From the Guidelines
Rifaximin is used to treat Irritable Bowel Syndrome with Diarrhea (IBS-D).
Key Points
- Rifaximin has been shown to be effective in treating IBS-D, with a significant improvement in symptoms such as abdominal pain, bloating, and stool consistency 1.
- The recommended dose of rifaximin for IBS-D is 550 mg three times a day for 14 days 1.
- Rifaximin has been found to be well-tolerated and safe, with a similar adverse event profile to placebo 1.
- The use of rifaximin should be restricted to difficult cases of IBS-D, due to concerns about promoting antibiotic resistance 1.
Clinical Use
- Rifaximin can be used as an initial treatment for IBS-D, as well as for retreatment in patients who have had a previous response to the medication but have experienced symptom relapse 1.
- The medication has been shown to be effective in improving symptoms such as abdominal pain, bloating, and stool consistency, and can also improve quality of life for patients with IBS-D 1.
- However, the efficacy of rifaximin may be modest, and repeated courses of therapy may be necessary to maintain symptom relief 1.
From the FDA Drug Label
XIFAXAN is a rifamycin antibacterial indicated for: • Treatment of travelers’ diarrhea (TD) caused by noninvasive strains of Escherichia coli in adult and pediatric patients 12 years of age and older (1.1) • Reduction in risk of overt hepatic encephalopathy (HE) recurrence in adults (1.2) • Treatment of irritable bowel syndrome with diarrhea (IBS-D) in adults (1. 3)
The use of Rifaximin (XIFAXAN) is for the treatment of:
- Travelers’ diarrhea caused by noninvasive strains of Escherichia coli in adults and pediatric patients 12 years of age and older
- Reduction in risk of overt hepatic encephalopathy (HE) recurrence in adults
- Treatment of irritable bowel syndrome with diarrhea (IBS-D) in adults 2
From the Research
Uses of Rifaximin
Rifaximin is a broad-spectrum oral antibiotic with various uses in the treatment of gastrointestinal and liver diseases. Some of the key uses of rifaximin include:
- Treatment of traveler's diarrhea caused by noninvasive diarrheagenic Escherichia coli 3
- Prevention of recurrent overt hepatic encephalopathy in patients with advanced liver disease 4, 5, 6
- Treatment of irritable bowel syndrome (IBS) and functional bloating 4, 5, 6
- Treatment of small bowel bacterial overgrowth 4, 3
- Prevention of recurrent diverticulitis and treatment of uncomplicated diverticular disease 4
- Potential therapeutic role in the treatment of liver fibrosis, metabolic dysfunction-associated steatotic liver disease, and alcohol-associated liver disease 7
Mechanism of Action
Rifaximin works by inhibiting bacterial RNA synthesis and has a highly favorable safety profile due to its poor absorption and minimal systemic adverse effects 4, 7, 3. It also modulates host tissue function through the activation of distinct molecular events, including the activation of the pregnane X receptor (PXR) 5.
Efficacy and Safety
Rifaximin has been shown to be effective in reducing the risk of recurrent overt hepatic encephalopathy and improving IBS symptom management 6. Its safety profile is comparable to placebo, with common adverse events including ascites, dizziness, fatigue, and peripheral edema 6. However, more studies are needed to confirm its efficacy for off-label indications and to determine the potential development of significant bacterial resistance 3.