What are the side effects of Xifaxin (rifaximin) and can a red and hot face be one of them?

Side Effects of Xifaxin (Rifaximin) with Focus on Facial Flushing

Facial redness and heat (flushing) is not listed as a common side effect of Xifaxin, but could potentially occur as part of a hypersensitivity reaction which requires immediate medical attention.

Common Side Effects of Xifaxin

Based on the FDA drug label, the most common side effects of Xifaxin (rifaximin) vary depending on the condition being treated:

For Irritable Bowel Syndrome with Diarrhea (IBS-D):

• Nausea (3% vs 2% with placebo) 1
• ALT elevation (2% vs 1% with placebo) 1

For Hepatic Encephalopathy:

• Peripheral edema (15%) 1
• Nausea (14%) 1
• Dizziness (13%) 1
• Fatigue (12%) 1
• Ascites (11%) 1
• Muscle spasms (9%) 1
• Pruritus (9%) 1
• Abdominal pain (9%) 1

For Traveler's Diarrhea:

• Headache (10% vs 9% with placebo) 1

Hypersensitivity Reactions

While facial redness and heat are not specifically listed among common side effects, the FDA label does mention several hypersensitivity reactions that could potentially include facial symptoms:

• Exfoliative dermatitis
• Rash
• Angioneurotic edema (swelling of face and tongue)
• Urticaria
• Flushing
• Pruritus
• Anaphylaxis 1

These hypersensitivity reactions can occur as early as within 15 minutes of taking the medication 1.

Severe Cutaneous Adverse Reactions

The FDA label also warns about severe cutaneous adverse reactions including:

• Stevens-Johnson syndrome (SJS)
• Toxic epidermal necrolysis (TEN)

These have been reported particularly in patients with cirrhosis 1.

Important Considerations

Minimal Systemic Absorption

Rifaximin is poorly absorbed (<0.4%) from the gastrointestinal tract 2, which contributes to its favorable safety profile compared to other antibiotics. This minimal absorption means systemic side effects are generally less common than with other antibiotics.

When to Seek Medical Attention

You should discontinue rifaximin and seek immediate medical attention if experiencing:

• Any signs of facial swelling
• Difficulty breathing
• Severe skin reactions
• Persistent facial redness or heat

Special Populations

• Liver Disease: Patients with severe hepatic impairment (Child-Pugh Class C) may experience increased systemic exposure to rifaximin 1, potentially increasing the risk of side effects.
• Drug Interactions: Concomitant use with P-glycoprotein inhibitors (like cyclosporine) can substantially increase systemic exposure to rifaximin 1.

Conclusion

While facial redness and heat are not specifically listed among the common side effects of Xifaxin, they could potentially occur as part of a hypersensitivity reaction. If you experience these symptoms, especially if accompanied by other signs of allergic reaction, you should contact your healthcare provider immediately.