Hepatic Encepalopathy medications (Lactulose and Rifamixin OR L-ornithine and L-aspartate)

[Dagmara]

Which medication would be better to treat HE. The doctor is giving my mom L-ornithine and L-aspartate. My mom has HE and is suffering from delusions which are getting worse.

I told my sister that Lactulose is a common medication to treat HE as I have read on the internet and told her to ask the doctor about this. The doctor said that L-ornithine and L-aspartate has the same effect as Lactulose. My sister sent me the link of a research article which concluded that L-ornithine and L-aspartate is effective in treating HE. I read on Wikipedia that there's very weak evidence proving the effectiveness of L-ornithine and L-aspartate. My sister tells me that Lactulose is an old medicine and L-ornithine and L-aspartate are the new medicines. I told her that if the doctor has said that both these medicines have the same effect then what's the harm in giving her Lactulose. Whenever I bring up this topic, she speaks in a somewhat aggressive tone and we end up arguing. My mother's urine output is low and she's seeing delusions. My sister tells me she has vaginal bleeding, her condition is worsening and she is in a lot of pain. Can anybody offer me some advice? Will she survive? Should we try to relieve her of her pain by ending her life and how do we do that in the most painless way possible?

[AyrshireK]

Never heard of the meds your Mum is receiving. In the UK the normal treatment is Lactulose in combination with Rifaximin.

[Dagmara in reply to AyrshireK]

I see.

It's listed in Wikipedia as a treatment for HE.

[Brett11 in reply to Dagmara]

I would insist on lactulose/rifixamin combined. It actually works. Don’t be told otherwise.

Cheers,

Brett

[Hidden]

I'm not a doctor, but from what I've read L-ornithine / L-aspartate also known as LOLA will help the body metabolize ammonia, but should be used in combination with lactulose for best results. Rifaximin may be added if needed.

Lactulose is dirt cheap, & fairly benign with the only side effect being loose/frequent stools, so there's really no reason her doc should resist prescribing this. If the LOLA / Lactulose combination doesn't lower ammonia to acceptable levels within a few days, Rifaximin should finish the job.

The squeaky wheel gets the grease so keep pestering those docs until you get this resolved.

[Dldtx]

Lactulose and rifaximin is what take but also had to change my diet because my dr was telling me about high protein intake may worsen encephalopathy for cirrhotic patients The purpose of the low-protein diet is to reduce intestinal ammonia production and thereby prevent exacerbation of hepatic encephalopathy. So this being somewhat contrary to me adding protein doing all that has helped, but I have to constantly watch what and when I eat.

Good luck

🤠 DlD

[Millie09 in reply to Dldtx]

Now i am confused.. I keep my protein intake to at least 40g May be 60 per day as that is what i was told by consultant. I do however take lactulose, have been for a year now due to mild hepatic encephalopathy, upon which i have upped my little dose of 20ml to 40 'll as it was no lonfer having any effect.. I've learnt something there Dldtx

Never knew protein in high dose affects HE ! 🤔..

[AyrshireK in reply to Millie09]

It's generally red meat protein that creates higher ammonia levels & some people find cutting out red meat reduces HE effects. A high protein diet is very important in late stage liver disease where muscles are wasting but alternatives to red meat are best - fish, pulses, eggs, white meat etc. Some people find a vegetarian diet using pulses and soya protein etc. give good results at reducing HE.

Don't cut protein out just watch what form you take it in.

Katie

[Millie09 in reply to AyrshireK]

Oh i see..dont like red meat which is good lol. Thack you Katie. Hope all went ok last week in Edinburgh with.hubby

Linda x

[AyrshireK in reply to Millie09]

Hospital went ok thanks Millie09, all stable from a bloods point of view, lower oesophagus varices still obliterated but some small varices appearing in upper oesophagus - repeat scope in 12 months time.

Katie

[Millie09 in reply to AyrshireK]

Oh thats good news ! They are obviously happy with him anyway. thack you for letting me know

Linda x

[dougalgromit]

Hi dagmara my husband had HE and he had serious bouts of it and the best thing that helped him was lactulose the consultant prescribed for him he took 25mls 3rimes a day and that really worked for him I hope this helps you Donna x

[Splodge60]

Do you live where euthanasia is an option. It is not in the uk. Much as I am suffering badly, I would not wish to make that choice. I’ve still got a lot to do before I pass over.

[ThreeSmiles]

Hi dagmara

Sorry to hear of you mum’s problems.

The aim of lactulose is to get you to do a poo three or four times a day. I was told I could keep increasing the dose until I achieved that on a fairly consistent basis. Going for poos a lot helps reduce the amount of toxins in the blood which is essential. I have never heard of those two L- drugs you mention but others have commented on those. Do they achieve she required toilet visits?

I don’t ever remember being assessed for the amount of ammonia in my blood - hardly ever got told anytging though to be honest.

After I still kept getting HE episodes (which can lead to delusions as you call them) they introduced Rifaximin for me. And then, continuing even further, as the effectiveness of the lactulose etc started to wear off, I was prescribed self administering enemas (note this seems quite rare from what I can tell and is not something I enjoyed doing ..........!).

The main aim of the lactulose treatment is to induce the loo visits!

Do not, please, worry too much about the delusions - I reckon that they will be happening during an HE episode? The HE episodes you really really must try and get minimised.

Please note I am not medically trained in any way but the above is all from my own experience.

Good luck to you all.

Miles