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Rifaximin: Uses, Dosage, and Side Effects Explained
Summary of Key Points
Rifaximin is an antibiotic commonly used to treat various gastrointestinal conditions, including traveler’s diarrhea, irritable bowel syndrome with diarrhea (IBS-D), and hepatic encephalopathy. It works by reducing harmful bacteria in the gut. While generally well-tolerated, like all medications, Rifaximin may cause side effects. Always consult your healthcare provider before starting or adjusting your dose. You can also schedule a telemedicine appointment with one of our providers for personalized care.
Names of Medication
US Brand Name: Xifaxan (Rifaximin)
The generic name refers to the active ingredient in a medication, while the brand name is assigned by the manufacturer.
Pharmacologic Category
Antibiotic, Rifamycin Derivative
Rifaximin Dosage
Rifaximin is prescribed for a variety of conditions, and the dosage will depend on the specific condition being treated. Always follow your doctor’s instructions and consult them before making any changes to your dose. You can also consult one of our telemedicine providers for guidance.
Traveler’s Diarrhea
Dosage: 200 mg
Frequency: Three times daily
Duration: 3 days
Hepatic Encephalopathy
Dosage: 550 mg
Frequency: Twice daily
Duration: Long-term treatment to reduce recurrence
Irritable Bowel Syndrome with Diarrhea (IBS-D)
Dosage: 550 mg
Frequency: Three times daily
Duration: 14 days
Clostridium Difficile Infection
Dosage: 400 mg
Frequency: Twice daily
Duration: 10 days
Small Intestinal Bacterial Overgrowth (SIBO)
Dosage: 550 mg
Frequency: Twice daily
Duration: 14 days
Non-Alcoholic Fatty Liver Disease (NAFLD)
Dosage: 400 mg
Frequency: Twice daily
Duration: 12 weeks
Diverticulitis
Dosage: 400 mg
Frequency: Twice daily
Duration: 7-10 days
Bacterial Infections
Dosage: 400 mg
Frequency: Twice daily
Duration: 7-10 days
Gastrointestinal Infections
Dosage: 400 mg
Frequency: Twice daily
Duration: 7-10 days
Antibiotic-Associated Diarrhea
Dosage: 400 mg
Frequency: Twice daily
Duration: 10 days
Dosage Forms and Strengths
Tablets: 200 mg, 550 mg
Administration Instructions for Rifaximin
Rifaximin tablets should be taken orally, with or without food. Swallow the tablet whole with a glass of water. Do not crush or chew the tablet. If you miss a dose, take it as soon as you remember. If it’s almost time for your next dose, skip the missed one. Do not double up on doses. Always follow your healthcare provider’s instructions for the best results.
Rifaximin Side Effects and Adverse Reactions
Like all medications, Rifaximin can cause side effects. Most are mild, but some may be more serious. If you experience any side effects, consult your healthcare provider immediately. You can also schedule a telemedicine appointment with one of our providers for further guidance.
Common Side Effects (Occurring in 1-10% of patients)
Nausea: Feeling sick to your stomach
Flatulence: Increased gas or bloating
Headache: Mild to moderate head pain
Less Common Side Effects (Occurring in less than 1% of patients)
Dizziness: Feeling lightheaded or unsteady
Fatigue: Feeling unusually tired or weak
Abdominal Pain: Discomfort or pain in the stomach area
Serious Side Effects (Seek medical attention immediately)
Severe Allergic Reactions: Swelling of the face, lips, or throat, difficulty breathing, or hives
Severe Diarrhea: Persistent or bloody diarrhea, which could indicate a more serious infection
Severe Abdominal Pain: Intense stomach pain that does not go away
Contraindications for Rifaximin
A contraindication is a specific condition where a medication should not be used because it may cause harm. It’s important to know if you have any contraindications before starting Rifaximin.
Contraindications for Rifaximin
Allergy to Rifaximin or similar antibiotics: If you’ve had an allergic reaction to Rifaximin or other antibiotics like rifampin or rifabutin, you should not take Rifaximin. Allergic reactions can range from mild rashes to severe, life-threatening conditions like anaphylaxis.
Severe liver disease: Rifaximin is processed by the liver. If you have severe liver disease, your body may not process the medication properly, increasing the risk of side effects or toxicity.
Diarrhea with fever or blood in stool: Rifaximin is not effective for treating diarrhea caused by infections involving fever or blood in the stool. These symptoms may indicate a more serious infection requiring different treatment.
Drug to Drug Interactions
Rifaximin can interact with other medications, potentially affecting its efficacy or increasing the risk of side effects. Always inform your healthcare provider about all medications you are taking, including over-the-counter drugs and supplements.
Medications that Interact with Rifaximin
Cyclosporine (Neoral, Gengraf, Sandimmune): Cyclosporine can increase Rifaximin levels in your blood, raising the risk of side effects.
Warfarin (Coumadin, Jantoven): Rifaximin may reduce the effectiveness of warfarin, a blood thinner, which could increase the risk of blood clots.
Oral contraceptives: Rifaximin may reduce the effectiveness of birth control pills, increasing the risk of unintended pregnancy. Consider using an additional form of contraception while taking Rifaximin.
Rifaximin in Pregnancy
Is it safe to take Rifaximin when pregnant?
There is limited information regarding the safety of Rifaximin during pregnancy. While animal studies have not demonstrated harm to the fetus, no well-controlled studies have been conducted in pregnant women. As a result, Rifaximin is generally not recommended during pregnancy unless the potential benefits clearly outweigh the risks. If you are pregnant or planning to become pregnant, it is essential to consult your healthcare provider before starting Rifaximin. Our telemedicine providers are available to help you carefully weigh the risks and benefits based on your individual situation.
Rifaximin while Breastfeeding
Is it safe to take Rifaximin while breastfeeding?
There is not enough data to determine whether Rifaximin passes into breast milk or if it could affect a nursing infant. Due to the potential for adverse effects in babies, caution is advised when considering Rifaximin while breastfeeding. It is important to discuss with your healthcare provider whether to continue breastfeeding or explore alternative treatments. Our telemedicine providers can assist you in making an informed decision that prioritizes both your health and your baby’s well-being.
Estimated Cost of Rifaximin Medication
The cost of Rifaximin can vary depending on the pharmacy and your insurance coverage. Without insurance, a 30-day supply of Rifaximin (550 mg tablets) typically ranges from $1,500 to $2,000. However, using a GoodRx coupon may reduce the cost to approximately $1,200. Be sure to check with your pharmacy for the most accurate pricing based on your specific circumstances.
Possible Alternatives to Rifaximin
If Rifaximin is not the right option for you, there are alternative treatments and lifestyle changes that may help manage your condition. It is important to discuss these options with your healthcare provider before making any changes to your treatment plan. Our telemedicine providers are available to guide you through these alternatives and help you find the best approach for your health.
Traveler’s Diarrhea
- Alternative antibiotics, such as ciprofloxacin or azithromycin.
- Hydration with oral rehydration solutions.
- Preventive measures, including avoiding contaminated food and water.
Hepatic Encephalopathy
- Lactulose, a medication that helps lower ammonia levels in the blood.
- Dietary adjustments, such as reducing protein intake.
Irritable Bowel Syndrome with Diarrhea (IBS-D)
- Eluxadoline (Viberzi), a medication that helps manage IBS-D symptoms.
- Dietary modifications, such as following a low-FODMAP diet.
- Probiotics to support a healthy balance of gut bacteria.
Clostridium Difficile Infection
- Antibiotics like vancomycin or fidaxomicin, which are specifically used to treat C. difficile infections.
- Fecal microbiota transplantation (FMT) for recurrent cases.
Small Intestinal Bacterial Overgrowth (SIBO)
- Antibiotics such as metronidazole or ciprofloxacin.
- Dietary changes, including a low-FODMAP or elemental diet.
Non-Alcoholic Fatty Liver Disease (NAFLD)
- Lifestyle changes, such as weight loss and regular exercise.
- Medications like pioglitazone or vitamin E.
Diverticulitis
- Antibiotics such as ciprofloxacin or metronidazole.
- Dietary changes, including increasing fiber intake after recovery.
Bacterial Infections
- Other antibiotics, depending on the type of bacterial infection (e.g., amoxicillin, doxycycline).
Gastrointestinal Infections
- Antibiotics like ciprofloxacin or azithromycin, depending on the cause of the infection.
- Hydration and electrolyte replacement.
Antibiotic-Associated Diarrhea
- Probiotics to help restore healthy gut flora.
- Discontinuing the antibiotic causing the issue, if possible, under the guidance of your healthcare provider.
Recent Updates on Rifaximin Research
Recent studies continue to explore new potential uses for Rifaximin beyond its current approved indications. For instance, ongoing research is investigating its role in managing conditions like Crohn’s disease and ulcerative colitis, where gut bacteria play a significant role in disease progression. Additionally, there is increasing interest in using Rifaximin to treat small intestinal bacterial overgrowth (SIBO) in patients with irritable bowel syndrome (IBS). Some studies have shown promising results in reducing symptoms such as bloating and diarrhea.
Another area of research focuses on the long-term safety of Rifaximin, particularly for conditions like hepatic encephalopathy, where patients may require extended or repeated courses of the medication. Early findings suggest that Rifaximin is generally well-tolerated, but more studies are needed to confirm its safety over prolonged periods.
If you are interested in how these recent findings might affect your treatment, our telemedicine providers are available to discuss the latest research and how it may apply to your care.
