Requires Prescription: Yes

Generics: Rifaximin

Used For: Bacterial Infections

How it Works: Rifaximin binds to the beta-subunit of bacterial DNA-dependent RNA polymerase, inhibiting bacterial RNA synthesis. It is effective against non-invasive strains of Escherichia coli (including enterotoxigenic and enteroaggregative strains). Rifaximin affects gut bacteria, potentially reducing the production and/or absorption of bacterial neurotoxins like ammonia, which can contribute to neurocognitive and neuromuscular dysfunction in hepatic encephalopathy.

Usage and Safety:

Dosage: Follow the dosage instructions provided by your healthcare provider

Side Effects:

Traveler’s Diarrhea:

Common: Flatulence, headache, abdominal pain, rectal urgency, nausea, constipation, fever, vomiting.

Uncommon: Lymphocytosis, monocytosis, neutropenia, ear pain, motion sickness, tinnitus, abdominal distension, diarrhea, dry throat, fecal abnormalities, gingival disorders, inguinal hernia, dry lips, stomach discomfort, chest pain, fatigue, malaise, dysentery, respiratory infections, sunburn, increased liver enzymes, blood in stool or urine, weight loss, anorexia, dehydration, joint pain, muscle spasms, myalgia, neck pain, abnormal dreams, dizziness, migraine, fainting, loss of taste, insomnia, choluria, dysuria, hematuria, polyuria, proteinuria, frequent urination, shortness of breath, nasal irritation, pharyngitis, rhinitis, rash, increased sweating, hot flashes.

Hepatic Encephalopathy:

Common: Peripheral edema, nausea, dizziness, fatigue, ascites, muscle spasms, itching, abdominal pain, distension, anemia, cough, depression, insomnia, upper abdominal pain, joint pain, back pain, constipation, shortness of breath, fever, rash.

Uncommon: Vertigo, lower abdominal pain, abdominal tenderness, dry mouth, esophageal variceal bleeding, stomach discomfort, chest pain, generalized edema, flu-like symptoms, pain, cellulitis, pneumonia, rhinitis, confusion, falls, procedural pain, weight gain, anorexia, dehydration, hyperglycemia, hyperkalemia, hypoglycemia, hyponatremia, myalgia, extremity pain, amnesia, attention disturbances, numbness, memory impairment, tremor, disorientation, nosebleeds, hypotension.

Drug Interactions: Rifaximin may interact with CYP3A4 substrates, rifamycins, and is a substrate of P-glycoprotein. Consult your pharmacist or physician for more information.

Indication:

To reduce the development of drug-resistant bacteria and maintain the effectiveness of rifaximin and other antibiotics, use rifaximin only for infections proven or strongly suspected to be caused by susceptible bacteria.

When Not to Use:

Contraindicated in patients with hypersensitivity to rifaximin, other rifamycins, or any component of the product.

Avoid use during pregnancy and in women of childbearing potential who are not using contraception.

Not recommended for traveler’s diarrhea caused by invasive pathogens like Campylobacter, Salmonella, and Shigella, which can cause dysentery-like diarrhea with fever, blood in stool, and high stool frequency.

Precautions:

Discontinue rifaximin if diarrhea symptoms due to non-E. coli pathogens worsen or persist for more than 24-48 hours. Consider alternative antibiotic therapy.

Warnings:

Clostridium difficile-associated diarrhea (CDAD): Can occur with nearly all antibiotics, including rifaximin, ranging from mild to severe colitis. Consider CDAD in patients with diarrhea following antibiotic use, even if it occurs up to two months later. Discontinue antibiotics not directed against C. difficile if CDAD is suspected or confirmed.

Breastfeeding: It is unknown whether rifaximin is excreted in human milk. Evaluate whether to discontinue breastfeeding or the drug, considering the drug’s importance to the mother.

Hepatic Insufficiency: Increased systemic exposure in severe hepatic insufficiency requires caution when administering rifaximin to these patients.

Additional Information:

Pregnancy Category: Consult your physician before use during pregnancy.

Storage: Store at room temperature, away from direct light and heat.