A Pilot Study Utilizing Nitazoxanide for Hepatic Encephalopathy in Chronic Liver Failure

Basu, Patrick; Rayapudi, Krishna; Esteves, J. Péricles; Brown, Robert N.

doi:10.14309/00000434-200809001-00392

Cited by 6 publications

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“…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. 43 Results such as these are encouraging larger studies.…”

Section: Nitazoxanidementioning

confidence: 83%

Current trends in the treatment of hepatic encephalopathy

Sibae¹,

McGuire²

2009

TCRM

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Hepatic encephalopathy (HE) is a common reversible neuropsychiatric syndrome associated with chronic and acute liver dysfunction and significant morbidity and mortality. Although a clear pathogenesis is yet to be determined, elevated ammonia in the serum and central nervous system are the mainstay for pathogenesis and treatment. Management includes early diagnosis and prompt treatment of precipitating factors (infection, gastrointestinal bleeding, electrolyte disturbances, hepatocellular carcinoma, dehydration, hypotension, and use of benzodiazepines, psychoactive drugs, and/or alcohol). Clinical trials have established the efficacy of lactulose and lactitol enemas in the treatment of acute hepatic encephalopathy. Extensive clinical experience has demonstrated the efficacy of oral lactulose and lactitol with the goal of two to three soft bowel movements a day for the treatment of chronic HE. However, lactulose and lactitol have significant gastrointestinal side effects. For patients unable to tolerate lactulose or lactitol or who still have persistent chronic HE with lactulose or lactitol, neomycin, metronidazole and rifaximin are second-line agents. More recent data supports the benefits of rifaximin used solely and as an additional agent with fewer side effects than neomycin or metronidazole. Newer therapies being investigated in humans with clinical promise include nitazoxanide, the molecular adsorbent recirculating system (MARS), L-ornithine phenylacetate, sodium benzoate, and/or sodium phenylacetate and Kremezin ® (AST-120).

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Section: Nitazoxanidementioning

confidence: 83%

Current trends in the treatment of hepatic encephalopathy

Sibae¹,

McGuire²

2009

TCRM

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“…Nitazoxanide was proved to be well-tolerated in the study by Basu et al, where only 3 out of 19 patients reported gastric distension and cramps which resolved by taking NTZ with food 29 . Other studies reported that NTZ had mild and transient adverse events 18,[66][67][68] .…”

Section: Fig3: Cldq Total and Domain Scores For Nitazoxanide Group Amentioning

confidence: 96%

“…Basu and colleagues presented a pilot prospective study showing clinical improvement in HE among cirrhotic patients who received NTZ and lactulose. Patients showed improvement in mental status and QOL score, and the drug was well-tolerated 29 .…”

Section: Introductionmentioning

confidence: 94%

“…Mental status improved 30-70% in 15 patients with an improvement in the QOL score from 20-80%. The regimen was welltolerated with 3 patients reporting gastric distension and cramps which resolved by taking NTZ with food 29 .…”

Section: Fig3: Cldq Total and Domain Scores For Nitazoxanide Group Amentioning

confidence: 99%

“…Similarly, NTZ had the same results in the study conducted by Basu et al where the patients' performance on Modified Encephalopathy Scale (MES) improved 30-70% in 15 out of 19 patients (79%). This scale comprised mental status, sleep, irritability, confusion, lethargy, tremor, and comprehension 29 .…”

Section: Fig3: Cldq Total and Domain Scores For Nitazoxanide Group Amentioning

confidence: 99%

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Untitled

2015

IJPSR

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Background: Hepatic encephalopathy (HE) is a brain dysfunction caused by liver insufficiency and/or portosystemic shunting. It is associated with poor survival and high risk of recurrence along with reduced quality of life (QOL) of patients and their caregivers. Nitazoxanide (NTZ) is an oral antimicrobial that improved mental status and QOL score in HE patients and is well-tolerated. Aim: To evaluate the efficacy and safety of NTZ compared to metronidazole and rifaximin in patients with grade II-III HE and to evaluate its effect on patients' QOL. Patients and Methods: A Prospective, Randomized, Controlled, Open-Label, Pilot study. Thirty four patients were randomly assigned to receive either Nitazoxanide (n=12), Metronidazole (n=11) or Rifaximin (n=11) for 7 days. Serum ammonia level, Clinical Hepatic Encephalopathy Staging Scale (CHESS) and Chronic Liver Disease Questionnaire (CLDQ) for QOL was measured at baseline and at end of treatment. Results: Baseline and after 1 week serum ammonia levels and CHESS scores, showed no significant difference among the 3 groups. There was no significant difference in serum ammonia level in each group for the 3 groups while it showed significance in CHESS score. Regarding QOL, there was a significant difference between baseline and after 1 week CLDQ total (p-value= 0.01) and fatigue scores (p-value= 0.01) for Nitazoxanide group. Conclusion: Administration of 500 mg of NTZ twice daily over 7 days showed the same efficacy on HE as standard treatment. However, it was superior in improving patients' QOL.

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Nitazoxanide versus rifaximin in preventing the recurrence of hepatic encephalopathy: A randomized double‐blind controlled trial

Glal

Mostafa

2021

J Hepato Biliary Pancreat

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Background/Purpose: Hepatic encephalopathy (HE) is a neuropsychiatric complication of liver cirrhosis. HE is associated with poor survival and detrimental effects on quality of life (QOL). The drawbacks of the long-term use of rifaximin in HE necessitates searching for alternative therapies. In this context, our study aimed at evaluating the safety and efficacy of nitazoxanide (NTZ) as compared to rifaximin (RFX) in preventing the recurrence of HE and assessing its impact on QOL. Patients and Methods: This prospective, randomized, double-blind controlled study included 60 patients who were randomly assigned to receive either rifaximin 550 mg twice daily (group 1; n = 30) or nitazoxanide 500 mg twice daily (group 2; n = 30) for 24 weeks. During the study period, the patients' neurological symptoms, mental status, and performance were monitored. The serum levels of HE triggers (ammonia, TNF-α, and octopamine) were assessed. The patients' health-related quality of life was also evaluated. Results: Six months after treatment, patients on NTZ therapy showed a statistically significant improvement in CHESS score and mental status. NTZ provided 136 days of remission vs 67 days of remission for patients on RFX (P 1 = .0001) and significant reduction in Child score (P 1 = .018). Additionally, NTZ showed a statistically significant decrease in serum ammonia, TNF-α, and octopamine levels as compared to rifaximin. Regarding QOL, NTZ group showed an improvement in total Chronic Liver Disease Questionnaire (CLDQ) score. Both groups experienced minor controllable side effects. Conclusion: Nitazoxanide may represent a suitable and safe alternative therapy to rifaximin in preventing the recurrence of hepatic encephalopathy.

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A Pilot Study Utilizing Nitazoxanide for Hepatic Encephalopathy in Chronic Liver Failure

Cited by 6 publications

References 0 publications

Current trends in the treatment of hepatic encephalopathy

Current trends in the treatment of hepatic encephalopathy

Untitled

Nitazoxanide versus rifaximin in preventing the recurrence of hepatic encephalopathy: A randomized double‐blind controlled trial

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