Is it safe to use Xifaxin repeatedly for IBS and SIBO

[Kelly C-D]

I see 2 GI docs. One of them thinks Xifaxin is perfectly safe to use as needed for SIBO and IBS. The other thinks it should only be taken very infrequently. Do any of you have experience or opinions on this?

 

 

 

 

 

 

[Jeffrey Roberts]

Hi Kelly C-D,

All I can recommend is that the FDA approved Xifaxin for IBS-D with the "label" for an initial 2-week treatment. That can be repeated 2 more times if there is a recurrence of symptoms. That's the way it was approved. Using it beyond that would be considered "off-label" use. Your doctor is free to use any medication "off-label" if they believe the benefit of the medication outweighs the risks.

It might be good and well that one of your GI docs feels you can use it as needed as they might have some of their own personal experience with it in some patients; however, I don't believe there is any clinical research to suggest that Xifaxin can be used as needed. I'm not saying that it's wrong or bad. I'm saying that because there is no clinical research to suggest that it was meant to be taken that way. For all we know it may be fine.

I can share with you that when Xifaxin was first up for approval by the FDA, they required the pharmaceutical to do another trial to determine the safety of a 3rd course of treatment before Xifaxin was approved. A new clinical research study indicated that a 3rd round appeared to be safe and also noted "Given that many patients may require long-term (eg, years) management of IBS-D symptoms, the potential risk-to-benefit profile of periodic administration of a nonsystemic antibiotic after 3 treatment courses is unclear." 

Perhaps you will hear from others who have some personal experience.

Source: https://digitalcommons.wustl.edu/cgi/viewcontent.cgi?article=6413&context=open_access_pubs

[Kelly C-D]

Thank you so much for this very thorough answer.  I didnt know it was approved for only two times.  I will be curious to see what other people may have experienced. Also, I have an appointment in a couple of days with a nutritionist that specializes in IBS and SIBO, and plan to ask her the same question.  For now, I will hold off on starting Xifaxin.  I have already taken it at least 4 or 5 different times over the past few years.

 

 

[Jeffrey Roberts]

Just to be clear because it is confusing, Xifaxin was approved for 1 time use + 2 repeats so 3 times in total. The "label" is a confusing because of the additional study that was required in order for it to be approved for IBS-D. The actual label says: "One 550 mg tablet 3 times a day for 14 days. Patients who experience recurrence can be retreated up to two times with the same regimen."

BTW, it is often prescribed "off-label" for SIBO because the label indication is actually only for IBS-D.

Source: https://www.accessdata.fda.gov/drugsatfda_docs/label/2017/021361s023lbl.pdf

[Kelly C-D]

Thanks. I needed that clarification because I was thinking it was 2 times in total.

 

 

[Chelsea L]

Hi Kelly,

I have IBS and Methane SIBO, I’ve had for over 25 years. Xifaxin has been one of the most effective treatments for me. The symptoms always come back eventually but I have used them probably 4-5 times in the last 5 years. It was explained to me that Xifaxin is poorly absorbed by the body and stays in the GI tract which is why it’s so effective. My doctor couldn’t say yes or no it’s safe to use regularly but I have made the choice for myself and it’s been an effective treatment plan when all my symptoms progress to the point they are at their worst. After a round of Xifaxin or Anti-Bacterial herbs regimen I work to restore good bacteria and work on my gut biome. This includes - prebiotics to feed the good bacteria, probiotics to re-populate good bacteria colonies, bone broth to heal gut lining, daily psyllium husk for good fiber, absolutely NO SUGAR, processed foods, bread or pasta, and intermittent fasting to let the digestive system have time to complete its segmentation and peristalsis actions. No snacking in between meals. This works for me but of course you know what works for you too! My doctor recommended probiotics with S-Boulardii as well. Great info here - https://bellalindemann.com/

And another article about Xifaxin- 
“The lack of absorption of rifaximin in the gastrointestinal tract enhances fecal concentrations of this drug and limits its systemic toxicity. Studies with radio-labeled rifaximin have demonstrated less than 0.4% of detectable rifaximin in the blood and urine, undetectable levels in the bile and breast milk, and 97% recovered unchanged in the stool after oral ingestion (2) (4).”  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4737517/

Hope this helps! Also, don’t pay $750 for Xifaxin, I guess depends where you live but you can order from canshipmeds.com.