Cirrhosis Support Group

http://www.mdjunction.com/forums/cirrhosis-discussions/ introductions-personal-stories/3054972-hello-im-here-for- help-with-my-mother#3057728

My mother was admitted back into the hospital with high ammonia levels and ascites again. This time she was 83. Lactulose and another paracentesis done. We admitted her from the rehab to a different hospital because we wanted her to be set up to see a hepatologist.

Well, one of the things we requested was to put her on the Rifamaxim and get her off the lactulose or a smaller dose. The GE doctor has informed me that Rifamaxim is not always covered by insurance and is like $900 a pill! She's getting it while in the hospital, though, but I will have to find out from my mother's insurance about coverage. The GE doctor said that she was on Flagyl with the lactulose, which sort of does the same thing, but they discontinued it since she'll be taking the Rifamaxim while there. They also lowered the lactulose after starting the Rifamaxim. He also mentioned possibly neomycin which I've heard of as well.

Does Rifamaxim work better than the other two? I asked the GE doctor about the metabolism of the other two in the liver and he said some and my concern about my mother is her NASH in which her liver is damaged from medications as it is. And the Rifamaxim doesn't even go through the liver. I don't want to see her liver worsen on the other two medications.

So I wanted to find out what you all think about Rifamaxim vs. the other two alternatives. She's just getting really sore with the lactulose.

I had some other questions but maybe I should put it on another thread. Please let me know.

Thanks-

Neomycin and Flagyl use to be the common treatment for encephalopathy.

However Neomycin can cause hearing loss and renal failure (Cirrhosis Patients are already at a greater risk for renal failure)

Flagyl can cause peripheral neuropathy (nerve damage), and many experience gastrointestinal side effects.

Rifamaxim works well and is considered safer so it is the most common choice of hepatologist. It is expensive however you can usually get a discount in the price if you contact the manufacturer. It is usually given while you still take the Lactulose at a lower dose.

Ask any question you wish Sometimes it is helpful to put new questions in a new post just so the rest of us don't miss them.

I hope this helps some.