose is a non-absorbable disaccharide that promotes ammonia excretion by acidifying the gut lumen.
Rifaximin
Rifaximin is a non-systemic antibiotic that reduces ammonia-producing gut bacteria.
Adjunctive Therapies
- Probiotics to modulate gut microbiota
- L-ornithine L-aspartate (LOLA) for ammonia detoxification
- Branched-chain amino acids (BCAAs) for neurological support
Monitoring and Follow-Up
Regular monitoring of ammonia levels and neurocognitive function is essential. Physicians should assess response to therapy and adjust treatment accordingly.
Conclusion
Pharmacological management of HE focuses on reducing ammonia levels and symptom control. Lactulose and rifaximin are first-line treatments, supported by adjunctive therapies.
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