Rifaximin

What is Rifaximin?

Rifaximin is an antibiotic medication used to treat traveler's diarrhea caused by Escherichia coli bacteria, prevent hepatic encephalopathy (a condition that occurs when your liver does not work normally), and treat irritable bowel syndrome with diarrhea. It is a nonabsorbable oral antibiotic that has a broad spectrum of activity against both gram-negative and gram-positive anaerobic and aerobic bacteria. Rifaximin works by killing the bacteria and preventing its growth. However, it will not work for colds, flu, or other virus infections.

Dosage

The recommended dosage of rifaximin depends on the condition being treated. For traveler's diarrhea, the recommended dosage is 200 mg three times a day for three days. For hepatic encephalopathy, the recommended dosage is 550 mg twice a day. For irritable bowel syndrome with diarrhea, the recommended dosage is 550 mg three times a day for 14 days.

Time of Day and With or Without Food

Rifaximin should be taken with or without food, depending on personal preference.

Side Effects

Common side effects of rifaximin include gas, bloating, stomach pain, and headache. These side effects are usually mild and go away after a few days of treatment. In rare cases, rifaximin can cause serious side effects, such as liver problems or an allergic reaction.

Interactions

Rifaximin may interact with other medications, such as clarithromycin, erythromycin, ritonavir, saquinavir, amiodarone, quinidine, and verapamil. It is important to talk to a healthcare provider before starting rifaximin if you are taking any other medications.

Human Studies

Rifaximin has been studied extensively in humans and has been shown to be effective in treating traveler's diarrhea caused by Escherichia coli bacteria, preventing hepatic encephalopathy, and treating irritable bowel syndrome with diarrhea. It is often used in combination with other medications to achieve optimal results.

Citations:
(1) https://www.mayoclinic.org/drugs-supplements/rifaximin-oral-route/description/drg-20065817
(2) https://medlineplus.gov/druginfo/meds/a604027.html
(3) https://www.mayoclinic.org/drugs-supplements/rifaximin-oral-route/side-effects/drg-20065817?p=1
(4) https://www.ncbi.nlm.nih.gov/books/NBK562329/
(5) https://www.xifaxan.com
(6) https://www.drugs.com/mtm/rifaximin.html

Is Rifaximin Safe and Well Tolerated for Long-term ?

Rifaximin is a gut-selective, oral antimicrobial agent that has been shown to be safe and well-tolerated for long-term use in maintaining remission from overt hepatic encephalopathy (HE) (1)(2)(3)(4)(5). It is a minimally absorbed, gut-selective antibiotic that is effective in maintaining remission from overt hepatic encephalopathy (2).

Safety and Tolerance

Studies have shown that long-term treatment (≥24 months) with rifaximin (550 mg, twice daily) provides a continued reduction in the rate of HE-related and all-cause hospitalization, without an increased risk of adverse events, infections (including Clostridium difficile), or development of bacterial antibiotic resistance (2)(4). The safety profile of rifaximin during long-term treatment was similar to that in the original randomized controlled trial (RCT), and adverse event rates, including discontinuation rates and deaths, were all lower during long-term rifaximin therapy compared with the RCT rifaximin group (2).

Dosage and Administration

The standard dose for rifaximin in maintaining remission from overt hepatic encephalopathy is 550 mg twice daily (1)(2)(4). The medication is typically taken with or without food, as directed by a healthcare professional.

Side Effects

The overall profile of adverse events (AEs) during treatment with rifaximin was consistent with expectations for patients with liver cirrhosis and a history of overt HE (2). Common side effects may include dizziness, gastrointestinal issues, and headaches (2). However, the rates and spectrum of adverse events with long-term rifaximin treatment were similar to those of the original RCT, and there was no increase in the rate of infections or development of bacterial antibiotic resistance (2)(4).

Interactions

Rifaximin is a gut-selective antibiotic with minimal systemic absorption, which reduces the potential for drug interactions (2). However, it is always recommended to consult a healthcare professional or pharmacist about potential interactions with other medications or supplements.

Citations:
(1) https://www.sciencedirect.com/science/article/pii/S154235651301968X
(2) https://journals.lww.com/ajg/Fulltext/2009/10003/Rifaximin_has_a_Favorable_Long_Term_Safety_Profile.360.aspx
(3) https://www.cghjournal.org/article/S1542-3565(13)01968-X/pdf
(4) https://pubmed.ncbi.nlm.nih.gov/24365449/
(5) https://www.cghjournal.org/article/S1542-3565(13)01968-X/fulltext
(6) https://www.wjgnet.com/1948-5182/full/v11/i6/531.htm