Sarcopenia is an important complication of cirrhosis affecting almost 13-50% patients. It has consistently been recognized as a poor predictor of outcomes in chronic liver disease (CLD), and is associated with a higher mortality in patients with hepatocellular cancer (HCC) and transplant waitlist. Muscle homeostasis is maintained by an intricate balance between protein synthesis and breakdown, regulated by cytokines, hormones, and inflammatory mediators. Elevated ammonia, a phenomenon unique to cirrhosis, is the most extensively studied common link in the liver-muscle axis. In the presence of hepatic dysfunction, muscle acts as the metabolic partner to the liver for ammonia disposal. Elevated ammonia promotes cataplerosis, impairs the Krebs cycle resulting in the metabolism of amino acids and fatty acids, decreases protein synthesis thereby activating an adaptive metabolic response of autophagy, and stimulates production of myostatin which impairs mammalian target of rapamycin (mTOR) complex signalling, further inhibiting protein synthesis. A combination of dietary interventions, exercise, and pharmacological therapy is the only approved treatment for sarcopenia. A calorie and protein intake of 30-35kcal/kg/day and 1.2-1.5g/kg/day, respectively is recommended. Regular exercise, combining both aerobic and resistance exercises, has consistently shown benefit in the outcomes in patients with cirrhosis. However, there is paucity of data on the role of ammonia lowering therapy in the management of sarcopenia. We plan a pilot open-label randomized controlled trial to assess the role of rifaximin in improving muscle mass in patients with cirrhosis. All patients in intervention group (standard medical therapy (SMT) plus rifaximin) will receive medical therapy according to the standard guidelines for the management of the etiology and complications of chronic liver disease. Standard medical therapy will also include dietary counselling and exercise instructions as recommended by the latest guidelines. Concomitant use of lactulose will be allowed in the study. In addition, all patients will receive 550mg of rifaximin, twice daily until 6 months after enrollment. Control group will receive standard medical therapy alone.