# What do you think of this dosage of Xifaxan?



## nw0528

I just returned from my GI's office. My breath test for hydrogen was extremely high and I am going to be treated with Xifaxan for SIBO. However, after reading Dr. Pimentel's book, I was shocked by the regimen my doctor ordered. I am to take three 200mg tablets for THREE DAYS. I questioned this. I said I had read it was 1000 mg for 10 days (Cedars Sinai Protocol) and my dr. opened up the drug leaflet and it clearly says for Traveler's Diarrhea 200 mg. three times a day for three days. Hmmm... I wasn't sure where to go from there. Certainly I'll take it for the 3 days, but I am not hopeful it will work in that short course. And, if it doesn't, perhaps my dr. will just say it must not have been SIBO. I specifically asked that we repeat the hydrogen breath test after the antibiotic was done and he said that would be interesting...but didn't seem familiar with Pimentel's protocol at all. (I live on the East Coast, so no hope of going to Cedars Sinai.) I'm interested in what people think...should I find a new GI? (I otherwise love mine.) or just take the 3 days and see what happens...As a side note, my doctor said some people cannot tolerate the xifaxan because of severe diarrhea and if that happens to me I should discontinue use. It's only three days... I'm curious what other people's experiences have been while on Xifaxan.Thanks!Nicole


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## MollyB

Xifaxan makes me constipated and gives me horrible gas. My dosage was 200 mg twice a day for a week.


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## nw0528

Molly,Did the Xifaxan elimate your SIBO???Thanks,Nicole


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## frantic1980

DO NOT take Rifaximin for 3 day....absolutely not, it would be a complete waste of time. You need to take it for at least 10 days to clear it up.... in fact the only people I have seen on this forum to get rid of it completely without relapse have taken it for 21 days. I've been on Rifaximin 5 times now... the first three 7 days, 10 days, 14 days I had good results but it came back within a week. Now rifaximin doesn't really have much effect on me as I think the bacteria have become resistant.Rifaximin is an amazing drug and it could cure you, but like all antibiotics you may become resistant to it after 2-3 uses. Don't waste this opportunity on a 3 day dose!!! Get your GP to give you the same dose but for 10-21 days - you've got nothing to lose but cost: its non-systemic so doesn't get absorbed into the bloodstream so lacks the risk of other antibiotics. I would strongly suggest also taking natural anti-microbials as well like Grapefuit seed extract (I get it on ebay and I am having good results) Garlic tablets (odourless of course) and peppermint oil. This is because antibiotics stop the bacteria from breeding and leave your immune system to kill it, but taking grapefruit seed extract, garlic etc will directly kill the bacteria. So its a multi-pronged attack. Also remember to take rifaximin with meals - it only kills the bacteria while they are feeding. its like posioning a rat - you need to bait the poison with something.


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## IanRamsay

hiThat is a very strange dosage to be given. ask your doctor why. also dont forget to take a strong probiotic while you are taking teh course and continue to take it for a few months after you have finished. find a multi strain probiotic with as many strains in it as you can.here is some general info on taking probiotics so you can get th best from them.the following strains have teh most research behind them in IBS studies with good positive outcomes in studies.L. bulgaricus, L. reuteri, L. plantarum, L. casei, B. bifidus, S. salivarius, and S. thermophilus and the yeast Saccharomyces boulardii. THERE ARE MANY MANY OTHERS though!here is some general info on taking them, if you dont already know it!They are best taken in the morning on an empty stomach, 30 minutes before food. ideally they should be taken for at least 3 weeks as it may take that long to see any results. although some people have a very good reaction in days. after 2 to 3 months they should be stopped for a while. if after a few days you start to notice that you can feel a physical difference or a worsening of your symptoms, start taking them again. other wise, there is no need to continue taking them untill you feel that you do need them. there isnt any harm in taking them as a permanant suppliment if they are taken is small numbers like in actimel or activia yoghurt, but if you are taking 10 billion cultures a day, it is good to give the body a break every now and then.also If at all possible, replace the FOS prebiotic with natural fruit and veg if you can tollerate it. FOS can play hell with the tummy in some people while it dosent bother others.After you start to take the probiotics, you may feel initially worse for a day to a week or so. this is called the herx reaction and unfortunately is perfectly normal. (Google it to get more detailed info). some people are not affected by herx and some are.if it gets too much though, just stopp teh probiotics for a few days and re start them at a half dose for a two weeks, then a three quarter dose for two weeks and then the full dose, and see how you get on with that.cheersIan


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## nw0528

Ian,Thanks for the probiotic info. What is FOS?Nicole


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## nw0528

Ian,I forgot to say that when I asked my GI about the dosage he said Xifaxan is FDA approved for Traveler's Diarrhea and the dosage is 200 mg. three times a day for three days. I asked about 1000 mg for 10-14 days for SIBO, but he pointed to the drug info. leaflet and said it is not FDA approved for that!I did call my GP but she will not order this med. for longer than my GI did. She said this is his specialty and he makes the call here.I'm thinking I need a second opinion from another GI...Nicole


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## IanRamsay

hiyou should definately get a second opinion, as any doctor that has to refer to the manufacturers leaflet should be viewed with caution.FOS is food for bacteria, both good and bad.cheersIan


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## frantic1980

DO NOT TAKE PROBIOTICS WITH RIFAXIMIN!I'm sorry ian but I very very strongly disagree your advice on this...The small intestine unlike the large intestine is Sterile (or almost sterile - less than 1000 Bacteria per ml of fluid). Digestion in the small intestine is based on Acid and enzymes - not bacteria!! What's is left over in your food after passing through the small intestine gets broken down in the large intestine by bacteria, where the majority of the bacteria reside (1,000,000,000 per ml --- 1 Billion bacteria per milliliter!). If you take probiotics with rifaximin you are basically crowding your small intestine with good bacteria when you want the rifaximin to focus on the bad bacteria that is causing your SIBO. Imagine trying to catch rats in a big room - is it easier to catch the rats in a room packed full of friendly hamsters..... or an empty room with just the rats on their own?Let the rifaximin work on the bad stuff - it will kill any type of bacteria good or bad.... so there's no point supplementing with probiotics while you're taking rifaximin, you're just making it more difficult to catch the rats.A lot of people get relief from Small Intestine Bacterial Overgrowth by taking loads and loads of probitics. Flooding the small intestine with good bacteria temporarily 'overruns' the bad bacteria. The good bacteria don't produce the toxins so things improve. But bacteria aren't supposed to digest food in the small intestine - so although things are somewhat improved (no toxins) you still get the bloating (bacteria produce gas) and you still get hungry all the time (the bacteria are eating your food, not you). This isn't how the small intestine is supposed to work!! Yes it gives relief but its not solving the problem.To cure SIBO you are trying to re-sterilize your small intestine - good bacteria won't help you get rid of the bad stuff.... you want Zero bacteria in your small intestines... although there is always a little.There may be some merit in taking probiotics AFTER rifaximin but absolutely not during. Let the rifaximin focus on the rats - it doesn't need a room full of friendly hamsters to kill too!


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## david1965

i am about to start rifaximin. from what i have read i need to do 2 tablets (200mg each) 3 times a day for at least 10 days. is that correct? also, from what i've read from your postings i should not take any probiotics until the prescription is finished, rather take the prescription with greatfruit seed extract, garlic tablets and pepermint oil. is that all correct. as well i should take the prescription just before eating and then take the greatfruit extract, garlic and peppermint oil after eating. let me know if there is anything else i should be doing or taking as you seem extremely knowledgeable and i am finding it difficult to find anyone (doctors included) that have any experitize in the area of ibs (at least in canada). thank you


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## david1965

also, my problem stems i think from the fact that i took advil like it was candy for years to relieve sports injuries. stumach cramps and bloating started about 6 months ago. so, i think my stumach lining got worn down and bacteria got into my lower intestine. as i said i am about to start rifaximin with anti-microbials. i will follow it up with probiotics. i understand fishoil is good for the stumach lining. when should i begin taking this type of supplement?


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## selly75

Hi,My breath test is positive so I am going to take Xifaxan again. I took it 3 months ago for 6 days only. Improvement was slightly noticable.Now it is confirmed that I have SIBO.Please can you suggest the best bdose of Xifaxan. I was thinking about 1200 mg for 14 days. Will it be enough to get rid of SIBO?Also another matter. I took my previous dose between meals. Maybe it is better to take it with meals?I would appreciate quick answer because I am going to see my doctor on Friday 26/8.Thanks.


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## harmoiny

> DO NOT TAKE PROBIOTICS WITH RIFAXIMIN!I'm sorry ian but I very very strongly disagree your advice on this...The small intestine unlike the large intestine is Sterile (or almost sterile - less than 1000 Bacteria per ml of fluid). Digestion in the small intestine is based on Acid and enzymes - not bacteria!! What's is left over in your food after passing through the small intestine gets broken down in the large intestine by bacteria, where the majority of the bacteria reside (1,000,000,000 per ml --- 1 Billion bacteria per milliliter!). If you take probiotics with rifaximin you are basically crowding your small intestine with good bacteria when you want the rifaximin to focus on the bad bacteria that is causing your SIBO. Imagine trying to catch rats in a big room - is it easier to catch the rats in a room packed full of friendly hamsters..... or an empty room with just the rats on their own?Let the rifaximin work on the bad stuff - it will kill any type of bacteria good or bad.... so there's no point supplementing with probiotics while you're taking rifaximin, you're just making it more difficult to catch the rats.A lot of people get relief from Small Intestine Bacterial Overgrowth by taking loads and loads of probitics. Flooding the small intestine with good bacteria temporarily 'overruns' the bad bacteria. The good bacteria don't produce the toxins so things improve. But bacteria aren't supposed to digest food in the small intestine - so although things are somewhat improved (no toxins) you still get the bloating (bacteria produce gas) and you still get hungry all the time (the bacteria are eating your food, not you). This isn't how the small intestine is supposed to work!! Yes it gives relief but its not solving the problem.To cure SIBO you are trying to re-sterilize your small intestine - good bacteria won't help you get rid of the bad stuff.... you want Zero bacteria in your small intestines... although there is always a little.There may be some merit in taking probiotics AFTER rifaximin but absolutely not during. Let the rifaximin focus on the rats - it doesn't need a room full of friendly hamsters to kill too!


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## harmoiny

Wow! Thank you for answering my "dilemma" question. My compassionate by unknowledgeable MD did prescribe RIFAXIMIN to my surprise! I showed him an article from Mt. Sinai. I honestly thought this would be my long awaited saving grace salvation to this awful "so called syndrome", IBS that is. I've been suffering with since 1996. I have been diagnosed with every GI disorder under the sun with one exception "colon cancer". My Mom who just passed away had Stage #4 diagnosed one year ago. Back in Dec ’97, I went to the ER because I could not take the pain anymore. This after being tested for everything from A-Z. The pain in my left side would stop me dead in my track. No one in “my” medical world ever even thought that I had divictercolitis. I had 8” of my infected colon removed and my sigmoid colon was resected. After I recovered, began feeling sick again. Back in those days, it was called “ulcerative colitis”. I remember back then being hospitalized a few times for this condition and was given IV antibiotics and narcotics. I've been suffering for so long that I cannot remember what antibiotics were used or how long I felt better. For the past 10 years, I have been taking "Oxycodone" of which I swear by. But I think I am becoming immune to same dosage. Getting them is like asking to see the Pope!My main complaint is “I can't take the PAIN". During the past year, I have been very ill with which is now known as IBS C (occasionally), but mostly D. I have been obsessed with researching and happy I found this IBS support group. As I said, I was SO EXCITIED to see the Mt. Sinai video on RIFAXIMIN on www.webmd.com. The lady being interviewed was "crying" from the start. Boy, do I know what that's like. My excitement about XIFAXAN (generic for RIFAXIMIN!) quickly diminished when I got the prescription filled and read the informational pamphlet that came with it. It can cause C. Diff !!!! Of which, I am scared to death of. My youngest brother almost died from this dreaded condition. I plan on discussing my rampant family history of GI disorders at a later time.A month has gone by and I haven't started the antibiotics with causes yet more diarrhea. I have been torn trying to figure out if I should give it a try. I have reviewed more good (short term) results than bad. You answered my question concerning "Align Probiotics". I was going to take both at the same time thinking it would help me not get the C-Diff. I've made my decision... I am going to take my 10 day (550mgx2) antibiotic program. I will be following up with Align that has the “B” good bacteria. Any relief is better than none, I pray to God, in Jesus name. This IBSyndrome has made me old, tired and now malnutritioned. I am dealing with IBS, Diabetes, Fibromyalgia, OCD/Anxiety disorders and of course depression. As far as meds, you name them, I’ve been prescribed them. One note of caution: My last experience with an antibiotic (Amoxicillin). I got Candida Thrush of the mouth! Prescribed for a tooth abscess. OMG, now that was a new one. With any antibiotics, ask “upfront” for prescription for possible yeast infection. I WANT MY LIFE BACK!


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## BQ

Just to be clear:


> This IBSyndrome has made me old, tired and now malnutritioned.


IBS doesn't cause malnutrition. Undereating or skipping meals might as well as other GI conditions which usually impact the small intestine.... like SIBO. But SIBO and IBS are two different things.Hope your new meds and the follow up Align help you!


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## pete2674

I went to my gastro doc today and prescribed me Xifixan for 2 weeks at 550mg twice a day. Then after he wants me to drink a colon cleansing prep. Then do probiotics for 30 days (align). I'm going to start taking it tonight. What is the most common side effect of the drug?


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