IBS Tales Home > Treatment Reviews > IBS Medications > Xifaxan


Overall rating 5/5 based on 5 reviews

Xifaxan (rifaximin) is an antibiotic which can treat diarrhea-predominant IBS. It is often used to treat patients who have been diagnosed with small intestinal bacterial overgrowth (SIBO) which can cause symptoms of diarrhea, abdominal pain, wind and bloating.

Treatment with Xifaxan can help to kill off the bad bacteria in the gut and relieve the symptoms of SIBO. However, some patients may need more than one course of treatment. A standard course of treatment will be one 200mg or 550mg pill taken two or three times a day. A usual course runs for 10 to 14 days. It can be taken with or without food.

Xifaxan Side Effects

As Xifaxan is not absorbed into the body there are few side effects of this medication. A small number of patients find that it can cause constipation, a headache, mild nausea or dizziness.

Can Xifaxan be crushed?

Crushing Xifaxan is not recommended as you may lose a small quantity of the drug in the crushing process. If you have trouble swallowing the pills it is best to leave the tablets intact and place the tablets in soft foods like jello or pudding.

Why is Xifaxan so expensive?

One course of Xifaxan can cost as much as $2000, although it can be available for closer to $1000. Unfortunately this is because SIBO has only recently been discovered and the antibiotic treatment for IBS has not been used for very long. Your health insurance company may also refuse to fund the treatment for SIBO.

To keep costs down try to use coupons available from the manufacturer and ask your pharmacist for advice on getting the best deal for your circumstances.


Review by Susan

I have had the breath test for small intestinal bacterial overgrowth three times now. I am positive every time. I have been suffering for a year. I have been on Xifaxan five different times in a year. I read Dr Pimentel's book but I can't get a doctor in Atlanta to follow his protocol. I am so tired of being sick. I have suffered with this pain for three years. As soon as I take the Xifaxan I am well. It just want it to last!

Review by Lisa

I have had severe IBS for about three years, but I have always had gut problems. I had several tests, went to different doctors and tried different meds. First, I changed my diet and checked out Heather Van Vorous' book for pointers. You can also get hypnosis CDs which really help with the anxiety that IBS sufferers face.

I then bought Dr Pimentel's book, A New IBS Solution. I followed the protocol in the book and my GI doctor was part of this. I had a breath test done and I was put on Xifaxan (a 10-day course). I now have had two rounds of this med. The first course gave me relief for nine weeks and this time so far I am on week 12. I'm hoping that the second round did it. I also take nortriptyline, 25mg once a day. My symptoms were mainly diarrhea and urgency. I was to the point where I thought I wouldn't be able to work or leave the house anymore.

Review by Andrew

I had mild IBS without knowing it from the ages of 17 to 23. From age 24 to 29 (now) I've had serious IBS-D that comes back every few months. I have strong reason to believe that usually moderate (but sometimes binge) alcohol consumption, an irregular sleep schedule, and regular low doses of antacids (to address heartburn) contributed to my development of IBS.

These treatments have instantaneously stopped a bout but have not worked every time: psyllium husk, a calcium, magnesium and zinc supplement, lactobacillus probiotic powder, and live Jarro Formula probiotics with P-Fos (yellow container). Desipramine (Norpramin, Pertofrane) worked to stop the pain or diarrhea but had unacceptable side effects.

Treatments that had no effect include Flagyl (metronidazole), Cipro, amoxicillin and Diflucan (fluconazole). Bentyl addresses the pain and diarrhea but not the bloating and discomfort. A two-week program of Xifaxan worked but has anti-bacteria resistant strain risks.

Treatment that were minimally effective, but sometimes saw no improvement include non-psyllium husk fiber supplements, golden seal root, black walnut hull, enteric-coated peppermint oil, Imodium, Gas-X and Pepto-Bismol.

I have identified some foods as triggers, including ibuprofen (one pill can start a bout), caffeine, alcohol (one drink can start a bout), lactose-containing products (I'm lactose intolerant), too much sugar, too much fructose, too much artificial sweetener and generally eating too much or too fast. Other triggers are waking up from deep sleep, not getting sunshine (sunshine actually lessens my pain), lack of sleep, irregular sleep, smoking and general stress.

At least for the people with IBS-D, I'm sure the information here will be very useful. Bentyl addresses the symptoms of diarrhea and severe pain but not the gassiness or the apparent underlying infection or bacterial overgrowth. I've yet to have a bout that was not knocked out by Xifaxan followed by probiotics.

I think that, had I known these things, I would not have lost five years of my life being an unfocused PhD student, then later an unfocused worker in all types of careers, being limited in productivity by a general toilet/urgency anxiety and lack of energy from internal hemorrhoids/blood and liquid number twos five to 20 times a day every day for three to 20 week runs, a few times a year, every year.

I'm finally starting on a path of making sure I'm insured so when problems arise, I'm on probiotics, psyllium and have an appointment with a gastroenterologist for a prescription of Xifaxan and Bentyl. I don't smoke. I don't drink. I'm otherwise very healthy, both mentally and physically, though the invasiveness of IBS-D and the long, long bouts have in the past made me think about 'the easier way', though only fleetingly.

Review by Pat

I first began to notice an increase in defecation around June 2006. It was never true diarrhea where I'd have to find a bathroom in seconds, but rather a frequency (sometimes up to seven or eight times at the extreme) and a change in consistency (fair amounts of mucus, sometimes only a mucus plug). I had stopped taking Wellbutrin XL a few months before that and that medication was for depression, not IBS. I did not feel the need for it any longer.

However, another factor that may have been causative, or in combination with the former, was a regimen of antibiotics in the winter of 2006 and 2007. I have had frequent use of large doses of antibiotics as far back as the 1980s when I was in a pilot program that used large doses of doxycycline as a possible treatment for PMS.

I entered that program in my early 40s and I had experienced PMS and period pains for most of the time I menstruated. The period pain more or less stopped while I was on the birth control pill and the PMS may have in fact started when I switched to the copper seven IUD for a few years.

At any rate, it was a problem for several years, and as is the wont of the medical establishment when dealing with any problem of a chronic, and as yet relieved by known medical treatments, condition affecting females, the psychological issue arises: they're hysterical, unstable, overly emotional, ad nauseum.

I was getting more concerned about the frequency of bowel movements, so I went to the internist because I also had some minor upper stomach pain on occasion. I told her that my Mom had had an ulcer which eventually required surgery and that I had read that the H. pylori bacterium might be implicated. She said there was a test for that, which came back positive, and I took the Prev-Pac treatment.

Around that same time I had a slight but persistent pain above my right eye which I consulted a neurologist for. His series of blood tests showed a B-12 deficiency in October 2006. By the way I am 66 and this started about two years ago.

Ironically, that September of 2006 I had completed my annual comprehensive physical with my Internist, when several blood tests were taken, but none were specified for the examination of B-12 levels. Unless one presents with a specific problem and engages the correct medical specialist, certain medical tests are not done. So, I'm treated with Prev-Pac in October 2006, then in November 2006 I get another nasty respiratory infection, which I get antibiotics for.

Then in late December 2006 and into January 2007 I had Lyme disease, for which I got large doses of doxycycline. I still have IBS, which really rears its ugly head in severity in October 2007.

Enter my GI doctor. He started with a treatment of Xifaxan, 200mg three times a day, for 10 days. That was from mid-November 2007 until after Thanksgiving. This stuff worked like magic. I could go to the bathroom once a day, no pain, just normal. That was followed by 14 days of OTC probiotics and that's when the IBS symptoms returned.

So, next came Flagyl for 10 days, then Xifaxan for 10 days but only 200mg once per day; then Donnatal two times per day, 200mg, I think, combined with nortriptyline 10mg to 20mg, at bedtime. Last visit, GI recommended Zoloft because I might be depressed. Well, Zoloft causes more frequent BMs, but Wellbutrin doesn't. I stopped all the last prescribed regimen and requested Xifaxan again, and called my internist for a Wellbutrin RX after being refused the Xifaxan by my GI - both refused my request.

I'm scheduled for removal of a cyst on my right kidney that might be a renal cell carcinoma, found when I was doing an MRI for a lower spine problem, so they don't want to prescribe anything. So, I'm left with solving this dilemma on my own.

I started Pepto-Bismol two or three days ago, and I also take Metamucil. Well, I have no churning, less stomach pain, and the frequent BMs are gone, replaced by a somewhat normal BM with some pebble-like, stone-type stuff also, once today. Why should Pepto, a traveler's diarrhea OTC prep, work, as did the Xifaxan at 600mg, if indeed there isn't some adverse bacteria, as yet unknown by the medical community, or something akin to that?

Right now, I'm hoping that this will tide me over until I find a GI specializing in IBS after I recuperate from impending surgery. I think I'll see the light on all of this, but not until a while from now. I wish all who suffer from this the very best chance of relief from the symptoms of IBS. Good luck to all of us!

Review by Janice

I am a senior who has suffered with IBS-D for over 20 years. Before that I had constipation. I have never been normal. I remember when my children were young I would have night sessions where I hurt so bad it felt like knives cutting my gut. When done my legs were rubbery and I would barely make it back to bed. I was just glad it happened when the children were asleep.

I was tested for ulcers, colitis and anything else they could think of. No results, so then they think it's a mental issue. I was tested and discovered I am allergic to the protein in milk (sodium caseinate). So I elimated diary from my diet. However, I revolved into IBS-D.

With losing my husband to brain cancer my life has become challenging. I have even tried a hypnotist. That didn't work. Finally I had some success with taking Xifaxan (which has become very expensive since getting FDA approval). I have followed that with a concoction I stumbled on.

You core two fresh apples (leave the skin on), microwave for two minutes, add one tablespoon of cinnamon and put in one cup of ginger ale that has been allowed to go flat. Blend in a blender or juicer and it makes it like apple sauce. Mix four spoonfuls of the mixture and add four spoonfuls of So vanilla coconut yogurt.

I have had normal movements since eating this once a day. The only time I slipped was when I forgot to eat this. I wanted to share this miracle for me that maybe will help others. I believe what is helpful in this is the natural non-dairy probiotic effect in the yogurt, the pectin in the apple skin and the calming effect of the ginger in the gingerale. Gingerale has become my drink of choice.

My digestive system has a history of disaster that is too long to cover here (two hospitalizations, many colonoscopies etc and removal of a good portion of my colon, removal of gallbladder and surgery for GERDS). This concoction seems so simple. I am a person of strong faith and I can't discount that my payers to God through Jesus have been answered.

Do you suffer from IBS? Have you tried Xifaxan? Please contact Sophie to send in your review.