Q: Which of the following found to be having some role in treatment of hepatic encephelopathy

A) Methadone
B) Flumazenil
C) Naloxone
D) Fomepizole
E) ETOH


Answer:  B

There is some evidence of an increase in benzodiazepine receptor ligands in patients with hepatic encephalopathy, so multiple attempts have been made to use benzodiazepine receptor antagonists to treat hepatic encephalopathy with various levels of success. But still evidence is far from enough to label it as a strong agent for use as a standard of treatment. It may be used in acute situations to buy some time and/or as temporizing measure for two to four hours. On positive note, those patients who respond to flumazenil usually have a favorable prognosis. 


References:

1.  Basile AS, Harrison PM, Hughes RD, et al. Relationship between plasma benzodiazepine receptor ligand concentrations and severity of hepatic encephalopathy. Hepatology 1994; 19:112. 

2. Gyr K, Meier R, Häussler J, et al. Evaluation of the efficacy and safety of flumazenil in the treatment of portal systemic encephalopathy: a double blind, randomised, placebo controlled multicentre study. Gut 1996; 39:319. 

3. Cadranel JF, el Younsi M, Pidoux B, et al. Flumazenil therapy for hepatic encephalopathy in cirrhotic patients: a double-blind pragmatic randomized, placebo study. Eur J Gastroenterol Hepatol 1995; 7:325. 

4. Pomier-Layrargues G, Giguère JF, Lavoie J, et al. Flumazenil in cirrhotic patients in hepatic coma: a randomized double-blind placebo-controlled crossover trial. Hepatology 1994; 19:32. 

5. Als-Nielsen B, Kjaergard LL, Gluud C. Benzodiazepine receptor antagonists for acute and chronic hepatic encephalopathy. Cochrane Database Syst Rev 2001; :CD002798. 

6. Goulenok C, Bernard B, Cadranel JF, et al. Flumazenil vs. placebo in hepatic encephalopathy in patients with cirrhosis: a meta-analysis. Aliment Pharmacol Ther 2002; 16:361.