The Use of Rifaximin for IBS
There are a variety of treatment options for irritable bowel syndrome (IBS). One that is becoming more common is the use of the antibiotic, rifaximin. The purpose of this article is to simply break down why this medication is commonly used, what it does, and what to consider if choosing to take it.
This is not reflective of my personal opinion or representative of what I would recommend to my IBS clients. Instead, this is purely a translation of the research so that you can decide what to do with your healthcare professionals.
What is IBS?
Before we talk about how the medication works, it’s important to understand IBS. IBS is a functional gut-brain disorder characterized by changes in the function of the digestive system and altered gut-brain communication.
The most common symptoms include bloating, abdominal pain, gas, diarrhea and/or constipation. It is one of the most commonly diagnosed gastrointestinal illnesses and is prevalent in 10-15% of the population. The diagnosis for IBS is based on symptoms, which means the diagnostic process can be a bit difficult and a diagnosis can many times overlap with other conditions, or be a misdiagnosis.
There is no single cause, but the most common causes are thought to be chronic stress, changes to the microbiome (various causes for this), and infection. Currently there is no cure, but symptoms are typically managed through dietary changes, lifestyle changes, and/or medication/supplement use. To learn more about what IBS is, read this article.
Pros of taking Rifaximin
Rifaximin is a synthetic (man-made) antimicrobial agent that is poorly absorbed. It’s a broad-spectrum agent that targets microbes in the gut. Due to rifaximin’s high bile solubility, it is most active in the small intestine and is less active in the large intestine (colon).
This is a good thing because our microbiome lives in the large intestine. The problem with most antibiotic use is that it can wipe out our microbes, which can lead to an altered immune system and an issue we call dysbiosis, which refers to a poor makeup of microbes. Dysbiosis is one of the major issues we see with IBS.
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Because rifaximin targets the small intestine, it is most commonly used for the treatment of small intestinal bacterial overgrowth (SIBO). SIBO is a condition where the bacteria from the large intestine make their way into the small intestine, leading to an increase in fermentation in the small intestine that can lead to painful bloating, abdominal distention, and foul-smelling gas. For some, this can also result in diarrhea.
Some causes of SIBO include chronic constipation, injury or surgery to the gut, and the use of certain medications. For more info on SIBO, check out this article.
In addition to treating SIBO, rifaximin has also been shown to be an effective treatment for travellers’ diarrhea and diarrhea predominant IBS (IBS-D). In studies, this has been shown to reduce symptoms of recurrent diarrhea, gas, pain, and bloating.
It’s not clear if these results show that a bacterial overgrowth was present for these patients, but some studies suggest that those with IBS-D may have larger quantities of bacteria in the small intestine. We still have more to learn about this and how to detect overgrowth in order to treat IBS more effectively.
Rifaxamin’s course of treatment varies depending on the reason for taking it. Typically, it’s taken for 3 days for travelers’ diarrhea, 2 weeks for IBS, and 10-14 days for SIBO. For IBS, rifaximin may be used frequently as it does not seem to pose a risk for bacterial antibiotic resistance. This would be prescribed by your doctor.
Cons of taking Rifaximin
The biggest problem with rifaximin is the cost. It can be very expensive and while insurance does cover some of the cost, there are typically many restrictions to getting it covered. This can lead to longer wait times to start the medication and may present as a barrier to those who aren’t able to pay the copay or don’t have insurance.
Another issue is that the long term effects of chronic rifaximin use are not clear. Some studies report an increased risk for fungal or bacterial infections, including clostridium difficile (c-diff). Other studies report no adverse side effects, and claim it is safe for chronic use. Evidence appears to suggest no risk for liver injury or toxicity.
The known side effects are gas, diarrhea, rectal tenesmus, nausea, headache, dizziness, fatigue, swelling in the hands or feet, and abnormal liver function tests. These should be discussed with your doctor.
Potential short and long term effects of the use of any medication should always be discussed with your doctor so that you can be confident in the choice you make.
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