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The dihexa half life ensures plasma concentrations fall to negligible levels within six to eight hours, meaning every-other-day dosing creates 40+ hour gaps with zero receptor engagement

Boyd A, Thomas R, Hansell AL, Gulliver J, Hicks LM, Griggs R, et al

In a network meta-analysis, lactulose was associated with significant improvement in CHE as well as a marked reduction in the risk of progression to OHE [123]

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Selected tests may be useful when food intake becomes very limited or symptoms suggest anemia or deficiency