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标题: 利福昔明针对肝性脑病的用量 [打印本页]

作者: hwd2000 时间: 2010-1-21 10:50 标题: 利福昔明针对肝性脑病的用量

本帖最后由风雨不动于 2012-4-14 09:25 编辑

先要感谢论坛上的朋友研究出这个药物能对肝性脑病起作用，我是看到论坛上一位孝女的帖子知道的，现在我好不容易买到利福昔明了，但不知具体怎么用比较有效且副作用小，比如一天几粒？连续服用多少天然后再停一段时间？服用后可能会出现的副作用？希望大家能帮忙一下，告诉我具体的注意事项，十分感谢！

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作者: hwd2000 时间: 2010-1-21 16:40

要沉下去了，赶紧顶一下，期待着解答，谢谢！再补充一下，是海南三叶生产的，商品名希捷

[ 本帖最后由 hwd2000 于 2010-1-21 16:45 编辑 ]

作者: liver411 时间: 2010-1-22 10:05

Xifaxan 或 Xifaxanpi 几乎没有副作用，说明书上的试药数据显示可以和安慰剂相比。比其它治疗肝性脑病的抗生素的副作用，特别是肾毒性要好很多很多。

用量不是看片，要看剂量。对于肝性脑病患者一般是 400 mg 每天三次。（1200 mg - 毫克）。可以不外加乳果糖。可以和饭菜或不和饭菜服用都可行。

作者: 百合花2009 时间: 2010-1-22 19:58

楼主：你好！
请问你在哪个城市。利福昔明我们也找过。南京没有。电话致海南公司给了江苏地区代理的电话。但只说邮购。不放心。一直没买。目前服用瑞甘（门冬氨酸鸟氨酸颗粒）。效果还可以。

作者: 神经妙算 时间: 2010-1-22 22:04

这个药主要用于革兰氏阳性及阴性。需氧及厌氧细菌所致急、慢性肠道感染;腹泻综合症；肠道菌群改变所致腹泻（小肠结肠炎，抗生素所致小肠结肠炎，旅行者腹泻）；术前及术后肠道预防用药；血氨过多，门静脉系统脑炎，肝性脑病。
　美国一项大范围、随机、安慰剂对照、有299例患者参加的研究得到的资料显示，在意向治疗人群中，接受利福昔明（每次550毫克，每日两次）的患者用药6个月后，预防临床HE事件的发生具有非常显著性意义（风险降低58%）。　　
　　根据此研究，如果获得批准，利福昔明将成为近30年来美国批准的用于HE患者的首个治疗药物。”

作者: lisunjun1 时间: 2010-1-29 17:35

原帖由 hwd2000 于 2010-1-21 10:50 发表
先要感谢论坛上的朋友研究出这个药物能对肝性脑病起作用，我是看到论坛上一位孝女的帖子知道的，现在我好不容易买到利福昔明了，但不知具体怎么用比较有效且副作用小，比如一天几粒？连续服用多少天然后再停一段时间？服用后可能 ...

请问利福昔明怎么买，我现在很需要用

作者: lisunjun1 时间: 2010-1-29 17:44

原帖由 hwd2000 于 2010-1-21 10:50 发表
先要感谢论坛上的朋友研究出这个药物能对肝性脑病起作用，我是看到论坛上一位孝女的帖子知道的，现在我好不容易买到利福昔明了，但不知具体怎么用比较有效且副作用小，比如一天几粒？连续服用多少天然后再停一段时间？服用后可能 ...

请问利福昔明怎么买，我现在很需要用

作者: lisunjun1 时间: 2010-1-29 17:45

请问利福昔明怎么买，我现在很需要买

作者: lisunjun1 时间: 2010-1-29 22:50

请问利福昔明怎么买，我现在很需要买

作者: liver411 时间: 2010-1-30 16:29

原帖由 百合花2009 于 2010-1-22 19:58 发表
楼主：你好！
请问你在哪个城市。利福昔明我们也找过。南京没有。电话致海南公司给了江苏地区代理的电话。但只说邮购。不放心。一直没买。目前服用瑞甘（门冬氨酸鸟氨酸颗粒）。效果还可以。 ...

http://www.medic360.com/html/read_20039.html

作者: liver411 时间: 2010-1-30 16:30

让医生处方。另外的名字叫：威利宁（利福昔明）

作者: liver411 时间: 2010-1-30 16:40

另外一个商品名：

作者: hwd2000 时间: 2010-1-30 19:09

原帖由 lisunjun1 于 2010-1-29 17:45 发表
请问利福昔明怎么买，我现在很需要买

这位兄弟不好意思啊，这段时间有些事情在办，没法上网，我这个是在杭州买到的，自行购买就只有那个邵逸夫医院旁边的邵医药店能买到，这个是属于处方药，一般是到医院去开才行的，感谢楼上各位朋友的热心解答，对我的帮助很大！太感谢了！

作者: hwd2000 时间: 2010-1-30 19:14

原帖由 liver411 于 2010-1-22 10:05 发表
Xifaxan 或 Xifaxanpi 几乎没有副作用，说明书上的试药数据显示可以和安慰剂相比。比其它治疗肝性脑病的抗生素的副作用，特别是肾毒性要好很多很多。

用量不是看片，要看剂量。对于肝性脑病患者一般是 400 mg 每天三次。 ...

非常感谢411老师，您说的这个是治疗的用量吧？我这个海南三叶生产的是一盒16粒，规格100mg，算下来一天要吃12粒，但如果是用于预防，每天应该不需要这么多吧？
另外还有个问题想了解一下，利福昔明本身的作用是可以治疗腹泻的，如果这个吃多了会不会导致便秘呢？

[ 本帖最后由 hwd2000 于 2010-2-1 12:01 编辑 ]

作者: hwd2000 时间: 2010-2-2 13:58

老师好像这两天不在啊

作者: 百合花2009 时间: 2010-2-2 14:41

感谢411老师提供利福昔明的资料！

作者: hwd2000 时间: 2010-2-7 19:03

期待着各位老师的解答

作者: hwd2000 时间: 2010-2-10 20:44

好几天都没看到老师了啊

作者: liver411 时间: 2010-2-11 16:07

1200mg 每天分三次，大约15-21天治疗；
550mg 每天两次，有过6个月的预防治疗对照（正常安慰剂组）。

作者: hwd2000 时间: 2010-2-16 16:01

太感谢411老师了！！！

作者: liver411 时间: 2010-6-9 04:14

http://www.hbvhbv.com/forum/view ... e%3D1&frombbs=1

http://www.hbvhbv.com/forum/view ... highlight=Rifaximin

作者: liver411 时间: 2010-6-9 04:22

利福昔明在肝性脑病中的治疗作用
Rifaximin treatment in hepatic encephalopathy.
出处：N Engl J Med 2010 Mar 362(12) :1071-81
作者：Bass NM;Mullen KD;Sanyal A.,

oordad F;Neff G;Leevy CB;Sigal S;Sheikh MY;Beavers K;Frederick T;Teperman L;Hillebrand D;Huang S;Merchant K;Shaw A;Bortey E;Forbes WP
PMID：20335583

背景：肝性脑病是肝硬化长期衰弱的并发症。利福昔明是一种吸收最少的抗生素，不少文献报道其对急性肝性脑病治疗有效，但对该病的预防效果尚未确定。
方法：在这项随机，双盲，安慰剂对照试验中，299名患者均处于由慢性肝病所致的复发性肝性脑病缓解期，我们将其随机分为两组，一组接受利福昔明，每日两次，每次550毫克(140例），另一组接受安慰剂 (159 例) ，治疗6个月。主要的疗效终点指标为治疗中肝性脑病首次发作时间，关键的次要终点指标为因肝性脑病首次住院时间。
结果：在6个月期间，与服用安慰剂比较，利福昔明显降低了肝性脑病发作的风险（应用利福昔明危险比为0.42；95％可信区间[CI]为0.28～0.64；P <0.001）。利福昔明组治疗中肝性脑病发作率为22.1％，而安慰剂组为45.9%。福昔明组患者因肝性脑病住院治疗占13.6％，而安慰剂组为22.6%，危险比为0.50（95％CI： 0.29～0.87；P=0.01）。超过90%的患者同时接受乳果糖治疗。研究期间两组报告不良事件的发生率相似，如严重不良事件的发生率。
结论：在6个月期间，利福昔明比安慰剂更有效维持肝性脑病的缓解。应用利福昔明治疗还能明显降低因肝性脑病而住院的风险。（ClinicalTrials.gov注册号：NCT00298038）

BACKGROUND: Hepatic encephalopathy is a chronically debilitating complication of hepatic cirrhosis. The efficacy of rifaximin, a minimally absorbed antibiotic, is well documented in the treatment of acute hepatic encephalopathy, but its efficacy for prevention of the disease has not been established. METHODS: In this randomized, double-blind, placebo-controlled trial, we randomly assigned 299 patients who were in remission from recurrent hepatic encephalopathy resulting from chronic liver disease to receive either rifaximin, at a dose of 550 mg twice daily (140 patients), or placebo (159 patients) for 6 months. The primary efficacy end point was the time to the first breakthrough episode of hepatic encephalopathy. The key secondary end point was the time to the first hospitalization involving hepatic encephalopathy. RESULTS: Rifaximin significantly reduced the risk of an episode of hepatic encephalopathy, as compared with placebo, over a 6-month period (hazard ratio with rifaximin, 0.42; 95% confidence interval [CI], 0.28 to 0.64; P<0.001). A breakthrough episode of hepatic encephalopathy occurred in 22.1% of patients in the rifaximin group, as compared with 45.9% of patients in the placebo group. A total of 13.6% of the patients in the rifaximin group had a hospitalization involving hepatic encephalopathy, as compared with 22.6% of patients in the placebo group, for a hazard ratio of 0.50 (95% CI, 0.29 to 0.87; P=0.01). More than 90% of patients received concomitant lactulose therapy. The incidence of adverse events reported during the study was similar in the two groups, as was the incidence of serious adverse events. CONCLUSIONS: Over a 6-month period, treatment with rifaximin maintained remission from hepatic encephalopathy more effectively than did placebo. Rifaximin treatment also significantly reduced the risk of hospitalization involving hepatic encephalopathy. (ClinicalTrials.gov number, NCT00298038.)

专家评价：
Piero Portincasa
University Medical School of Bari, Italy
Gastroenterology & Hepatology

In this interesting randomized, double-blind, placebo-controlled trial, the authors assigned 299 cirrhotic patients in remission from recurrent hepatic encephalopathy to either oral rifaximin (550mg twice daily) or placebo for a long time (6 months). Both the first episode of hepatic encephalopathy and first hepatic encephalopathy-related hospitalization were evaluated. The authors show that rifaximin maintained remission from hepatic encephalopathy more effectively than did placebo (22% vs. 46%) and significantly reduced the risk of hospitalization due to hepatic encephalopathy (14% vs. 23%). This positive effect of rifaximin was evident irrespective of treatment with lactulose and did not yield an increased incidence of adverse events.

Of note, in this study high doses of rifaximin were used chronically and not acutely (21 days or less) or intermittently for the maintenance of remission from episodes of hepatic encephalopathy in outpatients with a recent history of recurrent, overt hepatic encephalopathy. The effect of rifaximin was superior to that of lactulose alone. There are multiple issues that make this article highly interesting: (1) the choice of a frequent disease (hepatic cirrhosis) and hepatic encephalopathy as one of the most debilitating, costly and disturbing complications of liver cirrhosis; (2) the potentially harmful side effects of lactulose and/or oral antibiotics (neomycin, paromomycin, vancomycin, metronidazole) in the prevention of overt hepatic encephalopathy; (3) the use of oral rifaximin -- a minimally absorbed oral antimicrobial agent -- as an effective agent to challenge Gram-positive and Gram-negative aerobic and anaerobic enteric bacteria, with negligible risk of inducing bacterial resistance; (5) the clinically significant finding of a reduced risk of hospitalization in the rifaximin-treated group. The results of this study imply that the non-absorbable rifaximin is safe, effective and yields decreased hospital costs in cirrhotic patients at risk of hepatic encephalopathy. Larger studies are urgently required to confirm the findings of this study. Trial registration: NCT00298038
Rifaximin for Maintaining Remission in Hepatic Encephalopathy
During a 6-month study, rifaximin was more effective than placebo in reducing breakthrough episodes in cirrhotic patients Hepatic encephalopathy (HE) is a common complication of cirrhosis and is associated with substantial morbidity and mortality. Previous studies have shown that rifaximin (Xifaxan, a minimally absorbed antimicrobial agent with high concentration in the gastrointestinal tract) was superior to nonabsorbable disaccharides (the mainstay of therapy) and was as good or better than other antibiotics in treating patients with acute HE.
To evaluate the efficacy of using rifaximin concomitantly with a nonabsorbable disaccharide (lactulose) to maintain remission in HE patients, investigators conducted a randomized, double-blind, placebo-controlled trial involving cirrhotic patients who had experienced≥2 episodes of documented HE in the previous 6 months, were in remission at enrollment, and had a Model for End-Stage Liver Disease (MELD) score of <25. A total of 140 received rifaximin (55 mg twice daily), and 155 received placebo. About 91% of patients in each group were taking lactulose at baseline and during the study. Patients were monitored weekly for 2 weeks and then every 2 weeks until day 168.
Adherence to therapy (at least 80% of dispensed tablets) was nearly 85% in each group. At day 186, fewer breakthrough episodes of HE had occurred in the rifaximin group than in the placebo group (22.1% vs. 45.9%; hazard ratio, 0.42; P<0.001). Also, fewer patients in the rifaximin group than in the placebo group had been hospitalized for HE (13.6% vs. 22.6%; HR, 0.50

=0.01). The incidence of adverse events was similar in both groups.
Comment: These findings demonstrate that among patients with cirrhosis, most of whom were receiving lactulose, rifaximin was superior to placebo in reducing breakthrough episodes of HE. This study is different from previous smaller, randomized studies that showed that rifaximin was at least as effective as lactulose in treating patients with acute episodes of HE. These data add to the body of literature suggesting that rifaximin should be included among the therapeutic modalities for HE.
— Atif Zaman, MD, MPH
Published in Journal Watch Gastroenterology March 24, 2010

******************

这里面作者其一的Dr F. Poordad （认识他6年，最近在Clinical Care Options也有一个对于抗病毒新知的Flash）等在CSMC做此药研究颇有收效。

[ 本帖最后由 liver411 于 2010-6-9 04:23 编辑 ]

作者: 进口 时间: 2012-12-27 21:50

411老师这个利福昔明好像是抗生素，可不可以长期不停的吃？或者吃一段时间停一段时间？怕不怕耐药之类的？是否需要跟乳果糖合用？

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