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Discussion: Hepatic encephalopathy is precipitated due to liver dysfunction causing elevated ammonia levels in the systemic circulation. Hyperammonemia causes cerebral edema by astrocyte swelling in cirrhotic patients, which leads to the development of symptoms. A dysfunctional blood-brain barrier, neuronal inflammation, elevated bile acids & TNF levels are also key factors in precipitating symptomatic HE. EN is a type 3 hypersensitivity reaction with deposition & formation of immune complexes in the venules of the septae of the subcutaneous fat. Commonly implicated drugs are sulfonamides, bromides, anti TNF inhibitors and OCPs. Rifaximin is a broad spectrum bactericidal agent that binds to the βsubunit of bacterial DNA-dependent RNA polymerase. It is highly soluble in bile, active against enteric bacteria & used for the treatment & prevention of hepatic encephalopathy. NSAIDs, colchicine, oral …