Xifaxan interactions: Alcohol, medications, and other factors

Before you start treatment with Xifaxan, tell your doctor and pharmacist which prescription, over-the-counter, and other medications you take. By sharing this information with them, you may help prevent possible interactions. (To learn whether Xifaxan interacts with supplements, herbs, or vitamins, see the “Xifaxan and other interactions” section below.)

If you have questions about drug interactions that may affect you, ask your doctor or pharmacist.

Here’s a table of drugs that can interact with Xifaxan. Keep in mind that this table doesn’t include all drugs that may interact with Xifaxan. Some of these interactions are described in detail just below in “Drug interactions in depth.”

In some cases, factors or conditions could prevent your doctor from prescribing Xifaxan due to the risk of harm. These are known as contraindications. They include:

Having had an allergic reaction to Xifaxan, any of its ingredients, or similar drugs

If you have had an allergic reaction to Xifaxan or any of its ingredients, your doctor will likely not prescribe Xifaxan. Taking the drug could cause another allergic reaction. You can ask them about other treatments that may be better choices for you.

Xifaxan belongs to a class of drugs called rifamycin antibiotics. If you’ve had an allergic reaction to other drugs in this class, such as rifampin (Rifadin, Rimactane) or rifabutin (Mycobutin), your doctor will likely not prescribe Xifaxan. If you’ve had a past allergic reaction to these similar drugs, taking Xifaxan could cause another allergic reaction.

Note: Before you start treatment with Xifaxan, it’s important to tell your doctor if this contraindication applies to you. They can determine whether to prescribe Xifaxan.

There aren’t any known interactions between Xifaxan (rifaximin) and alcohol. However, your doctor may advise you to avoid or limit alcohol consumption during treatment.

This is because drinking alcohol while taking the drug may worsen some of Xifaxan’s side effects. For example, you may experience:

• nausea
• headache
• dizziness

If you consume alcohol during Xifaxan treatment, these side effects may be more likely to occur.

Alcohol can also worsen the condition you’re receiving Xifaxan to treat. For example, if you’re taking Xifaxan to help prevent hepatic encephalopathy, drinking alcohol can trigger an episode of it. Drinking alcohol can also worsen symptoms of traveler’s diarrhea and IBS-D.

If you have questions about drinking alcohol while taking Xifaxan, talk with your doctor.

Here’s a closer look at certain drug interactions of Xifaxan.

Certain antifungals

Antifungal drugs are used to treat fungal infections. Some of these drugs can interact with Xifaxan.

Interaction result: Taking certain antifungals with Xifaxan can raise your risk of Xifaxan side effects. For details about Xifaxan’s side effects, see this article.

Interaction explained: Certain antifungals reduce the action of a protein that helps clear Xifaxan from your body. Taking one of these antifungals with Xifaxan can make Xifaxan build up in your body. A higher level of the drug can increase your risk of side effects.

If you have liver problems, you may have a higher risk of Xifaxan side effects if you take certain antifungals with Xifaxan.

Examples of antifungal drugs: Here are some antifungals that may interact with Xifaxan:

• itraconazole (Sporanox)
• ketoconazole
• posaconazole (Noxafil)

Steps you or your doctor may take: If your doctor prescribes Xifaxan with one of the antifungals listed above, they may monitor you more closely for Xifaxan side effects.

Talk with your doctor if you have bothersome side effects while taking these medications together.

If you have questions about taking Xifaxan with an antifungal medication, talk with your doctor or pharmacist.

Cyclosporine (Neoral, others)

Cyclosporine is a drug that weakens your immune system. It’s prescribed to help prevent rejection of organ transplants. It’s also prescribed for certain autoimmune conditions, such as rheumatoid arthritis and psoriasis.

Interaction result: Taking cyclosporine with Xifaxan can increase your risk of Xifaxan side effects.

Interaction explained: Cyclosporine reduces the activity of a protein that helps remove Xifaxan from your system. As a result, taking cyclosporine with Xifaxan can cause Xifaxan to build up in your body. This can increase your risk of side effects.

If you have liver problems, you may have a higher risk of Xifaxan side effects if you take cyclosporine with Xifaxan.

Steps you or your doctor may take: If your doctor prescribes these drugs together, they may monitor you more closely for Xifaxan side effects.

Talk with your doctor if you have bothersome side effects while taking these medications together.

If you have questions about taking Xifaxan with cyclosporine, talk with your doctor or pharmacist.

Warfarin (Jantoven)

Warfarin is a blood thinner prescribed to treat and help prevent blood clots. There have been reports of this drug interacting with Xifaxan.

Interaction result: Taking Xifaxan with warfarin may make warfarin less effective. Or it may increase the risk of bleeding with warfarin.

Interaction explained: Xifaxan may change the blood-thinning effect of warfarin, but the interaction is not fully understood. If Xifaxan decreases warfarin’s effect, this can raise your risk of blood clots. But if it increases warfarin’s effect, this can raise your risk of bleeding.

Steps you or your doctor may take: If your doctor prescribes Xifaxan with warfarin, they’ll likely order frequent blood tests to check your international normalized ratio (INR). INR is a measure of how long it takes your blood to clot. It’s used to monitor the effect of warfarin on your body.

If needed, your doctor may adjust your warfarin dosage based on your INR.

If you have questions about taking Xifaxan with warfarin, talk with your doctor or pharmacist.

Here are some frequently asked questions about Xifaxan and possible interactions.

Can I take omeprazole with Xifaxan?

Yes, you can usually take omeprazole (Prilosec) with Xifaxan. Omeprazole is used to treat conditions caused by excess stomach acid, such as indigestion, heartburn, and stomach ulcers.

Omeprazole is not known to interact with Xifaxan.

If you have questions about taking these drugs together, talk with your doctor or pharmacist.

Can you take antacids with Xifaxan?

Yes, you can usually take antacids with Xifaxan. Antacids are used to treat indigestion and heartburn. Examples include calcium carbonate (Tums) and aluminum hydroxide/magnesium hydroxide (Mylanta).

Antacids can affect many other drugs, but they’re not known to interact with Xifaxan.

If you have questions about taking these drugs together, talk with your doctor or pharmacist.

Xifaxan may have other interactions, such as with supplements, foods, vaccines, or even lab tests. You’ll find details below. Keep in mind that the following information does not include all other possible interactions with Xifaxan.

Xifaxan and supplements

It’s possible for drugs to interact with supplements such as vitamins and herbs.

Xifaxan and herbs

There are no specific reports of herbs interacting with Xifaxan. However, that doesn’t mean herbal interactions won’t occur or be recognized in the future. Because of this, it’s important to check with your doctor or pharmacist before taking any of these products during Xifaxan treatment.

Xifaxan and vitamins

There are no specific reports of vitamins interacting with Xifaxan. However, that doesn’t mean vitamin interactions won’t occur or be recognized in the future. Because of this, you should talk with your doctor or pharmacist before taking any vitamin product with Xifaxan.

Xifaxan and food

There were no reports of food interactions with Xifaxan. If you’d like to learn more about eating certain foods during treatment with Xifaxan, talk with your doctor.

Xifaxan and vaccines

There aren’t any known interactions between Xifaxan and vaccines. You can talk with your doctor or pharmacist to see whether you’re due for any vaccines.

Xifaxan and lab tests

Xifaxan isn’t known to interact with any lab tests. If you have concerns about this medication interacting with lab tests, talk with your doctor.

XIFAXAN INTERACTION WITH CANNABIS OR CBD

Cannabis (often called marijuana) and cannabis products, such as cannabidiol (CBD), have been specifically reported to interact with Xifaxan.

Cannabis reduces the action of a protein called P-glycoprotein (P-gp), which helps clear Xifaxan from your body. As a result, using cannabis with Xifaxan can make Xifaxan build up in your body. This can increase your risk of Xifaxan side effects. If you have liver problems, you may have a higher risk of Xifaxan side effects if you use cannabis with Xifaxan.

Before you start treatment with Xifaxan, tell your doctor and pharmacist if you use cannabis. By sharing this information with them, you may help prevent possible interactions.

Note: Cannabis is illegal at a federal level but is legal in many U.S. states to varying degrees.

Certain medical conditions and other factors may increase the risk of interactions with Xifaxan. Before you take this drug, be sure to talk with your doctor about your health history. Xifaxan may not be the right treatment option if you have certain medical conditions or other factors affecting your health.

Health conditions or factors that might interact with Xifaxan include:

• Severe liver problems: If you have a severe liver problem, Xifaxan can build up in your body. This can raise your risk of side effects from the drug. Your doctor may monitor you more closely while you’re taking Xifaxan.
• Allergic reaction: If you’ve had an allergic reaction to Xifaxan, any of its ingredients, or other rifamycin antibiotics, your doctor will likely not prescribe Xifaxan. For more information, see the “When to avoid Xifaxan” section above.
• Breastfeeding: It’s not known whether it’s safe to use Xifaxan while breastfeeding. There isn’t enough information to determine whether the drug passes into breast milk or what effects Xifaxan may have on a child who is breastfed. If you’re breastfeeding or planning to, talk with your doctor before taking Xifaxan. They can talk with you about treatment options and ways to feed your child.
• Pregnancy: There haven’t been enough clinical trials to determine whether Xifaxan is safe to use while pregnant. Animal studies show that the drug may cause congenital anomalies (commonly known as birth defects). However, it’s important to note that animal studies don’t always indicate what may happen in humans. If you’re pregnant or planning to become pregnant, tell your doctor before starting Xifaxan. They can advise you on the right treatment plan for you.

You can take certain steps to help prevent interactions with Xifaxan. Your doctor and pharmacist are key resources, so reach out to them before starting treatment. They can advise you on what to avoid while taking Xifaxan. For example, you should plan to do the following:

• Let them know if you drink alcohol or use cannabis.
• Tell them about any other medications you take, as well as any supplements, herbs, and vitamins.
• Create a medication list, which your doctor and pharmacist can help you fill out.

It’s also important to read the Xifaxan label and other paperwork that may come with the drug. The label may have colored stickers that mention an interaction. And the paperwork, sometimes called the medication guide or patient package insert, may contain details about interactions.

If Xifaxan doesn’t come with paperwork, you can ask your pharmacist to print a copy. If you need help reading or understanding this information, ask your doctor or pharmacist.

You can also help prevent interactions with Xifaxan by taking it exactly as your doctor prescribes.

Disclaimer: Medical News Today has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or another healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.