rifaximin (Xifaxan, Fatroximin, Normix)
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Introduction
Tradename: Xifaxam
Indications
- traveler's diarrhea (noninvasive Escherichia coli)
- irritable bowel syndrome (IBS)[3][6], FDA-approved[7]
- reduces recurrence of overt hepatic encephalopathy in patients with advanced liver disease[4]
- small intestinal bacterial overgrowth
Dosage
- 200 mg TID for 3 days (with or without food)[1]
- 200 mg QD-TID for 2 weeks[2]
- 550 mg TID for 2 weeks (IBS)[6]
- hepatic encephalopathy: 550 mg BID[9]
Tabs: 200 mg, 550 mg
Pharmacokinetics
- not absorbed systemically (< 0.4%)
- induces cyt P450 3A4, but drug is absorbed
Adverse effects
- headache
- peripheral edema
- nausea, constipation
- dizziness, fatigue, insomnia
- urinary tract infection
- anemia
- pruritus
- ascites
- elevated serum ALT[9]
Drug interactions
- drug interaction(s) anticonvulsants with anti-bacterial agents
- drug interaction(s) of antibiotics with warfarin
Mechanism of action
- inhibits bacterial RNA synthesis by binding to beta-subunit of bacterial DNA-dependent RNA polymerase
Notes
- cost (2010) for prevention of hepatic encephalopathy about $1200/month[5]
More general terms
References
- ↑ 1.0 1.1 Prescriber's Letter 11(7):38 2004 Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=200706&pb=PRL (subscription needed) http://www.prescribersletter.com
- ↑ 2.0 2.1 Journal Watch 25(13):103, 2005 DuPont HL, Jiang ZD, Okhuysen PC, Ericsson CD, de la Cabada FJ, Ke S, DuPont MW, Martinez-Sandoval F. A randomized, double-blind, placebo-controlled trial of rifaximin to prevent travelers' diarrhea. Ann Intern Med. 2005 May 17;142(10):805-12. Summary for patients in: Ann Intern Med. 2005 May 17;142(10):I30. PMID: https://www.ncbi.nlm.nih.gov/pubmed/15897530
- ↑ 3.0 3.1 Pimentel M, Park S, Mirocha J, Kane SV, Kong Y. The effect of a nonabsorbed oral antibiotic (rifaximin) on the symptoms of the irritable bowel syndrome: a randomized trial. Ann Intern Med. 2006 Oct 17;145(8):557-63. Summary for patients in: Ann Intern Med. 2006,145(8):I24. PMID: https://www.ncbi.nlm.nih.gov/pubmed/17043337
Drossman DA. Treatment for bacterial overgrowth in the irritable bowel syndrome. Ann Intern Med. 2006 Oct 17;145(8):626-8. (No abstract) PMID: https://www.ncbi.nlm.nih.gov/pubmed/17043344 - ↑ 4.0 4.1 FDA NEWS RELEASE, March 24, 2010 FDA Approves New Use of Xifaxan for Patients with Liver Disease http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm206104.htm
Bass NM, Mullen KD, Sanyal A et al Rifaximin treatment in hepatic encephalopathy. N Engl J Med. 2010 Mar 25;362(12):1071-81 PMID: https://www.ncbi.nlm.nih.gov/pubmed/20335583 - ↑ 5.0 5.1 Prescriber's Letter 17(6): 2010 Rifaximin (Xifaxan) for Hepatic Encephalopathy Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=260608&pb=PRL (subscription needed) http://www.prescribersletter.com
Sidhu SS et al. Rifaximin improves psychometric performance and health-related quality of life in patients with minimal hepatic encephalopathy (The RIME Trial). Am J Gastroenterol 2011 Feb; 106:307. PMID: https://www.ncbi.nlm.nih.gov/pubmed/21157444
Bajaj JS et al. Rifaximin improves driving simulator performance in a randomized trial of patients with minimal hepatic encephalopathy. Gastroenterology 2011 Feb; 140:478. PMID: https://www.ncbi.nlm.nih.gov/pubmed/20849805 - ↑ 6.0 6.1 6.2 Pimentel M et al Rifaximin Therapy for Patients with Irritable Bowel Syndrome without Constipation N Engl J Med. 2011 Jan 6;364(1):22-32. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/21208106 <Internet> http://www.nejm.org/doi/full/10.1056/NEJMoa1004409
Tack J Antibiotic Therapy for the Irritable Bowel Syndrome N Engl J Med. 2011 Jan 6;364(1):81-2. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/21208112 <Internet> http://www.nejm.org/doi/full/10.1056/NEJMe1011211 - ↑ 7.0 7.1 FDA News Release. May 27, 2015 FDA approves two therapies to treat IBS-D http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm448328.htm
- ↑ NEJM Knowledge+ Gastroenterology
- ↑ 9.0 9.1 9.2 9.3 HIGHLIGHTS OF PRESCRIBING INFORMATION XIFAXAN<TM> (rifaximin) tablets, for oral use https://shared.salix.com/globalassets/pi/xifaxan550-pi.pdf