Is long-term Rifaximin use safe for my uncle with OHE at 70?

Question

Hello doctor,

My uncle is 70 years old and has had liver cirrhosis for the past five years. Over the last week, we noticed significant changes in his behavior, including increased irritability, confusion, and sleeping almost the entire day. He is also less responsive and sometimes does not recognize family members properly.

His recent lab reports show ammonia 96 micromoles per liter (µmol/L), bilirubin 3.0 Milligrams per deciliter (mg/dL), albumin 2.8 grams per deciliter (g/dL), and creatinine 1.6 mg/dL. He also has a history of coronary artery disease and is on blood thinners and other heart medications. The doctor diagnosed overt hepatic encephalopathy and started him on Rifaximin along with lactulose. I am concerned whether this treatment can interact with his heart medications or increase bleeding risk. Please tell me, is this medication considered safe and effective in elderly patients like him for long-term use?

Kindly help.

Answer 1

Hello,

Welcome to icliniq.com.

I read your query and can understand your concern.

Your uncle’s symptoms are like,

Confusion.
Excessive sleepiness.
Personality change.
Difficulty recognizing family

These are very typical signs of overt hepatic encephalopathy. His ammonia level of 96 µmol per liter supports that diagnosis and also indicates cirrhosis. In cirrhosis, the liver is no longer able to effectively clear toxins like ammonia from the bloodstream, and these toxins affect brain function.

The treatment your doctor started with lactulose, along with Rifaximin, is the standard approach. Lactulose works by drawing ammonia into the gut and helping eliminate it through bowel movements, and Rifaximin is a non-absorbed antibiotic that reduces ammonia-producing bacteria in the intestines. Together, they are proven to reduce symptoms and reduce the recurrence of future episodes.

Regarding your concern about heart medications and bleeding risk, Rifaximin (a broad-spectrum antibiotic) is minimally absorbed into the bloodstream, so it has very low potential for systemic drug interactions, including with common cardiac medications or blood thinners. It does not increase bleeding risk. Lactulose also does not increase bleeding risk, though if it causes excessive diarrhea and dehydration, that can worsen kidney function, which is something to monitor carefully since his creatinine is already mildly elevated at 1.6 milligrams per deciliter.

In elderly patients, both medications are considered safe for long-term use, and Rifaximin is often continued chronically to prevent recurrence of encephalopathy. The main goal is maintaining the right balance with lactulose, aiming for two to three soft bowel movements per day, not severe diarrhea.

His bilirubin of 3.0 and albumin of 2.8 mean very significant underlying liver dysfunction, and the kidney value suggests we must be careful about hydration and monitor for worsening renal function. At his age, especially with coronary artery disease and anticoagulation, it is also important to rule out any precipitating factors such as infection, gastrointestinal bleeding, constipation, dehydration, or medication changes because hepatic encephalopathy is often triggered by something reversible.

I hope this information helps you.

Feel free to ask further queries.

Thank you.