Should a patient with a complex medication regimen, including ADHD, depression, allergy, and low dose Naltrexone medications, and various supplements, discontinue their supplements while taking Xifaxan (Rifaximin) and Neomycin?

Should You Stop Your Supplements While Taking Xifaxan and Neomycin?

You do not need to stop most of your supplements while taking Xifaxan (rifaximin) and neomycin, but specific supplements require careful consideration based on potential interactions with your medications and the treatment goals.

Critical Supplements to Review

Probiotics and Immune-Modulating Supplements

• If you are taking any probiotics, immune stimulants, or supplements with immunomodulatory effects, discuss timing with your physician. 1 While the evidence primarily addresses immunotherapy contexts, the principle of avoiding interference with antibiotic treatment applies.
• Your Cytokine Suppress w/ EGCG falls into this category and may theoretically interfere with the intended antimicrobial effects, though no direct contraindication exists for rifaximin/neomycin specifically. 1

Antioxidants and Vitamin Supplements

• Continue your Vitamin D3 unless you are deficient or it's part of a specific protocol—there is no contraindication with rifaximin or neomycin. 2
• Your Quercetin + Luteolin, Hist DAO, and other antioxidant-containing supplements can generally be continued, as the concern about antioxidants primarily relates to chemotherapy/radiation therapy, not antibiotic treatment for gastrointestinal conditions. 2

Digestive Supplements

• Your digestive enzymes with ox bile, GI Revive, SBI Protect, and Motility Activator can be continued. These support digestive function and do not have documented interactions with rifaximin or neomycin. 3, 4
• These supplements may actually complement your treatment, as rifaximin and neomycin target bacterial overgrowth while your digestive supplements support overall GI function.

Magnesium and Other Minerals

• Continue Magnesium Glycinate—no interaction with rifaximin or neomycin exists, and magnesium supports bowel function. 5

Herbal Supplements

• Your Lavender oil pill is safe to continue with rifaximin and neomycin, as lavender has a low likelihood of drug interactions. 5

Medications That Are Safe to Continue

All of your prescription medications can be continued safely with rifaximin and neomycin:

• Your ADHD patch, depression medication, allergy medications (Cetirizine, Hydroxyzine, Famotidine), Guanfacine, Gabapentin, and low-dose Naltrexone have no documented interactions with rifaximin or neomycin. 1
• Your as-needed medications (muscle relaxant, Zofran, Dicyclomine) are also safe to continue. 1

Critical Monitoring Points

Watch for Antibiotic-Specific Concerns

• Neomycin can cause auditory loss and renal injury with prolonged use (>6 months). 1 Your 10-14 day course is well within safe limits, but report any hearing changes or decreased urine output immediately.
• Rifaximin is generally well-tolerated with minimal systemic absorption, making drug interactions rare. 1, 3

Combination Therapy Effectiveness

• The combination of rifaximin and neomycin is superior to either antibiotic alone for treating methane-positive conditions, with 85% clinical response rates versus 56% for rifaximin alone. 3
• This combination achieves 87% methane eradication compared to only 28% with rifaximin alone, supporting the rationale for your prescribed regimen. 3, 4

Common Pitfalls to Avoid

Do Not Self-Adjust Supplement Timing

• Taking supplements at the same time as antibiotics is generally acceptable—rifaximin and neomycin work through different mechanisms than most supplements. 3, 4
• Avoid taking calcium, iron, or magnesium within 2 hours of neomycin if you were taking these in high doses (which you are not), as they can theoretically bind to aminoglycoside antibiotics, though this is more relevant for systemic aminoglycosides than oral neomycin.

Disclose All Supplements to Your Healthcare Team

• 91% of patients take dietary supplements, but many do not disclose this to their physicians. 6, 2
• Your comprehensive supplement list should be reviewed by your prescribing physician or pharmacist to ensure no patient-specific contraindications exist based on your complete medical history. 5, 6

Do Not Stop Supplements Abruptly Without Cause

• There is no evidence-based reason to discontinue your current supplement regimen during this short antibiotic course, as none of your supplements fall into high-risk categories for interaction with rifaximin or neomycin. 5, 2

Treatment Duration and Follow-Up

• Your rifaximin and neomycin course is typically 10-14 days. 3, 4
• Symptom improvement should be assessed during treatment and for 4 weeks after completion. 4
• If constipation persists after treatment, methane breath testing may be repeated to determine if additional therapy is needed. 4