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Rifaximin

    Brands

    DEA Class; Rx

    Common Brand Names; Xifaxan

    • Antibiotics, Other; 
    • Antidiarrheals

    Oral, non-systemically absorbed rifamycin antibiotic
    Approved to treat traveler’s diarrhea (due to non-invasive strains of Escherichia coli), to reduce risk of hepatic encephalopathy recurrence, and treatment of irritable bowel syndrome with diarrhea (IBS-D)
    No significant drug interactions since not systemically absorbed

    Indicated for travelers’ diarrhea caused by noninvasive strains of Escherichia coli (E coli)

    Indicated for irritable bowel syndrome with diarrhea (IBS-D) in adult men and women

    For reduction in risk of overt hepatic encephalopathy recurrence.

    Limitations of use: Not indicated or shown effective in patients with traveler’s diarrhea complicated by fever or bloody stool or due to pathogens other than non-invasive strains of E coli

    Hypersensitivity to rifamycin antibiotics

    • Flatulence (11%)
    • Headache (10%)
    • Rectal tenesmus (7%)
    • Abdominal pain (7%)
    • Defecation urgency (6%)
    • Nausea (5%)
    • Constipation (4%)
    • Pyrexia (3%)
    • Vomiting (2%)

    Not effective in diarrhea complicated by fever, hematochezia, or diarrhea due to pathogens other than Escherichia coli

    Not effective against traveler’s diarrhea due to Campylobacter jejuni

    Clostridium difficile-associated diarrhea has been reported

    Efficacy against traveler’s diarrhea due to Shigella spp and Salmonella spp not proven

    Discontinue if symptoms worsen or persist >24-48 hr

    Possibility of pseudomembranous colitis

    Monitor patients with severe hepatic impairment for increased systemic exposure

    Coadministration with P-gp inhibitors substantially increases systemic exposure to rifaximin; coadministration of cyclosporine with rifaximin resulted in 83-fold and 124-fold increases in rifaximin mean Cmax and AUC in healthy subjects

    Pregnancy category: C

    Lactation: Do not use if nursing or do not nurse

    Adults

    600 mg/day PO for traveler’s diarrhea; 1100 mg/day PO for hepatic encephalopathy; 1650 mg/day for irritable bowel syndrome with diarrhea.

    Geriatric

    600 mg/day PO for traveler’s diarrhea; 1100 mg/day PO for hepatic encephalopathy; 1650 mg/day for irritable bowel syndrome with diarrhea.

    Adolescents

    600 mg/day PO for traveler’s diarrhea.

    Children

    >= 12 years: 600 mg/day PO for traveler’s diarrhea.
    < 12 years: Safety and efficacy have not been established.

    Infants

    Safety and efficacy have not been established.

    Neonates

    Safety and efficacy have not been established.

    Rifaximin

    tablet

    • 200mg
    • 550mg