Xifaxan (Rifaximin)
Also sold as: Xifaxan, Rcifax, Rifagut, Normix, Rifaxi
Pregnancy
Cat C
Lactation
Caution
Schedule
H
Forms
Tablet 200mg, 400mg, 550mg
Indications
- Traveller's diarrhea (non-invasive E. coli)
- Hepatic encephalopathy — prevention of recurrence
- Irritable bowel syndrome with diarrhea (IBS-D) — off-label
- Small intestinal bacterial overgrowth (SIBO)
- Clostridioides difficile infection (adjunct in recurrent cases)
Adult Dosing
Traveller's diarrhea
200 mg PO TDS
3 days
Only for non-bloody, non-febrile traveller's diarrhea (likely E. coli)
Hepatic encephalopathy (prevention)
550 mg PO BD
Indefinitely or until liver transplant
Combines with lactulose for best effect
IBS-D / SIBO
400-550 mg PO TDS
14 days; may repeat
Pediatric Dosing
Not established in children <12 years
Renal Dose Adjustment
| CrCl / eGFR | Dose Adjustment |
|---|---|
| Any | No adjustment — <1% systemic absorption; primarily acts in GI lumen |
Hepatic Adjustment
Use with caution in severe hepatic impairment (Child-Pugh C) — though primarily used for hepatic encephalopathy, systemic levels may increase slightly
Pregnancy & Lactation
Pregnancy: Category C
Limited data; avoid in pregnancy if possible — use metronidazole or fidaxomicin as alternatives.
Lactation: Caution
Unknown breast milk excretion; likely minimal systemic absorption.
Top Drug Interactions
| Interacting Drug | Effect | Severity |
|---|---|---|
| P-glycoprotein inhibitors (ciclosporin) | May increase rifaximin systemic exposure — monitor | Moderate |
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Side Effects
Common
- Flatulence
- Headache
- Nausea
- Abdominal pain
- Peripheral edema (in liver disease patients)
Serious / Discontinue If
- C. difficile diarrhea (rare — much lower risk than systemic antibiotics)
- Drug-resistant organisms (with prolonged use)
Contraindications
- Rifaximin hypersensitivity
- Diarrhea with fever or blood (invasive organisms — needs systemic antibiotics)
- Intestinal obstruction
Available Indian Brands
| Brand | Manufacturer | Price (approx) |
|---|---|---|
| Rcifax 400 | Cipla | 10 tab ₹295 |
| Rifagut 400 | Sun Pharma | 10 tab ₹265 |
| Xifaxan 550 | Salix/imported | 10 tab ₹685 |
| Normix 200 | Alfa Wassermann | 12 tab ₹220 |
Monitoring Required
- Hepatic function in liver disease patients
- Symptoms of encephalopathy (for HE prophylaxis: ammonia level, neurological status)
- Traveller's diarrhea: response within 24-48 hours
Patient Counseling Points
- For traveller's diarrhea: only for mild-moderate diarrhea WITHOUT fever or blood in stools
- Hepatic encephalopathy: take regularly as prescribed — prevents hospital admissions
- Do not stop HE prophylaxis without consulting gastroenterologist
- Can be taken with or without food
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Clinically reviewed by: Dr. Rajesh Nair, DM (Gastroenterology), Senior Consultant
Last reviewed: 2026-04-01
References
- BNF — Rifaximin
- AASLD Hepatic Encephalopathy Guidelines 2022
- ACG IBS Guidelines 2021
- AASR Trial HE prophylaxis