# Xifaxan question



## G.G.

Hello, I am 23 years old and have had IBS for around 8 years now. I have been on anti-depressants, anti-spasmodics, zelnorm, amitiza and many other random things I've hoped would work. About a year ago I took amoxicillan for an infection and within two days on the antibiotic my IBS was so much better that I went back to the doctor asking for more, of course they didn't give me any but then recently I heard of the "wonder drug antibiotic rifaximin" and was super excited that this might be the right thing for me. First of all, before I started taking the xifaxan, I felt that as long as I ate right and followed a strict schedule I could keep my IBS pretty much under control. Except for the gas, which I heard xifaxan had a good record of eliminating. So my doctor gave me a prescription for the very expensive xifaxan and I began taking it a week and a half ago, a 200mg pill 3 times a day for 3 weeks. Well, I am now much much worse no matter if I eat right or not. The pain is worse, the aching is worse, I have to go the bathroom after everything I eat and I never feel relieved. I've also been having really bad anxiety with my heart racing and feeling like I'm going to pass out, not sure if this is related to the xifaxan or not. But my question I guess therefore is, is this worseness of my IBS normal? For those of you who have taken this antibiotic does it take the full course of treatment to see and feel the improvements, does it get worse before it gets better? Or should I have felt some improvement by now, meaning this is not the right treatment for me and I should quit taking it? Thanks!


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## frantic1980

That's a very low dose of Rifaximin, and I wouldn't expect it to do anything for me. I've taken 3 times that much 3x200mg tablets 3 times a day with good results... Have you got IBS-D or IBS-C. As far as I know Rifaximin is good for D, but Neomycin (another non-systemic antibiotic) is better for C. Either way I think you should be on a much higher dose or Rifaximin.However last few times I have been on Rifaximin, I did get bad D while I was on it which cleared up when it went away. I figure the Rifaximin was killing the good bacteria in my colon as well as the bad in my small intestine. However, although the diareeah was temporarily worse, all the cramping, bloating, being hungry all the time, went away. Rifaximin has been less effective the last few times i've taken it. I have taken it with Neomycin the last few times. Each time things are great a few days after stopping then return to bad in about a week!


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## frantic1980

Forgot to mention.....Always take Rifaximin with food - it only kills the bacteria while they are feeding (half way through a carb-rich meal is best). Furthermore, if you have previously cut things out of your diet because they worsened your SIBO symptons (Milk/Gluten for me) - start eating these again while you are on the Rifaximin - give the bacteria PLENTY to feed on. its a bit like trying to poison a rat - you got to bait the posion with something before the rat will eat it. Low carb diets make SIBO symptoms improve, but when you are trying to kill the bacteria you want them to be feeding for the Xifaxan to work. But stop eating them again when you finish the course of Rifaximin, and introduce them slowly when you feel that the rifaximin course has worked.


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## G.G.

Thanks for all the good advice! I didn't know about neomycin but I'll mention it to my doctor. I have always had a combination of D and C so I'm not sure which would be best. I actually quit taking the rifaximin the other day because I was feeling so bad, but what you said made since, so perhaps I should try it again. Also, I have never actually been tested for SIBO so I'm not sure if this is even the route for me. I just heard rifaximin was good for IBS and my doctor gave me the prescription! So you took 3 pills 3 times a day and you noticed improvement of the cramping and bloating within how long after beginning the pills? I suppose I didn't give the pills long enough but they really made everything so much worse that I freaked out and quit! Anyway, thanks again for all your help!


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## frantic1980

Things improved for me within a day or two.... Regardless of the dosage through; I don't think Rifaximin should be making your symptoms WORSE at all. Even a small dose should provide some improvement. Neomycin and Rifaximin combined should be a good option I think. While I am on them my symptoms are loads better and for a week after I have perfect digestion but it keeps coming back. I am not sure what the secret is.This time (half way though my current dose) I am going to drink plenty of grapefruit seed extract when I finish to try and keep my small intestine sterile and acidic like it should be, not sure if it will work, its just an idea at the moment, but I will post back with my results.


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## kpdefina

frantic1980 please respondI am thinking of combining Neomycin with Rifaximin and was wondering what dose of each you would recommend, I am IBS-C. PEDRO


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## frantic1980

God I'm definitely no expert on this; and certainly not qualified to be prescribing drugs/dosages to people. I took 400mg Rifaximin 3 times a day and 1000mg of Neomycin 3 times per day. I would recommend seeking professional medical advice though - i'm no doctor.Neomycin always worsens my diareeha while I am on it; its known to have more side effects than Rifaximin, but things will return to normal within 2 days after stopping it.I know that people give contradicting advice on probiotics here; but I strongly believe that staying away from probiotics and yoghurt is the best thing you can do for yourself when treating SIBO - unless you're taking probiotics rectally via colonic hydrotherapy or something


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## kpdefina

Thanks for your advice, I was always going to be guided by my doctor, just interested to know what you or others have done with regards to combining these two drugs.kpdefina


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## UrbanUrbane

Hi - I see this post is a few months old, but frantic1980 - I'm intrigued by your advice above re: eating carbs whilst taking Xifaxan and I just had to ask for clarification on this. Forgot to mention.....Always take Rifaximin with food - it only kills the bacteria while they are feeding (half way through a carb-rich meal is best). Furthermore, if you have previously cut things out of your diet because they worsened your SIBO symptons (Milk/Gluten for me) - start eating these again while you are on the Rifaximin - give the bacteria PLENTY to feed on. its a bit like trying to poison a rat - you got to bait the posion with something before the rat will eat it. Low carb diets make SIBO symptoms improve, but when you are trying to kill the bacteria you want them to be feeding for the Xifaxan to work. But stop eating them again when you finish the course of Rifaximin, and introduce them slowly when you feel that the rifaximin course has worked. I've read Pimentel's book and done tons of research on SIBO, as well as taken Rifaximin myself several times. This makes no sense to me and I'd love clarification, thanks so much!


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## Moises

UrbanUrbane said:


> Hi - I see this post is a few months old, but frantic1980 - I'm intrigued by your advice above re: eating carbs whilst taking Xifaxan and I just had to ask for clarification on this. Forgot to mention.....Always take Rifaximin with food - it only kills the bacteria while they are feeding (half way through a carb-rich meal is best). Furthermore, if you have previously cut things out of your diet because they worsened your SIBO symptons (Milk/Gluten for me) - start eating these again while you are on the Rifaximin - give the bacteria PLENTY to feed on. its a bit like trying to poison a rat - you got to bait the posion with something before the rat will eat it. Low carb diets make SIBO symptoms improve, but when you are trying to kill the bacteria you want them to be feeding for the Xifaxan to work. But stop eating them again when you finish the course of Rifaximin, and introduce them slowly when you feel that the rifaximin course has worked. I've read Pimentel's book and done tons of research on SIBO, as well as taken Rifaximin myself several times. This makes no sense to me and I'd love clarification, thanks so much!


If I remember correctly, Pimentel does address this indirectly in his book. He strongly warns against doing Xifaxan at the same time you are doing the elemental diet.


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## faze action

*frantic1980 *That's interesting that you say always take rifaximin after (or during ) a meal. When I was taking the drug I found that I had much worse side effects (bloating, cramps, gas) if I took my dose anywhere near a meal. I had to take it either 30 minutes prior to eating, or wait until about 90 minutes had passed if I had already eaten. I also had what I assume to be a reaction to it when I was 8 days into a 10 course. I bloated severely within 10 minutes of taking a pill, and about 30 minutes later I had a sensation of pressure around my neck and throat. Not sure if you have ever heard of this before? I mentioned it to my doctor, but he didn't seem to have much input beyond telling me to discontinue the drug.BTW, my diarrhea was completely cured about 48 hours into my course, so it works GREAT other than those side effects...(I fear thta I may need another course of ABs at some point though).


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## UrbanUrbane

Moises said:


> If I remember correctly, Pimentel does address this indirectly in his book. He strongly warns against doing Xifaxan at the same time you are doing the elemental diet.


He also outlines a diet that you should follow while taking the course, and outside of allowing white carbs, which he feels are safe for the majority of SIBO-sufferers, his diet is a lower-carb, low-residue and lactose-free diet. This is quite different from just going wild and eating all kinds of sugar, carbs, lactose, etc. while taking the meds. I guess we're all different, and this may be okay for some (it is NOT for me) but that's not a basis for recommending it to anyone and I believe its a misreading of Pimentel to say that he recommends this.


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## UrbanUrbane

Sorry, correcting for a double post.


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