Rifaximin (Xifaxan) Antibiotic Used to Treat Crohn's

Rifaximin

I came across a drug called Rifaximin (Xifaxan) via a post about IBD drugs in the pipeline in the About.com IBD blog.

The drug has been around and used for over 20 years to treat travelers' diarrhea. The drug is an antibiotic that works exclusively in the GI tract and does not enter the bloodstream. Here's the excerpt from the About.com blog that comments on its efficacy:

Rifaximin (Xifaxan) is currently being studied for use in treating severe Crohn’s disease. This drug, manufactured by Salix Pharmaceuticals, is an antibiotic currently approved for use in traveler’s diarrhea. Rifaximin is not absorbed into the bloodstream like other antibiotics, but instead affects the digestive tract directly. The theory is that intestinal bacteria may have a connection to the inflammation in Crohn’s disease, and an antibiotic may be effective if it kills these bacteria.

In a 16-week study of rifaximin, 78 percent of the patients with Crohn’s disease experienced an improvement in their disease, and 59 percent went into remission.

This drug is also being studied for use in treating pouchitis, a complication that can occur after j-pouch surgery. In one study, 11 patients for whom other therapies had failed received either 400 mg of rifaximin twice a day or 200 mg three times a day -- both groups showed improvement.

I investigated the efficacy of this drug a bit more in terms of its use for Crohn's. I came across a website where folks post their experiences with drugs. There were two pages that were relevant, one for primary treatment of Crohn's and the other (with more responses) regarding maintenance of Crohn's.

From reading through the reviews, it appears that the drug provides quick relief of symptoms, but that relief appears to be temporary if you stop taking the drug (and even if you continue taking it). One person, for instance, went on a regimen combining Xifaxan, probiotics, and Boswellia serrata. Here's an excerpt from that person's experience I thought was worth capturing:

Xifaxan for Crohn's I take this med for Crohn's disease, my doc is trying it although it isn't a "recognized" Crohn's drug yet. I take 2-200mg pills twice a day. It is very easy to take, coated tablets do not taste bad although they are on the larger side. I do not feel nauseous on them or anything, no side effects at all. Can be taken with or without food. After 24 hrs on this (two doses) I had my first solid "BM" in a very long time, it worked like a charm. It continued to work for 4-5 days when I started getting BMs more frequently and less solid. I realized that this is probably killing off the good bacteria so I started supplementing with a several-strain probiotic which has helped (I take the probiotics between the doses of Xifaxan, not at the same time which would be useless).

One huge drawback of this medicine is the cost. My insurance has told me they won't cover it, so I am in the process of appealing that and hopefully they will cover it because a one month's supply costs $1100.00. Nope I'm not kidding. There is no generic.

Overall I think it has done me some good and hopefully my results will continue to be positive. Looking forward to reading about other people's experiences with this drug.

**Update 6/26/05

I have continued taking this drug along with Boswellia serrata capsules, probiotics, and a multivitamin and as of 2 days ago I was officially in remission! I am very pleased with the results and would encourage others to try it. Please read my rating on boswellia too because I truly believe that boswellia had a big impact on my remission as well as this antibiotic. Also, my insurance did eventually cover the entire cost of this medicine but my dr had to send a letter before they would do it.

Another person combined use of the Xifaxan with the Specific Carbohydrate Diet and probiotics and seemed to have positive results as well:

I was diagnosed with Crohn's disease in 2002. Since then I have tried just about everything to cure myself of this disease. Through my journey I have discovered that the Specific Carb Diet combined with a course of Xifaxan and high quality six strain probiotics (powder form) from customprobiotics.com has put me very close to remission. The first few days in Xifaxan caused severe painful bloating (die off of the bad bacteria) and then I was ok. You must stay way from bad carbs (ie. sugar, bread, cereal) and dairy if you want to get well.

The drug, combined with other regimens, certainly appears to have promising results and hence warrants further investigation. However, the use of antibiotics long-term is rather disconcerting to me. My assumption is that you need more than just a few strains of probiotics in your intestines to be really healthy (e.g. creation of Vitamin K). Can you really live your entire life taking antibiotics?