Xifaxan side effects anxiety

SIBO (small intestinal bacterial overgrowth) is a common cause of gas, bloating, constipation, and diarrhea. It can be treated with antibiotics, herbal antimicrobials, or a liquid elemental diet. The SIBO antibiotic is often given for two weeks. However, a recent study has shown this may not be the ideal approach for most patients and that one’s SIBO lab values can help determine the ideal use.

Dr. Michael Ruscio: Hi, this is Dr. Ruscio. And if you’re a patient that’s been diagnosed with SIBO—small intestinal bacterial overgrowth—which can typically manifest as the symptoms of IBS, including but not limited to gas, bloating, and either constipation, diarrhea, or abdominal pain, then you may be wondering what the ideal treatment length is.

  • Get help with SIBO (small intestinal bacterial overgrowth).
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  • Healthcare providers looking to sharpen their clinical skills, check out the Future of Functional Medicine Review Clinical Newsletter.

DrMR: Now, there are different treatment options. Two of the most used, I guess you could say, would be pharmaceutical antibiotics or herbal antimicrobials. And a recent study actually gives us some very valuable information in guiding how long to use the antibiotic Rifaximin in the treatment of SIBO. And this was a study predominantly looking at those with SIBO that had an IBS-D or an IBS diarrheal type presentation.

So, in short, what this study showed was that the higher one’s labs values may predict the longer need for treatment duration on this antibiotic. Now, more specifically, these researchers tracked a large group of patients. And the patients ended up being on either four weeks, eight weeks, or twelve weeks of Rifaximin.

Now, typically, a Rifaximin prescription is written for a two-week duration. So this is definitely quite a bit longer than is typically recommended. However, this is also a drug being used in a new application. So I still think we have much to learn.

So instead of the typical two weeks, these researchers found that the higher level of severity of the SIBO test, the SIBO breath test, that predicted if one would need Rifaximin for four weeks, for eight weeks, or even as long as twelve weeks.

Now, this, I think, provides us a few important things. One is the personalization of the dose. And I think that’s probably the most practical here because what we want to try to do is use a duration of treatment that’s going to have the highest likelihood of success—not too much, not too little.

“What this study again showed was that a patient will start to respond symptomatically before their labs impr”

Now, there’s another interesting finding from the study, which was that patients’ symptoms tended to improve before the labs improved. And why I think this is important is because it points to something that I think is a very important part of the clinical process, which is sometimes left out of modern day medicine or modern day health care, which is really having a strong concern for the way a patient is responding to treatment.

What this study again showed was that a patient will start to respond symptomatically before their labs improve. And so this may suggest that using the patient response to dictate the length of treatment and the retesting interval may be important.

I should note that the most significant symptomatic response on the antibiotic was seen at four weeks. So again, this, at most conservative, supports that perhaps using Rifaximin for longer than two weeks, four weeks, would be an intelligent strategy because it did appear that the most significant benefit was achieved at four weeks.

And there’s one other interesting point from this study, which was that someone’s severity of symptoms did not correlate with the severity of the labs. And I think this is important to mention because people can have problems in the gut. Or I should maybe say it this way: a problem in the gut could manifest as many different types of problems for different people and also different severities of problems.

So it’s important, I think, to keep this in mind where my personal opinion is that a problem in the gut can manifest in many different ways. And this is why it’s an important thing to evaluate digestive health before other considerations. And what this study is showing is that the severity of SIBO may not always correlate with the symptom severity. So someone may have a very mild case of SIBO but very severe symptoms, or very severe SIBO but very mild symptoms.

So this study provides some very interesting information. I think the biggest takeaway is that we may want to rethink or at least consider a longer duration of Rifaximin use in the treatment of SIBO, especially if a patient has a very high gas level on breath testing.

So this is Dr. Ruscio. Hopefully, this information helps you get healthy and get back to your life. Thanks.


What do you think? I would like to hear your thoughts or experience with this.
  • Get help using this information to become healthier.
  • Get your personalized plan for optimizing your gut health with my new book.
  • Healthcare providers looking to sharpen their clinical skills, check out the Future of Functional Medicine Review Clinical Newsletter.

Dr. Ruscio is your leading functional and integrative doctor specializing in gut related disorders such as SIBO, leaky gut, Celiac, IBS and in thyroid disorders such as hypothyroid and hyperthyroid. For more information on how to become a patient, please contact our office. Serving the San Francisco bay area and distance patients via phone and Skype.

SIBO Antibiotics

In this article, we will break down everything you need to know about SIBO antibiotics including:

  • How they work to treat SIBO and IBS
  • Which antibiotics are used and what it means if they don’t work
  • What Xifaxan is
  • What you need to know about the treatment protocols before you proceed, so you can have the best outcome

How Do Antibiotics Treat SIBO and IBS?

First of all, if you don’t understand the basics of small intestine bacterial overgrowth which is found in 60-80% of people with IBS, I would recommend reading this article.

Basically, antibiotics treat SIBO by killing the overgrowth of bacteria in the small intestine.

Antibiotics do this by either stopping bacteria from replicating or destroying them. The reason we want to kill bacteria is that people with SIBO have accumulated too many bacteria in their small intestine (there should be much less) which cause debilitating digestive symptoms such as gas, bloating, diarrhea, constipation, fatigue, and abnormal stools.

When you treat this imbalance of bacteria in the small intestine with specific antibiotics, you reduce the amount of gas being produced, which can reduce symptoms.

For some people just treating this bacterial overgrowth can solve the problem, but others will need to address other underlying causes which enabled this bacterial overgrowth in the first place. (We will touch upon prevention later)

Xifaxan for SIBO and IBS

While there are a few different antibiotics usually prescribed to treat SIBO and IBS, the most common antibiotic is Xifaxan (Rifaximin).

Xifaxan is a non-systemically absorbed rifamycin with antimicrobial activity against gram-positive and gram-negative aerobic and anaerobic organisms.1

Xifaxan is used to treat traveler’s diarrhea, hepatic encephalopathy, IBS/SIBO, and a few other bowel infections.2

The main difference between Xifaxan and other SIBO antibiotics is that it is very minimally absorbed throughout the body and works specifically in the gastrointestinal tract.

This means that you are less likely to have toxic or systemic side effects compared to other antibiotics.

Also, the solubility of the drug increases 100-fold in the presence of bile acids (which are delivered directly to the small intestine after eating), meaning that its antimicrobial effect is much greater in the small bowel than in the colon.3

More so, Xifaxan decreases mucosal inflammation which is likely another reason it helps IBS patients. 4 Because of these properties, Xifaxan is a top antibiotic chosen for SIBO treatment.

Xifaxan for IBS-D

Xifaxan has been studied and used in all subsets of IBS and SIBO patients including diarrhea, constipation, and mixed type patients. But, it’s important to understand that there are differences in the study results when Xifaxan is given under different protocols for diarrhea and constipation type patients. In this section, we will go over Xifaxan’s use in IBS and SIBO patients with diarrhea specifically.

Xifaxan is one of the best antibiotics for SIBO and IBS with diarrhea.

In a number of different studies, it has been shown that a 2-week course of Xifaxan at a dose of 550 mg 3 times per day provides significant relief of IBS/SIBO symptoms, such as bloating, abdominal pain, and loose or watery stools.

The only thing you need to keep in mind when using antibiotics is that relapse can occur after treatment, so it’s vital to take preventative measures and continue to improve your overall digestive function.

That being said, using Xifaxan for SIBO in patients who have diarrhea as a predominant symptom is usually a very effective option.

Xifaxan Dosages for Diarrhea

  • 1200 mg per day for 10 days with 5 g per day of partially hydrolyzed guar gum (source)
  • 1650 mg per day for 14 days (source)

Xifaxan for IBS and SIBO with Constipation

Xifaxan is also used in constipation cases but there has been different research findings and outcomes using it with constipation.

It’s important to note that usually Xifaxan is used alone only in people with diarrhea or mixed type symptoms, whereas it is used in combination with other medications in constipation-predominant cases.

Despite this, there is some evidence that Xifaxan alone can help some people with constipation, such as this study.

As with all medical treatments, each person has a unique body and using Xifaxan alone for constipation may not be helpful for everyone. But, it has been reported that using Xifaxan in combination with Neomycin (rather then either alone) for constipation can be much more effective.

In this study, patients who tested positive for methane on the SIBO breath test (which usually indicates constipation type symptoms) were split into 3 groups. One group got Xifaxan alone, one just Neomycin, and the last group a combination of Xifaxan and Neomycin.

This table shows the results:

Rifaximin + Neomycin

1200 mg Rifaximin1000 mg Neomycin

10 days

Neomycin Alone 1000 mg Neomycin10 days 33%
Rifaximin Alone 1200 mg Rifaximin10 days 28%

85% of patients getting combination treatment also noticed an improvement in their symptoms. These results show why Xifaxan alone is not the best option for those with constipation type symptoms; Xifaxan and neomycin work synergistically to treat different organisms in the gut, improving overall symptoms.

Xifaxan Combo Dosages for Constipation

  • 1200 mg Rifaximin + 1000 mg Neomycin per day for 10 days (source)
  • 1650 mg Rifaximin for 14 days + 1000 mg Neomycin for 10 days

The Pros and Cons of Using Xifaxan for SIBO

There are pros and cons when deciding to use SIBO antibiotics like Xifaxan.

Here is a list of both sides, so you can make the best decision possible


  • Works quickly when effective
  • Protocols have been researched thoroughly
  • One of the strongest treatment options
  • Xifaxan is a non-absorbable antibiotic so it doesn’t cause as many systemic side effects
  • Xifaxan can reduce mucosal inflammation


  • Xifaxan is very expensive, without insurance it usually costs around $1,500
  • Xifaxan can still cause negative side effects (though it doesn’t happen as often since it acts mostly in the gut)
  • You can still relapse after a successful treatment if there is a stubborn underlying cause
  • Xifaxan isn’t as effective in constipation cases and needs to be combined with Neomycin

Relapse Rates After SIBO Antibiotic Therapy

I think it’s important to touch on the relapse rates after using antibiotics for SIBO. This helps you make the decision whether to try natural treatments initially or go straight to antibiotics, especially if you have to do multiple courses.

I think you will find that in the long run, it’s important to incorporate a mostly natural strategy, only using pharmaceuticals when your symptoms are very severe.

In this study, the aim was to investigate SIBO recurrence in patients after successful antibiotic treatment. They took 80 patients treated with Xifaxan and reassessed them 3, 6, and 9 months after their breath tests normalized. The results are informative and very important for people who use antibiotics to understand.

The Results:

  • 3 months after successful antibiotic treatment 10 patients (10/80 or 12.6%) tested positive for SIBO again indicating relapse
  • 6 months after successful antibiotic treatment 22 patients (22/80 or 27.5%) tested positive for SIBO
  • 9 months after successful antibiotic treatment 35 patients (35/80 or 43.7%) tested positive for SIBO

They also showed that being older, having your appendix out, and chronically using proton pump inhibitors (like Prilosec) increased the chance of relapse. This means that if you have other health issues that are affecting your gut function you will be more likely to relapse and become a chronic SIBO patient.

This study is very important to understand; it shows that while antibiotics can definitely help a lot, they are only one helpful tool in the overall treatment strategy, and not a magic cure. In reality, many people deal with relapse and have to find a combination of strategies to help maintain their symptom relief while preventing recurrence.

Why Does SIBO Relapse?

This is a great question to ask any doctor or researcher who studies SIBO or IBS. There are many hypotheses right now but no final conclusion. Whoever figures out the solution to the relapse problem will be a rock-star! As mentioned above, SIBO is often a chronic condition, and like the study above showed, recurrence can occur even after a successful course of antibiotics.

It is thought the main reason recurrence occurs is that there is an underlying problem with gut function or the migrating motor complex (MMC).

Some patients who develop bacterial overgrowth have abnormal MMC, meaning that the waves that normally cleanse their small intestine are not effective. Therefore, they do not clear the bacteria and undigested materials as well as other people.

When these small intestine cleansing waves are damaged, it allows bacteria to accumulate, causing SIBO symptoms.

Some of the main prevention strategies which help SIBO patients are:

  • Eating a healthy lower carbohydrate diet
  • Prokinetic agents (natural or pharmaceutical)
  • Fixing other issues that decrease gut motility
  • Reducing stress and making healthy life changes (high stress can decrease motility)

What Does it Mean if SIBO Antibiotics Don’t Work?

While antibiotics are usually very effective for SIBO (at least in the short term), for others, they may not work at all or for only a very short period of time.

This can be very frustrating. So, what does this mean?

This can mean a few things:

  • The SIBO antibiotic protocol was not appropriate for your specific gut bacteria
  • You need an additional course of antibiotics or an elemental diet to treat your stubborn microbes
  • You have developed antibiotic resistance, meaning the bacteria are not affected by the antibiotics
  • You don’t really have SIBO, but instead a different type of gut dysbiosis or health issue
  • If you relapse very quickly, you may need to focus on figuring out any underlying causes that may be contributing

Can You Treat SIBO Without Antibiotics?

This is an important question many people ask after looking at the SIBO antibiotic relapse rates, side effects, and the cost of purchasing Xifaxan. Yes, you can definitely treat SIBO without antibiotics and in many cases, this may be a better strategy over the long term.

When you realize that most people will relapse after a successful course of antibiotics it makes sense to consider treating SIBO naturally and taking a more gradual approach.

There are a few treatment options that you might find to be effective:

  • Herbal antibiotics like Allimed, berberine, oregano oil, and neem
  • Elemental diet protocol
  • Long-term SIBO diet changes
  • Probiotics

Remember that while some treatments work for others, they may not be the best for you. Everyone has a different health history and underlying causes contributing to their issues. It’s best to consult with a doctor for specialized advice.

Concluding Thoughts on SIBO Antibiotics

If you’re thinking about taking SIBO antibiotics like Xifaxan, know that they can work effectively and quickly. However, a course of Xifaxan is very expensive and you may still have side effects. Also, remember that there is a chance you may relapse once you stop taking the antibiotics.

If you are someone who is dealing with a stubborn case of SIBO- and willing to spend the money on Xifaxan- it can be a good option. On the other hand, if you don’t want to spend as much money and want to take a gentler long-term approach, using a natural treatment protocol may be your best bet. Using herbal antibiotics, the elemental diet or long-term diet changes can be just as effective as antibiotics.

If you want to review all the different treatment strategies used for SIBO before making a decision see this overview.

Why Rifaximin is Not the Solution for SIBO or IBS

Xifaxan is the brand name for the antibiotic drug Rifaximin. Like all antibiotics, it works by killing off bacteria. What makes Rifaximin different is that it is non-systemic, meaning that it doesn’t get absorbed into the bloodstream and instead stays in the intestines. Thus, Rifaximin is often prescribed for intestinal infections such as Small Intestinal Bacterial Overgrowth (SIBO). Rifaximin was also recently approved for treating Irritable Bowel Syndrome (IBS).

Why Rifaximin is Prescribed for SIBO and IBS

Irritable Bowel Syndrome is a condition which affects upwards of 15% of the population. Yet, until recently, doctors were mostly clueless as to what causes IBS. The disorder was largely dismissed as stress and patients were told to “take it easy” and “watch what they eat.”

Now, we are finally starting to realize that IBS is a condition caused by dysbiosis of gut flora. In layman’s terms, this means that the levels of bacteria in our guts has become unbalanced.

SIBO is a condition in which there is too much and/or the wrong kind of bacteria in the small intestine. Research shows that as many as 84% cases of IBS are really misdiagnosed cases of SIBO! So, if you have been diagnosed with IBS, there is a good chance that you really have SIBO.

Since Rifaximin is an antibiotic which kills bacteria in the gut, it should be no surprise that multiple studies have shown it effective in getting rid of IBS and SIBO symptoms. In 2015, the FDA approved Rifaximin for treating IBS with diarrhea (IBS-D).1 Rifaximin is often prescribed for treating SIBO.

*Note that is why diets help for IBS and SIBO. Those diets all work by removing foods which bacteria feed off of.

My Own Personal Experience with IBS and SIBO

I should also note here that IBS and SIBO are something personal to me. I had long dealt with GI symptoms which were diagnosed as IBS. Only after nagging my doctor did he finally order a breath test which confirmed that I really had SIBO (read about how to diagnose SIBO here).

My doctor prescribed Rifaximin and, like so many others, I hoped that popping these antibiotic pills would cure me. And, like so many others, I soon found that curing SIBO isn’t as easy as taking an antibiotic.

The results from my first breath test which diagnosed me with SIBO

Rifaximin Is Ineffective for IBS and SIBO in the Long Run!

For the millions of people who suffer from IBS or SIBO, it should be great news that Rifaximin is an approved treatment.

But there is one little problem: Symptoms come back!

The recurrence rates of IBS and SIBO after treatment with Rifaximin are appalling.

IBS Recurrence Rate with Rifaximin

An initial study into Rifaximin for IBS found that symptom relief lasted 10 weeks after stopping the medication.2

Later clinical trials followed patients for longer. One study found that 64% of IBS patients relapsed after 6 weeks of taking Rifaximin. However, approximately 1/3 of patients did go 22 weeks without relapsing. Considering that there is no other IBS treatment other than diet protocols for managing symptoms, this makes Rifaximin a very attractive option for patients and doctors alike.3, 4, 5

SIBO Recurrence Rate with Rifaximin

There is a lot of variance in the findings of Rifaximin-SIBO findings. The antibiotic isn’t always effective for SIBO (depending on the study, Rifaximin is 40% to 91% effective in treating SIBO). When Rifaximin is effective for treating SIBO, the results don’t last long.6, 7 Studies show that SIBO recurs in almost half of patients within 1 year of treatment with antibiotics!8

Why Rifaximin Doesn’t Work in the Long Run

It’s an understatement to say that gut flora is complex. Researchers are only now starting to understand the multitude of roles that gut flora has in our daily wellbeing. Unbalanced gut flora could be at the root of diseases like depression, anxiety, obesity, autism, diabetes, and heart conditions.

Consider that we have 100 trillion bacteria in our intestines alone. This is 10x the number of cells we have in our bodies! The research is still in its infancy, but it is really fascinating stuff. To learn more, read this article on Gut Flora Dysbiosis.

Antibiotics like Rifaximin indiscriminately kill off ALL bacteria. They do NOT balance out the bacteria in our guts.

Rifaximin will likely relieve IBS and SIBO symptoms for a short time (because the antibiotic has reduced the amount of bacteria in your gut). But, once those bacteria start to breed again (and they will), the symptoms will only return.

Can’t I Just Take Rifaximin Again When Symptoms Return?

When I was diagnosed with SIBO, my doctor prescribed me Rifaximin and Neomycin (another antibiotic for SIBO) for 14 days. The 14-day course of antibiotics didn’t even come close to getting rid of my SIBO.

My doctor was ready to prescribe me more antibiotics for my SIBO. I later learned that it would have probably taken four courses of antibiotics to get rid of my severe case. And, considering the high recurrence rate, I probably would have had many more courses of antibiotics in the future!

There are a numerous reasons why you wouldn’t want to take antibiotics each time your SIBO or IBS recurs:

1. The Cost of Rifaximin Isn’t Cheap

According to Drugs.com, the cost for a supply of 30 Rifaximin tablets is $547. That doesn’t even include the costs of going to the doctor to get your prescription. Even with health insurance, the copay costs can quickly add up.

2. Rifaximin Can Have Some Nasty Side Effects

Drugs.com also lists some of the common side effects of Rifaximin, including:

  • Bloating
  • Difficulty with moving
  • Fever
  • Frequent urge to defecate
  • Headache
  • Passing gas
  • Stomach pain
  • Swelling of the hands, ankles, feet, or lower legs

And those are only some of the common Rifaximin side effects – not to mention the many less-common side effects!

It is rather ironic that you’d take an antibiotic which causes many of the very same IBS and SIBO symptoms you are trying to cure, and then adds even more symptoms on top of that.

3. Antibiotics Don’t Address the Underlying Problem which Caused SIBO or IBS in the First Place

If your gut flora is unbalanced, there is a reason it got that way. Bad diet is probably the main reason for this (read how bad diet causes IBS). Other causes of gut dysbiosis could include stress, oral contraceptives, alcohol, or antibiotics.9

Which brings us to….

4. Antibiotics May Cause SIBO and IBS

We now know that taking antibiotics disrupts our gut flora. The disrupted gut flora can lead to SIBO. It can also cause IBS by damaging the nerves in the gut.10

Luckily, most of the time our gut flora seems to recover from antibiotics quickly. However, this isn’t the case with everyone. As microbiology expert Jeroen Raes says in his Brussels TEDx talk on the subject,

“If you get a normal dose of broad-spectrum antibiotics, some of you will recover, in terms of gut flora, after a few weeks. For some of you, it will take months. For some of you it can take over a year for your gut flora to become ‘normal’ or to return to what it was again. And for some people, they never recover. They have permanently altered their gut flora.”

Considering that antibiotics may be the underlying cause of SIBO and IBS, it is ironic that Rifaximin is prescribed for treatment! If you want to learn more, read how antibiotics can cause IBS.

What’s a Better Alternative to Rifaximin for SIBO or IBS?

Sorry to break it to you, but there is no one easy solution for curing IBS or SIBO for the long run. Because our gut flora is so complex, it often takes a multifaceted approach.

For me personally to cure my SIBO, I took herbal antibiotics along with a prokinetic while simultaneously doing an elemental diet. I then followed a careful diet afterwards to ensure my gut bacteria developed in a balanced way.

You might not need to do all of this to cure your SIBO or IBS. But, if you haven’t had success with Rifaximin or simply don’t want to take antibiotics, one or more of these alternatives are worth considering.

Herbal Antibiotics

As with pharmaceutical antibiotics, herbal antibiotics also work by killing off bacteria in your body. However, herbal antibiotics are less likely to cause side effects, they don’t cause antibiotic resistance, and they may even be more effective.

The reason why herbal antibiotics are preferable over Rifaximin is because herbal antibiotics work on many levels. Whereas antibiotics like Rifaximin are just one isolated chemical, herbal antibiotics contain multiple chemicals which work together to attack bacteria on multiple levels.

In one study which compared herbal antibiotics to Rifaximin for SIBO, it was found that herbal antibiotics were effective with 46% of users compared to just 34% of the Rifaximin users. You can read more about herbal antibiotics for SIBO here.

There are numerous herbal antibiotics which can be used as an alternative to Rifaximin. These are the ones I used:

  • Allimed (Allicin) 450mg: Allicin is a component of garlic. Take 1-2 caps 3x per day for a total of 14 days (start with 1 cap 3x per day and on day 3 increase to 2 caps 3x per day). It is important that you take 450mg! You can buy Allimed here. You will need 1 bottle for a 14 day course.
  • Berberine Complex: Berberine is a compound found in Oregon grape, barberry, goldenseal, and other herbs. Take 2-3 caps 3x per day for a total of 14 days (start with 2 caps 3x per day and on day 3 increase to 3 caps 3x per day; can cause headaches). You can buy Berberine here. You will need to buy 2 bottles for a 14 day course.
  • Neem Plus: Neem is a tropical evergreen tree. Take 1 cap 3x per day for a total of 14 days. You can buy Neem here. You will need 1 bottle for a 14 day course.

I took all three of these herbal antibiotics for a 14 day course. Because 84% cases of IBS are really SIBO, it makes sense that these same herbal antibiotics would work for IBS patients as well.


In forums around the web, there is all sorts of anecdotal evidence of probiotics helping for SIBO and IBS. The reason for this is because probiotics are “good” bacteria which live in our guts. These good bacteria have important roles in digestion and some of them even kill off “bad” bacteria.

The problem with probiotics is that they are just one to a few different strains of bacteria. Consider that we’ve got at least 5,600 separate strains of bacteria in our colon alone.11 It is unlikely that adding two or three strains of bacteria as a probiotic to the mix is going to cure the unbalance!

This doesn’t mean that probiotics aren’t helpful. Here are some probiotics which are proven to work for IBS or/and SIBO. Unfortunately, I can’t recommend brands for all of them because, even if they are available, many manufacturers add off-limit ingredients. I’ve included links to the probiotic brands I can recommend.

  1. Saccharomyces boulardii: This is actually a type of yeast which fights off pathogenic bacteria and reduces inflammation. You can buy it here.
  2. Lactococcus lactis Rosell-1058: This probiotic produces enzymes which help digest starches and lactose. It is proven to help reduce bloating.
  3. Bifidobacterium bifidum MIMBb75: This probiotic was found to relieve pain, discomfort, bloating, urgency, and digestive disorder significantly in IBS patients.
  4. Bifidobacterium infantis 35624: Research suggests that this probiotic has immune-modulating roles which make it helpful for reducing pain, bloating, and bowel movement difficulty. Klaire Labs makes a gut-friendly probiotic with Bifidobacterium infantis called Ther-Biotic Complete. You can buy it here.
  5. Bacillus Indicus (HU36TM): Better known by its brand name MegaSporeBiotic, this is a soil-based probiotic which many SIBO and IBS sufferers have reported success with.
  6. Bifidus lactis: This probiotic is shown to enhance the immune system, reduce occurrence of antibiotic-associated diarrhea, and support proper bowel movements. Kirkman makes a good probiotic with this strain. You can buy it here.
  7. Lactobacillus plantarum: This probiotic is shown to reduce bloating, normalizes stool frequency, relieve abdominal pain, and improve IBS symptoms, prevent overproduction of yeast, and reduce bacterial translocation. This is also found in Ther-Biotic Complete by Klaire Labs. You can buy it here. 11, 12, 13, 14, 15

Note: Only Take Probiotics without Prebiotics

Bacteria is a living thing and it needs to eat something. This is true for probiotics as well. To help the probiotics thrive in the body, probiotic manufacturers often add something called a prebiotic, which is basically food for the probiotic.

The problem is that prebiotics can feed the “bad” bacteria living in your gut. Many of the prebiotics are also not allowed on the FODMAPs diet which is commonly used for treating IBS and SIBO symptoms. Without the prebiotics, the probiotics might not be able to repopulate your gut so you will have to take probiotics every day until your gut bacteria is reset.

Long-Term Diet Changes

As mentioned before, Rifaximin doesn’t address the underlying cause of your IBS or SIBO. To get rid of IBS or SIBO for good, you need to get rid of what caused it in the first place. In many cases, this is probably bad diet.

If you don’t fix your diet, the IBS or SIBO will probably come back eventually. Now is the time to stop eating all of those starchy foods, sugars, processed junk, and chemical additives.

Yes, You CAN Beat This!

IBS and SIBO can be frustrating and ruin your life. And treatment isn’t always easy either. But I want to emphasize that you can beat this disorder and get your life back.

There is only so much information I can give in a blog post. If you want detailed information on how to beat SIBO for good along with step-by-step instructions for treatment methods and diet protocols, download my eBook The SIBO Solution. You can buy it here.

It was a long battle, but I finally beat my SIBO. Here is a picture of my negative breath test!

Xifaxan And Other Antibiotics

One of the factors that is believed to cause or trigger irritable bowel syndrome (IBS) is the overgrowth of harmful bacteria in the intestines. Because of this, gut-specific antibiotics are often prescribed for patients with IBS, particularly those patients who complain of gas, bloating symptoms, abdominal pain, and diarrhea.1,2 Antibiotics are medicines that fight bacterial infections. They either kill bacteria or keep them from reproducing.3

The most studied antibiotic in IBS treatment is rifaximin, brand name Xifaxan. Xifaxan is minimally absorbed by the gastrointestinal tract, which allows more of the medication to remain in the intestines. Also, this means there is less of the medication in the rest of the body. Xifaxan does not seem to significantly alter the natural microflora (good bacteria) in the gut, and it does not cause diarrhea like some antibiotics may.1

What is Xifaxan?

Xifaxan is a prescription medication used in adults with IBS with diarrhea (IBS-D). Patients treated for two weeks with Xifaxan may get 6-24 weeks of relief from IBS-D symptoms, including abdominal pain and diarrhea. On average, patients in a clinical trial with Xifaxan experienced 10 weeks of relief. Patients can be retreated with Xifaxan up to two times if symptoms come back.4

How to take Xifaxan

Xifaxan comes in a 550mg tablet form and must be taken three times a day for two weeks. The tablets can be taken with or without food. It is important to take the entire course of treatment – three tablets a day for 14 consecutive days – to experience the effectiveness of the treatment. Treatment should not be discontinued even if the patient starts to feel relief from IBS symptoms. If a dose is missed, it should be taken as soon as it is remembered. However, if it is time for the next dose, the missed dose should be skipped. Double doses to make up for the forgotten dose are not recommended.3,4

Before taking Xifaxan, patients should discuss with their doctor all medications and supplements they are currently taking, especially cyclosporine or any other antibiotics. Patients who are allergic to rifaximin should not take Xifaxan. Patients who are pregnant, planning to become pregnant, or breastfeeding, should discuss their condition with their doctor before taking Xifaxan as it is unknown whether the medication might harm the baby.3,4

Xifaxan side effects

The most common side effects experienced by patients taking Xifaxan are peripheral edema, dizziness, nausea, headache, fatigue and an increase in liver enzymes (specifically Alanine aminotransferase, or ALT). These are not all the possible side effects of Xifaxan. Patients should talk to their doctor about what to expect with treatment with Xifaxan.

Other antibiotics for IBS

There have been some studies that have shown another antibiotic, neomycin, to be effective in treating IBS-D. However, there are more side effects with neomycin. Systemic antibiotics, those that are absorbed and circulate throughout the body, have not been well studied as a treatment for IBS.1

Other IBS treatments

Often, patients with IBS have to try several treatment options to find what works best for them. Many patients may find that a combination of treatment approaches helps manage their symptoms. In addition to antibiotics, other treatment options for IBS include adding exercise, making dietary changes, adding fiber, using probiotics, getting counseling, or trying complementary or alternative medicine.

Last week I described a condition with symptoms so severe that you can’t leave the house, yet many doctors call it a “functional” or “psychosomatic” disease, suggesting it’s all in your head.

Unfortunately, it’s a very real problem for the almost 50 million people — that’s 20 percent of Americans — who have irritable bowel syndrome (IBS). These people become plagued with uncomfortable, often disabling symptoms like bloating, cramps, diarrhea, constipation, and pain.

I have many patients with IBS, some of whom have suffered for decades without relief. Their previous doctors couldn’t find the cause of the illness, so they were told to simply add more fiber to their diet or take Metamucil, or were prescribed sedatives, anti-spasm drugs, or antidepressants.

That is NOT the answer. Most of those treatments don’t work, because they don’t address the underlying causes of why your digestion is not working. Emerging research has helped identify the underlying causes.

For about two decades I have been successfully treating IBS and other digestive conditions using a very simple methodology based on Functional Medicine. This process helps identify and remove the underlying causes and restores normal digestive function and health.

Research tells us that there are two main causes of irritable bowel: food allergies and overgrowth of bacteria in the small intestine. But there may be many others, including a lack of digestive enzymes, parasites living in the gut, yeast overgrowth, zinc or magnesium deficiency, and heavy metal toxicity.

This is precisely why personalizing treatment based on the unique circumstances that exist for each person who suffers from IBS becomes critically important. The solution is most certainly not one-size-fits-all. But solutions can be found if we look carefully at the underlying causes and treat them.

In this follow-up blog, I want to provide strategies to reverse both of the most recognized underlying causes of IBS – food allergies and bacteria overgrowth, and then I will offer some simple strategies to improve your digestive health.

Addressing Food Allergies

If you suspect food allergies are the underlying cause for your IBS, then you can take one of two strategies to identify and eliminate these intolerances. One is to test for IgG food allergies using a specialized test that determines how your immune system reacts to proteins in common trigger foods such as gluten and dairy. IgG antibodies will become elevated in response to foods you are sensitive or allergic to. It’s your body’s defense mechanism trying to protect you from something you have sensitivities to. When I use this diagnostic test, I often see positive IgG food allergy test results for several foods that are common to the Standard American Diet.

A Functional Medicine doctor or Registered Dietitian can order the test and chart out a modified diet plan to eliminate the foods that test positive for 12 weeks.

If you can’t afford these tests, then just eliminate the most common food allergens for 12 weeks —dairy, gluten, yeast, eggs, corn, soy, and peanuts. And then reintroduce them one at a time to see if they cause symptoms.

To use just one example, for 75 percent of the world’s population, consumption of dairy products leads to digestive problems such as IBS. Eliminating dairy and other reactive foods creates an effective way to isolate the foods that may be causing you problems.

I have created a simple program to follow based on a comprehensive elimination diet called The UltraSimple Diet. You might also choose to work with a Functional Medicine doctor or Registered Dietitian who specializes in food allergies. These practitioners can help develop a long-term plan that eliminates problematic foods.

How Gut Imbalances Can Lead to IBS

Imagine the size of a tennis court. Believe it or not, that surface area is equivalent to the surface area of your small intestine, which is where your food is absorbed. Your small intestine is also the home of your gut-immune system – which accounts for about 60 percent of your total immune system. The lining of this sophisticated system is just one cell layer away from a toxic sewer where all of the bacteria and undigested food particles live in your gut.

If that lining breaks down — from stress; too many antibiotics or anti-inflammatory drugs like aspirin or ibuprofen; steroids; intestinal infections; a low-fiber, high-sugar diet; alcohol; and more – your immune system will be exposed to foreign particles from food, bacteria, and other microbes.

This will trigger and activate an immune response and will irritate your second brain (which I discussed last week), creating havoc that leads to an irritable bowel, an irritable brain, and other system-wide problems including allergies, arthritis, autoimmunity, and mood disorders.

The microbial ecosystem in the gut must be healthy for you to be healthy. When your gut bacteria are out of balance — when you have too many pathogenic bacteria and not enough healthy bacteria — it makes you sick.

Understanding and Fixing Gut Imbalances

If you have bacterial or yeast overgrowth or if you have bad bugs, parasites or worms, you can get IBS.

Most of the bacteria are in your large intestine, but sometimes, they kind of move up and go into the small intestine. That’s not very good, because the small intestine is meant to be sterile and needs to remain that way.

If the bad guys move in and take over— then they can start fermenting the food you digest, particularly sugar or starchy foods.

This is called small intestine bacterial overgrowth (SIBO), and it’s a major cause of IBS.

When you eat starchy foods—bread, cereal, pasta, rice, or sugary foods—the bacteria in your gut ferment the sugars in the food. It’s like the way apple cider blows up a plastic container when the cider goes bad. The fermentation process emits gas and everything expands.

That’s what happens in your gut. The bacteria ferment the sugars in the food you eat, and then your gut blows up. That’s why you get bloating right after meals. We call that postprandial bloating or as one of my patients calls it – a “food baby.”

This is a very common symptom of SIBO. Most doctors never diagnose or treat this properly. But once it’s recognized, it’s a very common and very easy thing to treat if you use the right modality.

SIBO can be diagnosed by a breath test, which measures gas production by the bacteria, or by a urine test that measures the byproducts of the bacteria after they are absorbed into your system.

Yeast overgrowth is also common in your gut. It’s sort of like a garden where the weeds take over. Yeast overgrowth happens because of taking antibiotics, steroids, birth control pills, or acid-blocking drugs. It also occurs if you eat a lot of sugar, drink alcohol, or you are diabetic.

All these things tend to cause overgrowth of yeast, and that can be treated with an antifungal, such as Diflucan, Nystatin, or Sporanox.

I’m not a big fan of medication, but sometimes for irritable bowel, a good non-absorbed antibiotic called Xifaxan will clear out the SIBO (bacterial overgrowth) and stop bloating and diarrhea.

Using Xifaxan and an antifungal is almost like hitting the reset button on your computer; you reboot your gut and then you start over.

I also like to use herbs for cleaning out bad bacteria or yeast overgrowth. Besides antifungal herbs, such as oregano, I also recommend a blend of essential oils and herbal extracts – such as:

  • Candibactin BR (two capsules, three times a day for a month) for bacterial overgrowth
  • Candibactin AR (two capsules three times a day) for yeast overgrowth

Other bugs can also be a problem.

You can often identify if you have bad bugs in your system by reviewing your medical history and then treat the underlying issue using the simple steps outlined here. If you don’t get better, then stool testing may be needed to identify parasites or worms. At The UltraWellness Center, we do innovative stool testing that examines your entire gut ecosystem. We are not only looking for infections but also imbalances in your ecosystem which are contributing to your IBS.

The bottom line is: in order to reboot your gut, you need to get rid of the bad guys and put in the good stuff.

So let’s recap…

The first step is to get rid of unwanted visitors in your small intestine. You’ll probably want to work with your doctor or Functional Medicine practitioner for this.

Then you’ll want to repopulate your digestive tract with good bacteria. You can do that by taking very high-potency probiotics (look for at least 25 billion live CFU’s from diversified strains of Lactobacillus, Bifidobacterium, and Saccharomyces boulardii), taken twice a day for one to two months. Start slowly and observe how the probiotics affect your gut. In some cases, certain individuals may need to delay probiotics until their gut is more intact.

7 Strategies to Restore Optimal Gut Health

Now that we’ve identified the more obvious reasons for IBS, I want to help get you on the path to optimal gut health. Remember, every case is different, so generalizing a strategy to eradicate IBS is not a one-size-fits-all situation. Ideally, everyone is able to discover the root of their IBS by testing and proper diagnosis. However, I find that nearly everyone does well when employing these strategies to restore good gut health and function:

  1. Take digestive enzymes with meals. These help break down food while your gut heals. You may need these for two or three months, and many people benefit from taking them permanently.
  2. Remove sugary, processed foods. Besides wrecking your gut, these foods contribute to diabesity. Take an afternoon to hunt and gather all these foods in your kitchen and throw it all out. Be merciless. Then replace the fake food with real, whole, fresh foods.
  3. Eat an anti-inflammatory diet. Inflammation underlies IBS and many other gut conditions, so you’ll want to incorporate plenty of anti-inflammatory foods like wild-caught fish into your diet. We also use herbs like quercetin and turmeric to reduce inflammation and heal leaky gut and other gut conditions that can contribute to or exacerbate IBS. I recommend for my patients UltraInflamX and OmegaGenics 720 (fish oil) to reduce inflammation.
  4. Take gut-healing nutrients. Other nutrients that help heal the lining of the gut including GLA (from evening primrose oil), zinc, vitamin A, and glutamine. You might also consider a supplement like this one that combines gut-healing nutrients.
  5. Eat fermented foods. Include plenty of probiotic-rich foods like kimchi, kombucha, miso, or sauerkraut. Sometimes, you can also eat yogurt if you are not allergic to dairy. Try unsweetened sheep or goat yogurt. These are all foods that help your gut flora get and stay healthy.
  6. Exercise regularly. Randomized controlled trials show regular, consistent exercise reduces IBS. Even 30 minutes’ vigorous walking can help, and if you want something more intense, try high-intensity interval training (HIIT) or weight resistance. Click here for a comprehensive, easy-to-apply fitness plan.
  7. Reduce stress. If you struggle with IBS, you don’t need studies to tell you stress can exacerbate these symptoms. Regardless, such studies exist. Whether you employ yoga, meditation, deep breathing, or tapping, find something that works for you to control stress and do it regularly. My UltraCalm CD is a great way to melt away stress and anxiety.

By following this approach, most people can heal their irritable bowel and restore gut function. If you are not getting better, you may need medical help. You may need treatment for SIBO, food allergies, or other underlying conditions.

If you struggle with IBS or another gut issue, please join us for our April 10-Day Detox Diet Challenge. We are offering a brand new bonus segment on IBS. Whether you have extra pounds to lose, have a chronic condition like IBS, or both, the 10-Day Detox Diet Challenge will help you completely reboot your health in 10 days. .

Rifaximin (Xifaxan) Online Prescription

  • Request rifaximin prescription online
  • Same day prescriptions available
  • No hidden fees

Rifaximin (Xifaxan) – Overview

Rifaximin, marketed under the name Xifaxan, is an antibacterial medication used in the treatment of travelers’ diarrhea when a possible infection is proven or strongly suspected to have been caused by bacteria. People who might need a rifaximin prescription can connect with a medical provider through Push Health who can prescribe Xifaxan when appropriate to do so.

Rifaximin – Uses and Mechanism of Action

Xifaxan (rifaximin) is a type of antibacterial medication with the primary use being the treatment of noninvasive strains of Escherichia coli causing travelers’ diarrhea in adult patients. Rifaximin is a semi-synthetic, non-aminoglycoside compound similar to rifampin. The rifaximin in Xifaxan is thought to work by inhibiting bacterial RNA synthesis by binding to bacterial DNA-dependent RNA polymerase. Escherichia coli has demonstrated resistance to rifaximin in vitro and the potential for cross-resistance has not been thoroughly analyzed. Xifaxan tablets are poorly absorbed after oral administration and plasma levels of rifaximin are variable and often undetectable. Rifaximin is almost exclusively excreted in the feces.

Xifaxan – Cost and Dosage

Xifaxan (rifaximin) is expensive, costing over $20 per Xifaxan 200 mg tablet at most pharmacies. Fortunately, some insurance plans will cover the cost of a rifaximin prescription and Xifaxan coupons are sometimes available online to reduce the cost even further. Xifaxan 200 mg tablets are pink in color and round. For travelers’ diarrhea, some prescribers will choose a regimen involving Xifaxan 200 mg tablets taken 3 times a day for 3 days orally, with or without food. Xifaxan tablets should generally be stored at 20° C to 25° C.

Can I Buy Rifaximin Online?

Rifaximin (Xifaxan) requires a prescription before a pharmacy can dispense it in the United States. As a result, one cannot buy Xifaxan online or get rifaximin over the counter at a pharmacy. The first step is getting a rifaximin prescription from a licensed medical provider. Push Health can connect people who need a Xifaxan prescription with a medical provider who can prescribe rifaximin when appropriate to do so.

Rifaximin (Xifaxan) – Side Effects

Rifaximin can cause side effects. Side effects resulting from Xifaxan use include headache, stomach and rectal pain, gas, and nausea. Rifaximin is not effective in treating diarrhea with fever or blood in the stool or for treating organisms other than Escherichia coli. People with allergies or a known hypersensitivity to rifaximin (Xifaxan) should not use the medication. Xifaxan and alcohol should not be used concomitantly. Xifaxan use has been associated with Clostridium difficile-associated diarrhea. Questions about possible side effects related to rifaximin use should be directed to one’s pharmacist and medical provider before using the medication.

More Rifaximin (Xifaxan) Information

Last updated July 9, 2019. Given the evolving nature of medicine and science, this information might not be accurate and should not be construed as medical advice or diagnosis / treatment recommendations. Please consult a licensed medical provider if you have additional questions.

Antifibrotic and molecular aspects of rifaximin in alcoholic liver disease: study protocol for a randomized controlled trial

The present biopsy-controlled, double-blind study will include a total of 136 patients randomized 1:1 to receive a 550-mg tablet of rifaximin or placebo twice daily for 18 months. Randomization is being performed in blocks of four, with stratification according to the Metavir fibrosis score from initial liver biopsies and whether or not participants abstained from alcohol for 6 months prior to study onset. Participants are each assigned a consecutively numbered three-digit identification number in the trial. Each identification number is by chance allocated to either placebo or rifaximin. The randomization list is generated electronically by a central computer stored at the pharmacy at Odense University Hospital (Odense, Denmark); only authorized pharmacy personnel know the randomization code. Sponsors, investigators, nurses, laboratory assistants, and/or personnel involved in trial participant care have no knowledge of the randomization. Sealed, opaque envelopes with randomization keys for each participant are being kept at Odense University Hospital. Sponsors and investigators have access to the coded envelopes at all times in case unblinding is necessary. Placebo tablets will be similar in size, shape, and weight to the rifaximin tablet to secure concealment. Pre- and post-treatment biopsies are assessed together in a blinded manner by one expert pathologist. Fecal samples are collected at home and frozen immediately in a home freezer. They are transported to the clinic in ice where they are stored at –80 °C. Samples are processed for shotgun metagenomics sequencing of the gut microbiota using the recommended procedures by the International Human Microbiome Standards Consortium . Saliva samples are collected at the clinic in two tubes. One tube is frozen to –80 °C immediately. The other is stored at +5 °C for 3 h before freezing to –80 °C. Microbial DNA extraction is performed with a Macherey-Nagel NucleoSpin Kit, and 16S ribosomal RNA gene sequencing of the oral microbiota is performed by amplifying the V4 hypervariable region using standard procedures . Urine samples are collected to detect the presence or absence of ethyl glucuronide, a marker of alcohol consumption. For further information, see the populated Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT) checklist in Additional file 1.

Primary outcome measure

The primary outcome measure is the proportion of patients with an improvement in their liver biopsy Ishak (fibrosis) score greater than or equal to 1.

Secondary outcome measures

The secondary outcome measures are as follows:

  • Markers of fibrosis: collagen proportionate area, enhanced liver fibrosis score, Pro-C3, and hydroxyproline level

  • Markers of matrix remodeling: tissue inhibitor of metalloproteinase 1, matrix metallopeptidase 2, and profibrotic cytokines (transforming growth factor β1, platelet-derived growth factor β, and connective tissue growth factor)

  • Proinflammatory cytokines: tumor necrosis factor α, monocyte chemoattractant protein 1, and cluster of differentiation 163

  • Liver stiffness assessed by transient and shear wave elastography

  • Changes in the composition of the gut microbiota assessed by shotgun metagenomics sequencing

  • Quality of life assessed by the Short Form (36) Health Survey and Chronic Liver Disease Questionnaire

  • Nutritional status assessed by weight and hand grip strength

Recruitment and enrollment of participants

Participants are being recruited from an ongoing observational study (Liver Disease in Alcohol Overusing Patients) at the department of Gastroenterology and Hepatology, in which liver biopsies were taken from 400 patients with alcohol overuse (defined as the use of ≥ 24 g alcohol/day for women and ≥ 36 g alcohol/day for men; approved by regional committees on health research ethics for southern Denmark, project ID S-20120071). Among these, a subset of 136 patients will be enrolled in the current study if they comply with the inclusion and exclusion criteria outlined below.

Inclusion criteria

The inclusion criteria are as follows:

  1. 1.

    Women of child-bearing age and potential should use safe contraception and provide a negative pregnancy test during the study period.

  2. 2.

    Patients with a liver fibrosis Ishak score of 1–4.

Exclusion criteria

The exclusion criteria are as follows:

  1. 1.

    Patients with a known allergy to rifaximin

  2. 2.

    Patients whom the investigator judges will not be or are not compliant with the trial treatment protocol

  3. 3.

    Patients who received antibiotic treatment of any kind 4 weeks prior to study onset

Study withdrawal

Patients will be withdrawn from the study for the following reasons:

  1. 1.

    If blinding is repealed

  2. 2.

    If the patient undergoes treatment with another antibiotic for more than 4 consecutive weeks or four times during the study period

  3. 3.

    If the trial participant withdraws written consent

  4. 4.

    If the investigator judges that withdrawal is in the participant’s best interest

Study dropouts

Trial participants will be classified as dropouts if they meet either of the following criteria:

  1. 1.

    The trial participant ingests less than 75% of the planned treatment.

  2. 2.

    The trial participant does not attend planned visits, despite contact by telephone, letter, or mail.

Sample size calculation

According to a previous trial, alcoholic liver fibrosis was calculated to regress in 27% of patients, remain unchanged in 57%, and progress in 16% over a 2-year period when patients with hepatitis C were excluded . Therefore, we estimated the natural history of regression to be approximately 14% during an 18-month period for our study population. The smallest relevant difference is considered to be a 25% absolute increase in the percentage of patients who regress by 1 point or more in their histological score. If the risk of performing type 1 and type 2 errors is set to 5% and 20%, respectively, then 136 patients are needed when one performs a power calculation using a two-sided test; this includes a dropout rate of 20%. Both intent-to-treat and per protocol analyses will be performed.

Measurements and investigations

Measurements and investigations follow the study plan outlined in Fig. 1.

Fig. 1

Measurements and investigations. Legend section: SF-36 Short Form (36) Health Survey, CLDQ Chronic Liver Disease Questionnaire, AE adverse event, *by transient and shear wave elastography, **by weight and hand grip strength

During follow-up, the investigators or a study nurse will keep a record of the medication and hand out new trial medication to participants in the outpatient clinic (Fig. 1); both used and unused trial medication is registered to keep track of the amount ingested by each participant. In cases of uncertainty regarding the amount of medicine ingested, the highest dose definitively known will be registered. During the planned follow-up, adverse events, alcohol consumption, and use of antibiotics will be routinely registered in the case report form.

Drug information

Rifaximin is a semisynthetic analog of the antimicrobial rifampicin that has an excellent safety profile and selective impact on gut microbiota . The tolerability of long-term rifaximin use in patients with liver disease has proven to be good in a previous study involving 299 patients. In that study, participants were randomized to placebo (n = 159) or 550 mg of rifaximin (n = 140) twice a day for 6 months in order to prevent recurrent hepatic encephalopathy in patients with cirrhosis . Their results showed that rifaximin significantly reduced the risk of a breakthrough episode of hepatic encephalopathy from 46% (placebo) to 22% (rifaximin). The majority of reported side effects were of gastrointestinal origin, including nausea and abdominal discomfort. The incidence of moderate and serious adverse events was similar in patients receiving placebo or rifaximin .

Risks and disadvantages for participants

Percutaneous liver biopsy is considered a safe investigation with few complications when used to diagnose nonmalignant hepatic disorders. However, most patients experience some pain related to the puncture site. Potential risks related to the procedure are intra-abdominal bleeding, bile peritonitis, and perforation of the gallbladder. The mortality rate is 1 in 10,000; however, no deaths have been directly related to the procedure when it is used to help diagnose the cause of an abnormal liver function test. Major bleeding episodes (the most frequent complication) appear in 2.2 out of 1000 biopsies in patients who are under further examination due to an abnormal liver function test . To minimize risk to the current trial participants, this procedure will only be done by trial investigators or medical staff with extensive experience. Furthermore, there is no discomfort or risk related to B-mode abdominal ultrasonography or ultrasound elastography.


Currently there are no known effective drugs to treat fibrotic liver disease, and the effects of rifaximin remain unclear. Hence, no patient will be withheld medication with proved efficacy by participating in this trial. All patients should continue their regularly prescribed medications during the trial. Patients receiving placebo are unlikely to experience any improvements in their disease or symptoms due to the treatment per se. However, it is necessary to treat half of the patients with placebo in order to ascribe observed effects to rifaximin with certainty. All patients are at risk for disease progression and will benefit from close follow-up and early detection of advanced liver disease by undergoing a liver biopsy. During the trial, participants will be encouraged to reduce their alcohol consumption. As suggested by a previous study, many patients who overuse alcohol included in clinical trials on alcoholic liver disease stop drinking or reduce their alcohol consumption, causing spontaneous improvement of their liver disease symptoms . Overall, we believe the benefits of participating in this trial outnumber the risks, and we also believe it to be ethically safe. Informed consent is obtained from all participants.


How does this medication work? What will it do for me?

Rifaximin belongs to the class of medications called antibacterial agents. Specifically, it belongs to the family of rifamycin antibacterials. It is used in addition to lactulose to reduce the risk of hepatic encephalopathy recurrence in adults. Hepatic encephalopathy is a condition that frequently develops when a person has chronic (long term) liver disease and the body is unable to easily get rid of the waste product ammonia. The buildup of ammonia causes changes in brain function and may lead to coma or death if it is not controlled.

Rifaximin is believed to work by eliminating bacteria in the digestive system that produce ammonia. It is very poorly absorbed into the rest of the body, making the digestive system the main area in which it works.

This medication may be available under multiple brand names and/or in several different forms. Any specific brand name of this medication may not be available in all of the forms or approved for all of the conditions discussed here. As well, some forms of this medication may not be used for all of the conditions discussed here.

Your doctor may have suggested this medication for conditions other than those listed in these drug information articles. If you have not discussed this with your doctor or are not sure why you are taking this medication, speak to your doctor. Do not stop taking this medication without consulting your doctor.

Do not give this medication to anyone else, even if they have the same symptoms as you do. It can be harmful for people to take this medication if their doctor has not prescribed it.

What form(s) does this medication come in?

Each pink, oval, biconvex tablet with “rfx” debossed on one side contains rifaximin 550 mg. Nonmedicinal ingredients: colloidal silicon dioxide, glyceryl distearate, microcrystalline cellulose, polyethylene glycol, polyvinyl alcohol, red iron oxide, sodium starch glycolate, talc and titanium dioxide.

How should I use this medication?

The recommended adult dose of rifaximin is 550 mg taken 2 times a day. This medications should be swallowed whole with water. Do not crush or chew rifaximin tablets.

Rifaximin should be taken on an empty stomach.

Many things can affect the dose of medication that a person needs, such as body weight, other medical conditions, and other medications. If your doctor has recommended a dose different from the ones listed here, do not change the way that you are taking the medication without consulting your doctor.

It is important that this medication be taken exactly as prescribed by your doctor. If you miss a dose, take it as soon as possible and continue with your regular schedule. If it is almost time for your next dose, skip the missed dose and continue with your regular dosing schedule. Do not take a double dose to make up for a missed one. If you are not sure what to do after missing a dose, contact your doctor or pharmacist for advice.

Store this medication at room temperature, protect it from light and moisture, and keep it out of the reach of children.

Do not dispose of medications in wastewater (e.g. down the sink or in the toilet) or in household garbage. Ask your pharmacist how to dispose of medications that are no longer needed or have expired.

Who should NOT take this medication?

Do not take rifaximin if you:

  • are allergic to rifaximin or any ingredients of the medication
  • are allergic to any other rifamycin antibacterial medications

What side effects are possible with this medication?

Many medications can cause side effects. A side effect is an unwanted response to a medication when it is taken in normal doses. Side effects can be mild or severe, temporary or permanent.

The side effects listed below are not experienced by everyone who takes this medication. If you are concerned about side effects, discuss the risks and benefits of this medication with your doctor.

The following side effects have been reported by at least 1% of people taking this medication. Many of these side effects can be managed, and some may go away on their own over time.

Contact your doctor if you experience these side effects and they are severe or bothersome. Your pharmacist may be able to advise you on managing side effects.

  • bloating
  • diarrhea (mild)
  • dizziness
  • headache
  • itchiness
  • nausea
  • reddish colour to sweat, urine or tears

Although most of the side effects listed below don’t happen very often, they could lead to serious problems if you do not check with your doctor or seek medical attention.

Check with your doctor as soon as possible if any of the following side effects occur:

  • abdominal pain
  • muscle spasms
  • signs of anemia (low red blood cells; e.g., dizziness, pale skin, unusual tiredness or weakness, shortness of breath)
  • signs of depression (e.g., poor concentration, changes in weight, changes in sleep, decreased interest in activities, thoughts of suicide)
  • skin rash
  • unsteadiness

Stop taking the medication and seek immediate medical attention if any of the following occur:

  • signs of bowel inflammation (e.g., fever that appears after starting the medication, watery and severe diarrhea )
  • signs of a severe allergic reaction (e.g., abdominal cramps, difficulty breathing, nausea and vomiting, or swelling of the face and throat)

Some people may experience side effects other than those listed. Check with your doctor if you notice any symptom that worries you while you are taking this medication.

Are there any other precautions or warnings for this medication?

Before you begin using a medication, be sure to inform your doctor of any medical conditions or allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should use this medication.

Antibiotic-related diarrhea:As with other antibacterials, rifaximin can cause a severe form of diarrhea associated with a condition known as pseudomembranous colitis. If you develop severe diarrhea while taking (or within a few weeks of taking) this medication, contact your doctor.

Liver function: Liver disease or reduced liver function may cause this medication to build up in the body, causing side effects. If you have liver problems, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed. Your doctor may want to test your liver function regularly with blood tests while you are taking this medication.

Pregnancy: This medication should not be used during pregnancy unless the benefits outweigh the risks. If you become pregnant while taking this medication, contact your doctor immediately.

Breast-feeding: It is not known if rifaximin passes into breast milk. If you are a breast-feeding mother and are taking this medication, it may affect your baby. Talk to your doctor about whether you should continue breast-feeding.

Children: The safety and effectiveness of using this medication have not been established for children.

What other drugs could interact with this medication?

There may be an interaction between rifaximin and any of the following:

  • BCG vaccine
  • cyclosporine
  • sodium picosulfate
  • warfarin

If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:

  • stop taking one of the medications,
  • change one of the medications to another,
  • change how you are taking one or both of the medications, or
  • leave everything as is.

An interaction between two medications does not always mean that you must stop taking one of them. Speak to your doctor about how any drug interactions are being managed or should be managed.

Medications other than those listed above may interact with this medication. Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them.

All material copyright MediResource Inc. 1996 – 2020. Terms and conditions of use. The contents herein are for informational purposes only. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Source: www.medbroadcast.com/drug/getdrug/Zaxine

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