A Novel Use of Tenapanor in Patients With Hepatic Encephalopathy: A Case Series

Hepatic encephalopathy (HE) is often inadequately managed by standard therapies (lactulose and/or rifaximin). This case series presents 5 patients with decompensated cirrhosis and HE who received tenapanor (50 mg once or twice daily) due to inadequate response to standard therapies. Outcomes included bowel movement frequency, HE symptom improvement, and safety. Four patients showed improved bowel frequency, stool consistency, and HE severity. HE recurred in 3 patients after discontinuation. Tenapanor was well-tolerated, with mild, self-resolved dehydration in one case. Patients preferred tenapanor for taste and dosing convenience over lactulose. The findings suggested that tenapanor may alleviate HE with high safety and compliance.