Limited coverage criteria – rifaximin

rifaximin

550 mg, oral tablet

For reducing the risk of overt hepatic encephalopathy (HE) recurrence in patients who meet the following criteria:

• have been hospitalized with HE associated with cirrhosis of the liver

AND

• are unable to achieve adequate control despite taking the maximum tolerated dose of lactulose

AND

• a Special Authority request is submitted by an internal medicine specialist or a gastroenterologist

Rifaximin should be used in combination with a maximal tolerated dose of lactulose

6 months