Can rifaximin and Sucrosomial iron (iron sucrose) cause muscle twinges, fatigue, and dizziness?

Rifaximin and Sucrosomial Iron Side Effects: Muscle Twitches, Fatigue, and Dizziness

Both rifaximin and Sucrosomial iron can potentially cause dizziness and fatigue, while muscle twitches are less commonly associated with either medication but could occur as part of their side effect profiles.

Rifaximin Side Effects

Rifaximin is a poorly absorbed oral antibiotic primarily used for hepatic encephalopathy, irritable bowel syndrome with diarrhea (IBS-D), and travelers' diarrhea. According to the FDA label:

• Common side effects (≥5% of patients) 1:

  • Dizziness (13% vs 8% in placebo)
  • Fatigue (12% vs 11% in placebo)
  • Peripheral edema (15%)
  • Nausea (14%)
  • Muscle spasms (9%)

• Less common side effects 1:

  • Myalgia (muscle pain)
  • Increased blood creatine phosphokinase
  • Rhabdomyolysis (in patients with cirrhosis)

The FDA label specifically mentions that cases of rhabdomyolysis have been reported in patients with cirrhosis taking rifaximin, with or without concomitant statin use 1. This could potentially manifest as muscle twitches or spasms.

Sucrosomial Iron Side Effects

Sucrosomial iron is a newer oral iron formulation designed to improve absorption and reduce gastrointestinal side effects compared to traditional iron salts.

• While specific data on muscle twitches with Sucrosomial iron is limited, iron preparations in general can cause:

  • Fatigue (especially during initial treatment)
  • Dizziness (particularly if rapid changes in iron status occur)

• Sucrosomial iron has fewer gastrointestinal side effects compared to conventional iron salts 2, but systemic effects can still occur.

Potential Mechanisms

1. For rifaximin:

   • Despite minimal systemic absorption (<0.4%), rifaximin may affect neuromuscular function in sensitive individuals 3
   • Alterations in gut microbiome could potentially impact systemic inflammation and neurological function
   • Drug interactions if taking other medications

2. For Sucrosomial iron:

   • Rapid changes in iron status can temporarily affect energy metabolism
   • Iron's role in neurotransmitter synthesis and function
   • Oxidative stress from iron supplementation

Management Recommendations

If experiencing these symptoms:

1. Timing assessment:

   • Note whether symptoms occur in relation to medication administration
   • Document duration and severity of symptoms

2. For rifaximin-related symptoms:

   • Consider dose adjustment if symptoms are severe
   • For hepatic encephalopathy patients, weigh benefits against side effects
   • Monitor for signs of more serious adverse effects like rhabdomyolysis

3. For Sucrosomial iron-related symptoms:

   • Consider taking with food if not already doing so
   • Evaluate for possible iron overload with serum ferritin testing
   • Consider splitting the daily dose

4. For both medications:

   • Ensure adequate hydration
   • Rule out other causes of symptoms
   • Consider temporary discontinuation to assess if symptoms resolve

When to Seek Medical Attention

• Severe or persistent muscle twitches, especially if painful
• Significant fatigue interfering with daily activities
• Dizziness causing balance problems or risk of falls
• Any signs of allergic reaction (rare but possible with both medications)

Alternative Options

• For rifaximin: If side effects are intolerable, discuss alternative treatments for the underlying condition
• For Sucrosomial iron: Other iron formulations may be considered, though they may have more gastrointestinal side effects

While both medications are generally well-tolerated, individual responses vary. The symptoms described (muscle twitches, fatigue, and dizziness) should be evaluated in the context of the patient's overall health status, medication regimen, and the condition being treated.