Xifaxan, made simple.
Xifaxan is an antibiotic, but an unusual one. It works almost entirely inside your gut and barely enters the rest of your body. It is used for a few different things, and how long you take it depends on which. This guide explains all of it. A Mississippi pharmacist wrote it for you.
This guide is here to teach you. It is not medical advice, and it does not replace your doctor or pharmacist. Always do what your doctor tells you, and ask a pharmacist before you change how you take any medicine.
Print this guide for your fridgeYour 60 second Xifaxan safety checklist
- Know why you take it.Xifaxan is used for IBS with diarrhea, for preventing recurring hepatic encephalopathy, and for certain cases of travelers' diarrhea. The schedules are not interchangeable.
- Follow the complete prescribed schedule.Follow the exact strength, number of tablets, frequency, and duration printed on your prescription. Do not stop early, stretch tablets to save cost, or use tablets left from an older prescription.
- Take it consistently.It may be taken with or without food. Consistent timing on your individualized schedule is what matters.
- Know when diarrhea needs reassessment.Watery or bloody diarrhea, fever, severe cramps, or diarrhea that worsens during or after treatment needs a prompt call.
- Check important interactions.Warfarin, cyclosporine, and other rifamycin family medicines need pharmacist review. On warfarin, INR monitoring matters.
- Know the allergy warning.A prior serious reaction to rifaximin or another rifamycin drug needs prescriber review. Facial or throat swelling, trouble breathing, hives, or a severe rash is an emergency.
What Xifaxan is and why your doctor gave it to you
Xifaxan is an antibiotic. Its other name is rifaximin. What makes it unusual is that it stays in your gut and is barely absorbed into the rest of your body, so it works right where the problem is.
Doctors use Xifaxan for three main reasons.
- Travelers' diarrhea. A short course treats diarrhea caused by a common type of bacteria picked up while traveling.
- IBS with diarrhea, called IBS-D. A two week course can ease the diarrhea, cramping, and discomfort of this kind of irritable bowel syndrome.
- Liver-related brain symptoms. In people with serious liver disease, Xifaxan helps prevent a confusion and thinking problem called hepatic encephalopathy from coming back.
The simple version: Xifaxan is a gut-focused antibiotic. The most important thing to know is which of these three reasons is yours, because how long you take it is very different for each.
How Xifaxan works
Most antibiotics are absorbed into your bloodstream to fight infection throughout the body. Xifaxan is different. It stays almost entirely in your intestine.
There, it lowers the number of certain bacteria living in your gut. It does this by blocking a step those bacteria need to grow.
Because Xifaxan stays in the gut, it tends to cause fewer of the whole-body side effects that other antibiotics can. Its work, and its effect, are mostly local.
Your dose, and how long you take it
Xifaxan comes as tablets. You can take it with or without food. Your doctor decides your dose and your pharmacist checks it. This page will not tell you what dose to take.
How long you take Xifaxan is the part that really depends on why you are taking it, so be clear with yourself about which is yours. For travelers' diarrhea, it is a short course of just a few days. For IBS-D, it is a 2 week course, and then you stop. For liver-related brain symptoms, it is usually taken every day, long term, as ongoing protection.
If you are not sure which applies to you, ask your pharmacist. Getting the length right is the key to using Xifaxan well.
Timing, and what to do if you miss a dose
Take Xifaxan at evenly spaced times, as your doctor prescribed. It can be taken with or without food.
There is one point worth knowing about IBS-D. Xifaxan for IBS-D is not a daily forever medicine. It is given as a 2 week course. If your symptoms come back later, the course can be repeated, up to two more times. Your doctor manages that.
If you miss a dose:
- If you miss a dose, take it as soon as you remember.
- If it is almost time for your next dose, skip the one you missed and take the next on schedule.
- Never take two doses at once to catch up.
- For a short travelers' diarrhea course, try hard not to miss doses, finishing the full few-day course matters for it to work.
Side effects, what is normal and what is not
Common, and usually mild.
- Nausea.
- Dizziness, or feeling tired.
- Some gas or stomach discomfort.
- In studies, side effects were often similar to a sugar pill, so many people tolerate it well.
Call your doctor if you notice:
- Diarrhea that is getting worse, or not improving, during treatment.
- Watery diarrhea with stomach cramps that starts during or after the antibiotic. This can be a different gut infection that needs attention.
- For travelers' diarrhea, a fever, or blood in your stool. If that happens, Xifaxan is not the right treatment, and you need to be seen.
- If Xifaxan is for liver disease: new confusion, unusual sleepiness, personality or behavior changes, or difficulty waking or staying awake. Caregivers should watch for these too.
Go to the emergency room right away if:
- You have signs of a severe allergic reaction, such as hives, swelling of the face, lips, tongue, or throat, or trouble breathing.
What to be careful with
Because Xifaxan stays in the gut and is barely absorbed, it has fewer interactions than most antibiotics. Still, a couple of things are worth knowing.
If you take the blood thinner warfarin, tell your doctor before starting Xifaxan. The interaction does not always move in one predictable direction, so your INR blood test may need a closer look during and after the course. The transplant medicine cyclosporine can raise Xifaxan levels and needs a pharmacist review. And if you have ever had a serious reaction to rifaximin or another rifamycin family medicine, your prescriber and pharmacist need to know before you start.
If you have very severe liver disease, more of the medicine can get into your body than usual, so your doctor will weigh that carefully. Make sure your prescriber knows the state of your liver.
The simple rule: tell your pharmacist about every medicine and supplement you take, and that you are starting Xifaxan.
What it costs
The cost is different for every person, because every insurance plan is different.
Here is the honest way to find your price. If you pay cash, call Fairview and we will give you a price for your situation. If you have private insurance, there may be a coupon or a savings program from the maker of the drug that helps lower your cost, and we will check if one is available for you. The best step is to let a pharmacist look at your plan. We do this for every patient.
Do not let cost make you skip doses. Call us first. There is almost always something we can do.
Availability and insurance coverage can change. Fairview will check whether an FDA approved lower cost alternative, a manufacturer savings program, an insurance exception, or another cost saving option is available for your specific prescription.
What should be checked
What gets checked with Xifaxan depends on why you are taking it.
Your doctor should check, depending on your situation:
- Whether your symptoms are improving, especially for a short travelers' diarrhea course.
- Your blood test for warfarin, if you take that blood thinner.
- Your liver, if you take Xifaxan long term for liver-related brain symptoms.
- Whether any new diarrhea is from a different gut infection.
Your pharmacist should:
- Make sure you know which use is yours and how long to take it.
- Check your other medicines, including warfarin.
- Help with cost, since Xifaxan is expensive.
- Answer questions about side effects.
At Fairview, we make sure every Xifaxan patient is clear on how long their course should last. If a refill is running late, we call you.
Special situations
Know which use is yours.
The single most useful thing with Xifaxan is knowing which of its three uses applies to you, because the length of treatment is so different. A few days for travelers' diarrhea, 2 weeks for IBS-D, ongoing daily use for liver-related brain symptoms. If you are unsure, ask your pharmacist before you start.
Travelers' diarrhea with a fever.
Xifaxan only treats travelers' diarrhea from a certain common bacteria. If you have a fever, or you see blood in your stool, that points to a different cause, and Xifaxan will not help. In that case, stop and get medical care rather than waiting it out.
IBS-D is treated in courses.
For IBS-D, Xifaxan is not a daily forever medicine. It is a finite 2 week course. If symptoms return, retreatment must come from your prescriber, who can order the course again, up to two more times. Do not automatically restart leftover tablets whenever symptoms return. This is normal and planned, not a sign of failure.
Long-term use for liver disease.
If you take Xifaxan to prevent liver-related brain symptoms, this is the one use where it is taken every day, long term, with no refill gaps. Xifaxan may be part of a broader plan that includes lactulose and liver disease management. Do not stop or adjust your lactulose on your own, and do not stop Xifaxan on your own.
Cost should never be the reason you stop.
Xifaxan is brand only and is one of the more expensive gut medicines. Coverage can also vary by insurance and by state. There is a manufacturer assistance program. If cost is a worry, call Fairview before you skip doses, and we will help you find your options.
How Fairview helps Xifaxan patients
When you fill Xifaxan at Fairview, here is what you get. This is normal care for us, not something extra.
At your first fill:
- We confirm with you which use is yours and how long to take it.
- We check your other medicines, including warfarin.
- We talk through cost and help you find any program you qualify for.
If you take it long term:
- We make sure there is no gap between refills.
- We answer questions about side effects.
- We keep an eye on your overall medicine list.
On our own, without being asked:
- If a refill is late, we call you.
- If we see a medicine that interacts, we flag it.
- We check your cost at every fill to keep it as low as possible.
Questions people ask about Xifaxan
Three things: treating travelers' diarrhea from a common bacteria, treating IBS with diarrhea, and preventing liver-related brain symptoms called hepatic encephalopathy from coming back.
Related guides
Have a question about your Xifaxan? Ask a pharmacist who knows it well.
Xifaxan is straightforward once you know which use is yours and how long your course should run. Fairview will make sure you do. If something made you wonder, ask us. Moving your prescription to us takes one phone call.