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Evidence summaries

Dopaminergic Agonists for Hepatic Encephalopathy

Dopaminergic agonists are probably not effective for patients with acute or chronic hepatic encephalopathy, or fulminant hepatic failure. Level of evidence: "C"

A Cochrane review [Abstract] 1 included five trials with 144 participants. Three trials assessed levodopa, and two trials assessed bromocriptine. The mean daily dose was 4 grams for levodopa and 15 grams for bromocriptine. The median duration of treatment was 14 days (range seven to 56 days). None of the trials followed participants after the end of treatment.

Random-effects model meta-analyses showed that dopamine agents had no beneficial or detrimental effect on hepatic encephalopathy in the primary analyses (15/80 (19%) versus 14/80 (18%); OR 2.99, 95% CI 0.09 to 100.55; two trials) or when paired data from cross-over trials were included (OR 1.04, 95% CI 0.75 to 1.43). Dopamine agents had no beneficial or harmful effect on mortality (42/144 (29%) versus 38/144 (26%); OR 1.11, 95% CI 0.35 to 3.54; five trials).

Comment: The quality of evidence is downgraded by imprecise results (limited study size for each comparison) and by limitations in study quality.

References

  • Junker AE, Als-Nielsen B, Gluud C et al. Dopamine agents for hepatic encephalopathy. Cochrane Database Syst Rev 2014;2():CD003047. [PubMed]

Primary/Secondary Keywords