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Xifaxan
Xifaxan, the brand name for rifaximin, is an antibiotic used to treat specific gastrointestinal conditions, such as irritable bowel syndrome with diarrhea (IBS-D), hepatic encephalopathy, and travelers' diarrhea caused by certain bacteria (Escherichia coli). Unlike many antibiotics, Xifaxan is unique because it works primarily in the gastrointestinal tract, with minimal absorption into the bloodstream. It targets and reduces harmful bacteria in the intestines, helping to relieve symptoms like diarrhea, abdominal pain, and brain fog in liver disease patients.
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Frequently Asked Questions
How long does it take for Xifaxan to work?
For conditions like IBS-D or travelers' diarrhea, symptoms often begin to improve within a few days of starting treatment. In the case of hepatic encephalopathy, Xifaxan is used long-term to help prevent episodes.
Can Xifaxan treat other types of infections?
No, Xifaxan is specifically used for gastrointestinal conditions and is not suitable for systemic infections, as it is minimally absorbed into the bloodstream.
What should I do if I miss a dose of Xifaxan?
If you miss a dose, take it as soon as you remember. If it’s close to your next scheduled dose, skip the missed dose and take your next dose as usual. Do not double up on doses.
Is Xifaxan safe for long-term use?
Yes, Xifaxan is often prescribed for long-term use in patients with hepatic encephalopathy to prevent episodes. Your healthcare provider will monitor your liver function and symptoms to ensure safety during long-term use.
Can Xifaxan cause diarrhea?
While Xifaxan is used to treat diarrhea, it can, in rare cases, cause Clostridium difficile-associated diarrhea (CDAD). If you develop severe, watery diarrhea, contact your healthcare provider.
Comprehensive Drug Guide
How Does Xifaxan Work?
Xifaxan works by inhibiting bacterial RNA synthesis, which prevents bacteria from multiplying. Because Xifaxan is not absorbed well into the bloodstream, it acts locally in the gut, reducing the bacterial population in the intestines without causing widespread effects on the body's natural flora. This makes it especially useful for treating conditions like travelers' diarrhea, IBS-D, and preventing hepatic encephalopathy in patients with liver disease.
Common Dosages
- 200 mg tablets
- 550 mg tablets
Typical Dosing
- For IBS-D: The typical dose is 550 mg taken three times daily for 14 days. If symptoms recur, patients may be treated again.
- For hepatic encephalopathy: The usual dose is 550 mg twice daily to reduce the recurrence of episodes of hepatic encephalopathy.
- For travelers' diarrhea: The dose is 200 mg three times daily for 3 days.
Typical Dosing
FDA Approved Indications
- Irritable Bowel Syndrome with Diarrhea (IBS-D)
- Hepatic encephalopathy (to reduce the risk of episodes in adults)
- Travelers' diarrhea caused by Escherichia coli
Who Shouldn't Take Xifaxan?
- Known hypersensitivity to rifaximin, rifamycin derivatives, or any of the components of the formulation.
- Severe liver impairment (for certain conditions), as this may increase the risk of side effects.
- Diarrhea caused by other pathogens (such as Clostridium difficile), as Xifaxan is only effective against E. coli and may not treat other causes of diarrhea.
Advice From The Pharmacist
- Take Xifaxan exactly as prescribed, with or without food.
- Finish the entire course of medication, even if your symptoms improve early, to ensure the infection is fully treated.
- If using Xifaxan for hepatic encephalopathy, it is typically part of a long-term treatment plan, so follow your healthcare provider's instructions carefully.
- Do not use Xifaxan for diarrhea caused by fever or blood in the stool, as it may not be effective in such cases.
- Let your doctor know if symptoms persist or worsen during or after treatment.
Side Effects of Xifaxan
Common Side Effects
- Nausea or vomiting
- Abdominal pain
- Flatulence (gas)
- Headache
- Bloating
Uncommon/Severe Side Effects
- Severe allergic reactions (rash, swelling, difficulty breathing)
- Severe diarrhea (which could be a sign of a Clostridium difficile infection)
- Liver problems (especially in patients with severe liver impairment)
Risks and Warnings of Xifaxan
- Severe liver disease: Xifaxan should be used with caution in patients with severe liver disease, as they may be more prone to side effects, and the drug may build up in their system.
- Clostridium difficile-associated diarrhea (CDAD): Antibiotic use can lead to an overgrowth of C. difficile, causing severe diarrhea. If diarrhea becomes severe, watery, or persistent, contact your healthcare provider.
- Allergic reactions: As with other rifamycin derivatives, Xifaxan may cause allergic reactions. Discontinue use immediately if symptoms of an allergic reaction occur.
Interactions with Xifaxan
Common Drug Interactions
- Warfarin: Xifaxan may interact with warfarin, a blood thinner, and could affect how your blood clots. Regular monitoring may be needed to ensure that your INR levels remain stable.
- Cyclosporine: Coadministration of cyclosporine can significantly increase rifaximin concentrations, potentially increasing the risk of side effects.
- Other rifamycins: Since Xifaxan is a rifamycin derivative, caution should be used if taken with other antibiotics from the same family, such as rifampin, as it may increase side effects.
Alternatives to Xifaxan
- Metronidazole (Flagyl): An alternative antibiotic used for treating some bacterial infections in the gastrointestinal tract, including C. difficile infections.
- Neomycin: Another antibiotic used to manage hepatic encephalopathy in certain cases.
- Lactulose: Often used in combination with Xifaxan for preventing hepatic encephalopathy in liver disease patients.
- Eluxadoline (Viberzi): An oral medication used to treat IBS-D, an alternative to Xifaxan for managing this condition.
