13th March 2017


NICE NG50: Cirrhosis in over 16s: assessment and management 1

“Hepatic encephalopathy is a major complication of cirrhosis.”

“Approximately 50% of people with cirrhosis will develop clinically apparent hepatic encephalopathy at some stage after diagnosis – the risk being around 5-25% within 5 years.”

“Hospital admissions are common and inpatient stays often prolonged. The presence of hepatic encephalopathy is associated with a significant increase in mortality; survival after the first episode is 42% at 1 year and 23% at 3 years.” 1

View the full NG50 guidance  

NICE TA337 guidance 2 for preventing episodes of overt hepatic encephaopathy with TARGAXAN® 550 (rifaximin-α)

Section 1.1 recommends rifaximin-α, within its marketing authorisation, as an option for reducing the recurrence of episodes of overt hepatic encephalopathy in people aged 18 years or older. 2

Costing Report TA337, Section 2.5:
“Expert clinical opinion suggests that rifaximin-α is effective in reducing the recurrence of hepatic encephalopathy episodes and is well tolerated. Treatment with rifaximin-α may improve quality of life, prevent readmissions to hospital and reduce morbidity and carer burden.” 3

Evidence supporting HE management with rifaximin-α around the UK and Republic of Ireland:

SMC: Rifaximin-α (TARGAXAN®) is accepted for use within NHS Scotland. 4

NCPE Ireland: Product accepted but no formal appraisal required 5

DHSSPS: The Department of Health Social Services and Public Safety (DHSSPS) have endorsed NICE TA 337 in Northern Ireland. 6

AWMSG: Product meets exclusion criteria due to positive NICE appraisal. 7

UK/XIF5/0719/0521    DOP: October 2019


  1. National Institute for Health and Care Excellence (NICE). National guideline 50 - Cirrhosis in over 16s: assessment and management. July 2016. Available at: https://www.nice.org.uk/guidance/ng50/resources/cirrhosis-in-over-16s-assessment-and-management-1837506577093
  2. NICE. Technology appraisal guidance 337. Rifaximin for preventing episodes of overt hepatic encephalopathy. March 2015. Available at: https://www.nice.org.uk/guidance/ta337/resources/rifaximin-for-preventing-episodes-of-overt-hepatic-encephalopathy-82602552414661
  3. NICE. Costing report: Implementing the NICE guidance on rifaximin for preventing episodes of overt hepatic encephalopathy (TA337). Available at: https://www.nice.org.uk/guidance/ta337/resources/costing-report-428453677
  4. Scottish Medical Consortium. Advice regarding rifaximin 550mg film coated tablets (TARGAXAN®). 2013. SMC No. (893/13). Available from: http://www.scottishmedicines.org.uk/files/advice/rifaximin_Targaxan_FINAL_August_2013_for_website.pdf
  5. National Centre for Pharmacoeconomics, NCPE Ireland, Pharmacoeconomic Evaluation of Rifaximin (TARGAXAN®). Available from: http://www.ncpe.ie/drugs/rifaximin-targaxan-2/
  6. The Department of Health Social Services and Public Safety (DHSSPS). Available from: https://https://www.health-ni.gov.uk/articles/nice-endorsed-technology-appraisals-20152016
  7. All Wales Strategy Medicines Group. Appraisal information, Reference no. 1058, rifaximin (TARGAXAN®). Available from: http://www.awmsg.org/awmsgonline/app/appraisalinfo/1058