P>Background/aim: This study aimed to assess the effectiveness and safety of naloxone in the management of hepatic encephalopathy (HE). Methods: Cochrane collaboration methodology was used in a meta-analysis of randomized controlled trials of naloxone therapy for HE. Results: Seventeen randomized trials were identified with 15 studies involving 1054 patients meeting criteria for inclusion. Naloxone use was associated with a significant improvement in HE [relative risk (RR) 1 center dot 46; 95% confidence interval (CI) 1 center dot 27-1 center dot 67; P = 0 center dot 0005]. This comparison showed statistical heterogeneity (P < 0 center dot 10, and chi 2 = 44 center dot 93). Subgroup analysis indicated naloxone administered parenterally by intermittent or continuous infusions to be effective (RR 1 center dot 34; 95% CI 1 center dot 17-1 center dot 53; P < 0 center dot 0001). A significant in trials by infusion route (RR 1 center dot 42; 95% CI 1 center dot 19-1 center dot 69; P < 0 center dot 0001) interaction was observed. Conclusions: Naloxone may improve HE. However, published data are limited.