What are the effective treatments for hepatic encephalopathy?

Question

Hello doctor,

My uncle, 67 years old, has advanced liver disease. He was recently admitted for overt hepatic encephalopathy and was sent home with Xifaxan. After coming back, he sleeps almost the whole day and stays awake at night, talking confused and sometimes saying things that do not make sense.

Is this normal during recovery, or does it mean the problem is coming back again? How long should he continue this medicine, and is it dangerous if it is stopped suddenly? Are there any specific foods, sleeping pills, or other drugs we must strictly avoid? Please explain in simple terms when we should take him back to the hospital and what warning signs to look for.

Please help.

Thank you.

Answer 1

Hello,

Welcome back to icliniq.com.

I understand your concern.

What you are describing is common after a recent episode of overt hepatic encephalopathy (HE). The brain needs time to recover after exposure to toxins like ammonia. Sleep-wake reversal (sleeping in day, awake at night), slow thinking, and mild confusion can persist for days to weeks and gradually improve with proper treatment.

The role of Xifaxan (Rifaximin) is to reduce ammonia-producing gut bacteria and prevent recurrence. This medicine is usually continued long-term or lifelong, especially after an overt HE episode. Stopping it suddenly is not dangerous in itself, but it significantly increases the risk of confusion returning. Also, ensure lactulose compliance if prescribed, targeting two to three soft stools daily.

Avoid these strictly:

Sleeping pills (especially benzodiazepines like Diazepam, Alprazolam).
Alcohol completely.
Constipation.
Dehydration.
Sedatives and opioid painkillers, unless prescribed.
Excessive protein restriction (normal intake is needed).

Take him urgently to the hospital if:

Increasing confusion or drowsiness.
Not recognizing family.
No bowel movements for more than 24 to 48 hours.
Fever, vomiting, or GI (gastrointestinal) bleeding.
Difficulty waking him.

With regular medicines and trigger prevention, many patients remain stable and improve significantly.

I hope this helps.

Kindly follow up if you have more concerns.

Thank you.