From the Guidelines
For diarrhea and cramping while taking Rifaximin, the most effective approach is to consider alternative treatments for IBS-D, such as Eluxadoline, which has been shown to be superior to placebo in improving abdominal pain and stool consistency 1. When experiencing diarrhea and cramping while taking Rifaximin, it is essential to prioritize managing these symptoms to improve quality of life.
Key Considerations
- Staying well-hydrated by drinking plenty of clear fluids is crucial to prevent dehydration.
- Over-the-counter medications like loperamide (Imodium) can be used to reduce diarrhea, but it's essential to follow the recommended dosage 1.
- For cramping, applying a heating pad to the abdomen and consuming peppermint tea may provide relief.
- Eating smaller, more frequent meals consisting of bland, low-fiber foods, such as the BRAT diet, can help alleviate symptoms.
Treatment Options
- Eluxadoline, a μ-opioid and κ-opioid receptor agonist and δ-opioid receptor antagonist, has been shown to be effective in treating IBS-D, with significant improvements in abdominal pain and stool consistency 1.
- Other treatment options, such as 5-HT3 receptor antagonists (e.g., alosetron and ramosetron), may also be considered, but their availability and safety profiles vary 1.
Important Notes
- Rifaximin, while effective in treating certain intestinal conditions, can temporarily disrupt gut flora, leading to digestive discomfort 1.
- If symptoms are severe or persist beyond 2-3 days, it is essential to contact a healthcare provider to adjust medication or explore alternative treatments 1.
From the FDA Drug Label
For those patients being treated for travelers’ diarrhea, discontinue XIFAXAN if diarrhea persists more than 24-48 hours or worsens. If diarrhea occurs after therapy or does not improve or worsens during therapy, advise patients to contact a physician as soon as possible
If a patient experiences diarrhea and cramping while taking Rifaximin, the patient should:
- Discontinue XIFAXAN if diarrhea persists more than 24-48 hours or worsens
- Contact a physician as soon as possible if diarrhea occurs after therapy or does not improve or worsens during therapy 2
From the Research
Diarrhea and Cramping while taking Rifaximin
- Rifaximin is a nonabsorbable rifamycin derivative with an excellent safety profile and a broad spectrum of antimicrobial activity against a variety of enteropathogens causing acute infectious diarrhea 3, 4.
- It has shown excellent efficacy in numerous clinical trials of bacterial diarrhea and is useful in treating hosts such as pregnant women in whom the currently favored fluoroquinolones are contraindicated 3.
- For the treatment of acute diarrhea unrelated to travel, a short course of rifaximin significantly reduced the duration of diarrhea, and its overall efficacy was comparable to that of ciprofloxacin 4.
- Rifaximin is also indicated for the treatment of irritable bowel syndrome with diarrhea (IBS-D) in adults and has been shown to improve individual and composite IBS-D symptoms, including abdominal pain, bloating, stool consistency, and urgency 5, 6.
- The use of loperamide in combination with antibiotic treatment, such as rifaximin, is also beneficial as it has been shown to further reduce gastrointestinal symptoms and duration of illness 7.
Management of Diarrhea and Cramping
- Rifaximin can be used to treat diarrhea-predominant irritable bowel syndrome and has been shown to reduce global IBS symptoms and improve bloating, abdominal pain, and stool consistency in some patients with non-constipated IBS 5.
- A 2-week course of rifaximin 550 mg TID has been evaluated for its efficacy on individual and composite IBS-D symptoms, and results showed that rifaximin significantly improved multiple, concurrent IBS-D symptoms 6.
- For acute watery diarrhea, rifaximin (200 mg 3 times per day for 3 days) is an alternative treatment option, but it should not be used with invasive illness 7.