Rifaxin
Generic Name
Rifaximin
Manufacturer
Alfasigma S.p.A. (originator, often marketed by licensees like Bausch Health/Salix in some regions)
Country
Italy (originator), USA (for marketing by Salix/Bausch Health)
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Price Details
Current market pricing information
| Variant | Unit Price | Strip Price |
|---|---|---|
| rifaxin 550 mg tablet | ৳ 45.00 | ৳ 360.00 |
Description
Overview of the medicine
Rifaximin is a non-systemic antibiotic that acts locally in the gut. It is primarily used to treat traveler's diarrhea, irritable bowel syndrome with diarrhea (IBS-D), and to prevent recurrence of hepatic encephalopathy.
Uses & Indications
Dosage
Adults
For Hepatic Encephalopathy: 550 mg orally twice daily. For IBS-D: 550 mg orally three times daily for 14 days. For Traveler's Diarrhea: 200 mg orally three times daily for 3 days (note: this entry is for 550 mg, so TD is often handled by 200mg strengths, but can be given off-label with 550mg adjusted).
Elderly
No specific dosage adjustment recommended.
Renal_impairment
No dosage adjustment recommended for mild-to-moderate renal impairment due to minimal systemic absorption. Not studied in severe renal impairment.
How to Take
Take orally, with or without food. Complete the full course of treatment as prescribed by the doctor.
Mechanism of Action
Rifaximin is a rifamycin derivative that binds to the beta-subunit of bacterial DNA-dependent RNA polymerase, thereby inhibiting bacterial RNA synthesis. Due to its very low systemic absorption, it exerts its antibacterial effects primarily within the gastrointestinal tract.
Pharmacokinetics
Onset
Within 24-48 hours for traveler's diarrhea; may take longer for IBS-D or HE.
Excretion
Mainly excreted unchanged in feces (over 96% of oral dose). Very little urinary excretion.
Half life
Approximately 5-6 hours (systemically absorbed fraction).
Absorption
Minimally absorbed systemically (less than 0.4% orally).
Metabolism
Limited systemic metabolism, primarily hydrolyzed in the gut.
Side Effects
Contraindications
- Hypersensitivity to rifaximin, rifamycin antibiotics, or any component of the formulation
- Patients with diarrhea complicated by fever or blood in the stool
- Patients with severe hepatic impairment (for some indications, caution is advised)
Drug Interactions
Warfarin
While systemic absorption is minimal, monitoring of INR is recommended if coadministered due to potential alterations in gut flora influencing Vitamin K synthesis.
Cyclosporine
Coadministration with cyclosporine has been shown to significantly increase systemic exposure to rifaximin due to P-gp inhibition. Caution is advised.
Storage
Store below 30°C (86°F). Protect from moisture and light. Keep out of reach of children.
Overdose
Due to minimal systemic absorption, overdose is unlikely to result in systemic toxicity. In case of suspected overdose, discontinue the drug and provide symptomatic and supportive care.
Pregnancy & Lactation
Pregnancy Category C. Use only if the potential benefit justifies the potential risk to the fetus. It is unknown if rifaximin is excreted in human milk; caution should be exercised when administered to a nursing woman.
Side Effects
Contraindications
- Hypersensitivity to rifaximin, rifamycin antibiotics, or any component of the formulation
- Patients with diarrhea complicated by fever or blood in the stool
- Patients with severe hepatic impairment (for some indications, caution is advised)
Drug Interactions
Warfarin
While systemic absorption is minimal, monitoring of INR is recommended if coadministered due to potential alterations in gut flora influencing Vitamin K synthesis.
Cyclosporine
Coadministration with cyclosporine has been shown to significantly increase systemic exposure to rifaximin due to P-gp inhibition. Caution is advised.
Storage
Store below 30°C (86°F). Protect from moisture and light. Keep out of reach of children.
Overdose
Due to minimal systemic absorption, overdose is unlikely to result in systemic toxicity. In case of suspected overdose, discontinue the drug and provide symptomatic and supportive care.
Pregnancy & Lactation
Pregnancy Category C. Use only if the potential benefit justifies the potential risk to the fetus. It is unknown if rifaximin is excreted in human milk; caution should be exercised when administered to a nursing woman.
Frequently Asked Questions
Common questions about this medicine
Pack Sizes
Shelf Life
Typically 2-3 years from manufacturing date, refer to package for exact expiry.
Availability
Available in pharmacies worldwide
Approval Status
FDA Approved
Patent Status
Patent for specific indications/formulations may exist, generic versions available for some uses.
Clinical Trials
Rifaximin has undergone extensive clinical trials supporting its efficacy and safety for traveler's diarrhea, hepatic encephalopathy, and IBS-D. Key trials include TARGET 1 & 2 for IBS-D and numerous studies for HE recurrence prevention.
Lab Monitoring
- No routine lab monitoring is generally required due to minimal systemic absorption. For patients on warfarin, INR monitoring may be prudent.
- Liver function tests may be considered in patients with severe hepatic impairment, though no dose adjustment is routinely recommended for mild-to-moderate impairment.
Doctor Notes
- Emphasize rifaximin's gut-selective action and minimal systemic absorption to patients.
- Advise patients to complete the full course to minimize resistance and ensure efficacy.
- Consider potential drug-drug interactions with P-gp inhibitors (e.g., cyclosporine) despite low systemic absorption, as it can increase rifaximin exposure.
Patient Guidelines
- Complete the entire course of rifaximin as prescribed by your doctor, even if your symptoms improve.
- Do not take a double dose to make up for a missed one.
- Contact your doctor if your symptoms do not improve or worsen, or if you develop new or bloody diarrhea during or after treatment.
Missed Dose Advice
If you miss a dose, take it as soon as you remember. If it is almost time for your next dose, skip the missed dose and resume your regular dosing schedule. Do not double the dose.
Driving Precautions
Rifaximin typically does not affect the ability to drive or operate machinery. However, if you experience dizziness (an uncommon side effect), avoid driving or operating heavy machinery.
Lifestyle Advice
- Maintain adequate hydration, especially if experiencing diarrhea.
- For IBS-D, consider dietary modifications as advised by your healthcare provider (e.g., low-FODMAP diet).
- Avoid alcohol while on medication, if it worsens gastrointestinal symptoms.
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