Xifaxan
Xifaxan (rifaximin) is a rifamycin antibiotic that's used to treat people 12 years and older with travelers' diarrhea caused by Escherichia coli (E. coli). The medication can also treat irritable bowel syndrome with diarrhea (IBS-D) and prevent hepatic encephalopathy (HE) in adults. Xifaxan (rifaximin) is a tablet that's taken by mouth 2 to 3 times per day, depending on the medical condition you're using it for. Side effects generally include swelling, dizziness, and fatigue.
What is Xifaxan (rifaximin)?
What is Xifaxan (rifaximin) used for?
- Treatment of travelers' diarrhea caused by E. coli in people ages 12 years and older
- Treatment of irritable bowel syndrome with diarrhea (IBS-D) in adults
- Prevention of hepatic encephalopathy (HE) in adults
How Xifaxan (rifaximin) works
Xifaxan (rifaximin) is a rifamycin antibiotic. It works by stopping bacteria from making important proteins that the bacteria need to survive. As a result, the bacteria can't grow or spread.
Drug facts
Side effects of Xifaxan (rifaximin)
The following side effects may get better over time as your body gets used to the medication. Let your healthcare provider know immediately if you continue to experience these symptoms or if they worsen over time.
Common Side Effects
Travelers' diarrhea:
- Headache (10%)
IBS-D:
- Nausea (2-3%)
HE:
- Swelling in hands and feet (15%)
- Nausea (14%)
- Dizziness (13%)
- Tiredness (12%)
- Extra stomach fluid and swelling (11%)
Less Common Side Effects
- Muscle spasms
- Muscle pain
- Joint pain
- Stomach pain
- Sore throat and runny nose
- Trouble breathing
- Itching
- Fever
- Rash
Xifaxan (rifaximin) serious side effects
Contact your healthcare provider immediately if you experience any of the following.
- C. difficile-related diarrhea: rapid heart rate, foul-smelling diarrhea, fever, nausea, frequent bowel movements (even up to 15 times per day)
- Severe allergic reaction: rash; trouble breathing; swelling of the face, lips, tongue, or throat
More on Xifaxan (rifaximin) side effects
The following Xifaxan (rifaximin) side effects have also been reported
Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor immediately if any of the following side effects occur:
More common
Black, tarry stools
dizziness or lightheadedness
rapid breathing
shortness of breath
trouble sleeping
Less common
Blood in the urine
bloody nose
continuing ringing or buzzing or other unexplained noise in the ears
fainting
feeling of constant movement of self or surroundings
increased heart rate
sensation of spinning
sunken eyes
ulcers, sores, or white spots in the mouth
unusual bleeding or bruising
unusual tiredness or weakness
Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:
More common
Bloated
difficulty with moving
excess air or gas in the stomach or intestines
frequent urge to defecate
full feeling
headache
lower back or side pain
muscle pain or stiffness
pain in the joints
passing gas
stomach pain
straining while passing stool
swelling of the hands, ankles, feet, or lower legs
Less common
Abnormal dreams
blurred vision
chills
confusion
decreased urination
difficulty having a bowel movement (stool)
dizziness, faintness, or lightheadedness when getting up suddenly from a lying or sitting position
dry lips
ear pain
feeling of warmth
hearing loss
lightheadedness
loss of appetite
loss of taste
painful or difficult urination
pale skin
redness of the face, neck, arms, and occasionally, upper chest
sweating
swollen glands
thirst
vomiting
wrinkled skin
Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.
Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.
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Pros and cons of Xifaxan (rifaximin)
Pros
- Works well for travelers' diarrhea, HE, and IBS-D
- Can treat travelers' diarrhea in children 12 years and older
- Can take with or without food
Cons
- Need to take 2 to 3 times per day, depending on why you're taking it
- Only available as tablets
- Might not be the best option for people with severe liver problems
Pharmacist tips for Xifaxan (rifaximin)
- Take Xifaxan (rifaximin) exactly as prescribed. Make sure to finish your treatment course, even if you're feeling better. Stopping the medication earlier than prescribed can make your infection come back and become harder to treat.
- Take Xifaxan (rifaximin) with or without food. Taking the medication with food might help if it's hurting your stomach.
- For traveler's diarrhea: Stop Xifaxan (rifaximin) and get medical help if you have diarrhea for more than 1 to 2 days or if your diarrhea gets worse. Also call urgent care if you develop a fever or if you have bloody diarrhea. These could be signs that you need different medications to appropriately treat your diarrhea or that you need more medical attention.
- Tell your prescriber and pharmacist about all the medications you take and are planning to take. Xifaxan (rifaximin) can interact with cyclosporine (Sandimmune, Neoral), warfarin (Coumadin), and other medications. These interactions can affect medication levels in the body, which can either raise your risk for side effects or make your medications work less well. Your care team can check whether you need any changes to your medications to keep you safe.
- If you're pregnant or thinking of becoming pregnant before you start Xifaxan (rifaximin) or during treatment, speak with a healthcare professional. Xifaxan (rifaximin) isn't recommended during pregnancy because of the potential risk for harm to the unborn baby.
Common questions about Xifaxan
Yes, Xifaxan is a rifamycin antibiotic. It stops bacteria from growing and spreading by preventing bacteria from making proteins they need to survive.
How long Xifaxan takes to work will depend on what medical condition you're using the medication for. Clinical studies show that people who took Xifaxan for travelers' diarrhea had improved symptoms within a day or two (32 hours). But people who took Xifaxan for HE or for IBS-D started to see improvement in their symptoms within a month of starting their treatment course. Speak with your prescriber if you have questions about how long you should expect Xifaxan to start working for you.
It takes a little more than a day (30 hours) for most of Xifaxan to leave the body after one dose. This time frame is based on the medication's half-life, which is a measure of the time it takes to get rid of the medication from the body. Since the liver helps break down and get rid of the medication from the body, Xifaxan might stay longer in the body if you have liver problems (i.e., your liver isn't working as well).
Side effects from Xifaxan, such as headache or nausea, can last for as long as it takes for the medication to clear from your body. This can be about a day after your last dose. It might also depend on what specific side effect you have. It's best to contact a healthcare professional to examine you if you have severe side effects or side effects from Xifaxan that aren't going away.
Alcohol doesn't appear to interact with Xifaxan. But you shouldn't drink alcohol while you're taking Xifaxan because it can worsen the medical condition you're using the medication to treat. For example, it's best to avoid alcohol while you're taking Xifaxan for hepatic encephalopathy (HE), or problems with brain function due to liver problems. Alcohol can also cause liver damage, and drinking alcohol with this medication while you're getting treated for HE can raise the risk that your liver problems get worse. Talk with your prescriber about your drinking habits and whether Xifaxan is an appropriate option for you.
The manufacturer doesn't say whether or not Xifaxan can be crushed. To be safe, don't crush Xifaxan tablets because it might affect how well the medication works. Let the prescriber or your pharmacist know if you're having trouble swallowing the tablets whole. Some studies show that it's possible for them to ask a compounding pharmacy to make a special suspension of the medication that you can drink.
Xifaxan isn't approved to treat small intestine bacterial overgrowth (SIBO) (too much bacteria growing in the small intestine that causes stomach upset). But a 2017 systematic review and meta-analysis found that Xifaxan was safe and worked well for treating of SIBO. This is considered an off-label use of Xifaxan since the medication isn't FDA approved for SIBO. Speak with your healthcare team about your treatment options if you have SIBO.
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Risks and warnings for Xifaxan (rifaximin)
Xifaxan (rifaximin) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Worsening of travelers' diarrhea
Xifaxan (rifaximin) only works to treat travelers' diarrhea that's caused by specific bacteria called E. coli. E. coli is the most common cause of travelers' diarrhea, but there are other bugs that can also cause this type of diarrhea. And Xifaxan (rifaximin) might not be able to fight against these other bugs. This might lead to worsened travelers' diarrhea if you're not getting the appropriate treatment you need.
Stop taking Xifaxan (rifaximin) and seek medical help if you continue to have diarrhea for more than 1 to 2 days or if your diarrhea gets worse. Also get urgent care if you have a fever or bloody diarrhea. These could be signs that you need to take a different medication to treat your symptoms more appropriately or that you need more medical attention.
Diarrhea from Clostridioides difficile infection
- Risk factors: Using antibiotics
All antibiotics, including Xifaxan (rifaximin), can lead to an infection caused by the bacteria called Clostridioides difficile (C. diff). This infection can happen because antibiotics change the normal bacteria in your stomach and intestines. As a result, C. diff can overgrow in the gut and cause potentially life-threatening diarrhea.
C. diff-related diarrhea is considered a medical emergency. It can cause fast heart rate, foul-smelling diarrhea, fever, nausea, and frequent bowel movements (even up to 15 times per day). Get medical attention right away if you have any of these symptoms. You'll get tested for C. diff-related diarrhea and get appropriate treatment, if needed.
Xifaxan (rifaximin) dosage
Tablet| Dosage | Quantity | Price as low as | Price per unit |
|---|---|---|---|
| 200mg | 9 tablets | $105.83 | $11.76 |
| 550mg | 42 tablets | $2,338.49 | $55.68 |
Typical dosage for Xifaxan (rifaximin)
- Travelers' diarrhea: The typical dose is 200 mg by mouth three times daily for 3 days.
- Hepatic encephalopathy: The typical dose is 550 mg by mouth twice daily.
- Irritable bowel syndrome with diarrhea (IBS-D): The typical dose is 550 mg by mouth three times daily for 2 weeks. If your symptoms come back after treatment, your prescriber might decide to take the medication again using the same treatment course. Your can repeat the treatment course for up to 2 times.
Interactions between Xifaxan (rifaximin) and other drugs
Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking this medicine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.
Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
- Cholera Vaccine, Live
How much does Xifaxan (rifaximin) cost?
$105.83
Xifaxan (rifaximin) contraindications
Contraindications are specific health conditions or situations in which a person should not take a medication due to safety concerns. If you have any of the following conditions or if any of the following apply to you, let your healthcare provider know because Xifaxan (rifaximin) will not be safe for you to take.
- Severe allergy to Xifaxan (rifaximin), rifampin (Rifadin), or rifabutin (Mycobutin)
What are alternatives to Xifaxan (rifaximin)?
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