How should I time Rifaximin (Rifaximin) and Neomycin (Neomycin) alongside low dose naltrexone (Naltrexone) and PHGG (Partially Hydrolyzed Guar Gum) with meals and supplements?

Timing Rifaximin, Neomycin, Low-Dose Naltrexone, and PHGG with Meals and Supplements

Take rifaximin on an empty stomach (30-60 minutes before meals or 2 hours after meals), neomycin can be taken with or without food, low-dose naltrexone at bedtime on an empty stomach, and PHGG anytime during the day with or without food.

Rifaximin Timing

Rifaximin should be taken on an empty stomach for optimal absorption and efficacy. 1

• Take rifaximin 30-60 minutes before meals or 2 hours after meals 1
• This timing is critical because rifaximin, like other rifamycin derivatives, achieves better local gastrointestinal concentrations when not competing with food 1
• For your regimen of rifaximin 3 times daily, practical timing would be: morning (before breakfast), midday (before lunch or 2 hours after), and evening (before dinner or 2 hours after) 1
• Rifaximin is virtually unabsorbed after oral administration, so its effectiveness depends on maintaining adequate local concentrations in the gastrointestinal tract 2

Neomycin Timing

Neomycin can be taken with or without food, but consistency is important.

• Neomycin does not have specific meal-timing requirements like rifaximin 1
• For weeks 3-4 when you're taking both rifaximin and neomycin, take neomycin 2 times daily at consistent times 3, 4
• A practical approach: take neomycin with your morning and evening meals while maintaining rifaximin's empty-stomach timing 4
• The combination of rifaximin and neomycin has been shown to be more effective than either antibiotic alone, particularly for methane-positive patients 3, 4

Low-Dose Naltrexone Timing

Take low-dose naltrexone 2mg at bedtime on an empty stomach.

• Bedtime dosing is standard for low-dose naltrexone as prescribed [@general medical knowledge@]
• Take it at least 2 hours after your last meal to ensure empty stomach conditions [@general medical knowledge@]
• This timing avoids any potential interaction with the antibiotics and allows for optimal absorption [@general medical knowledge@]

PHGG (Partially Hydrolyzed Guar Gum) Timing

PHGG can be taken anytime during the day and does not require specific meal timing.

• PHGG is a soluble fiber supplement that can be taken with or without food [@general medical knowledge@]
• To avoid any theoretical interference with antibiotic absorption, consider taking PHGG at least 1-2 hours separated from rifaximin doses [@general medical knowledge@]
• A practical approach: take PHGG with lunch or as an afternoon supplement, which naturally separates it from most medication doses [@general medical knowledge@]

Practical Daily Schedule

Weeks 1-2 (Rifaximin only):

• Morning (7-8 AM): Rifaximin on empty stomach, wait 30-60 minutes before breakfast
• Midday (12-1 PM): Rifaximin 30-60 minutes before lunch OR 2 hours after breakfast
• Evening (6-7 PM): Rifaximin 30-60 minutes before dinner OR 2 hours after lunch
• Bedtime (10-11 PM): Low-dose naltrexone 2mg (at least 2 hours after dinner)
• Anytime: PHGG (preferably mid-morning or mid-afternoon, separated from rifaximin)

Weeks 3-4 (Rifaximin + Neomycin):

• Morning (7-8 AM): Rifaximin on empty stomach, wait 30-60 minutes, then breakfast with neomycin
• Midday (12-1 PM): Rifaximin 30-60 minutes before lunch OR 2 hours after breakfast
• Evening (6-7 PM): Rifaximin 30-60 minutes before dinner OR 2 hours after lunch, then dinner with neomycin
• Bedtime (10-11 PM): Low-dose naltrexone 2mg (at least 2 hours after dinner)
• Anytime: PHGG (preferably mid-morning or mid-afternoon)

Important Considerations for Supplements

Separate any other supplements from rifaximin by at least 2 hours to avoid absorption interference.

• If taking probiotics, wait until after completing the antibiotic courses before starting or resuming them [@general medical knowledge@]
• Multivitamins and minerals should be taken at least 2 hours separated from rifaximin [@general medical knowledge@]
• The 6-month maintenance regimen with low-dose naltrexone and PHGG should begin immediately, even during the antibiotic phases [@general medical knowledge@]

Common Pitfalls to Avoid

• Do not take rifaximin with meals - this significantly reduces its effectiveness in the gastrointestinal tract 1
• Maintain consistent timing - irregular dosing schedules reduce antibiotic efficacy and may promote resistance 1
• Do not skip the neomycin phase - the combination of rifaximin and neomycin is significantly more effective than rifaximin alone for certain conditions, particularly those associated with methane production 3, 4
• Continue the maintenance therapy - starting low-dose naltrexone and PHGG immediately helps prevent symptom recurrence after antibiotic completion 5