Xifaxan and alcohol: can they be used together?

Medically reviewed by  Jamie Winn, PharmD

Drinking alcohol with Xifaxan should be considered carefully. If you are taking Xifaxan it means you have an infection that needs treating because your immune system is weak. Since drinking alcohol can lower your body’s immune system you risk prolonging the time it takes for your body to repair. Read on to find out how Xifaxan works and why it may be beneficial to not drink while taking the drug.

What is Xifaxan?

Xifaxan belongs to a class of drugs called antibiotics that targets bacterial infection in the intestines by disrupting its growth. It is manufactured by Salix Pharmaceuticals and contains the active ingredient rifaximin (derived from rifamycin). Xifaxan is a prescription medicine that is approved by the US Food and Drug Administration (FDA) to treat the symptoms of traveler’s diarrhea, hepatic encephalopathy, and irritable bowel syndrome with diarrhea (IBS-D).

What is the dosage for Xifaxan?

• Rifaximin 200 mg tablets, one three times a day for three days for adults to treat traveler’s diarrhea caused by Escherichia coli bacteria. In children use and dose must be determined by your doctor
• Rifaximin 550 mg tablets, one twice daily are used to prevent episodes of hepatic encephalopathy (when the liver stops working and cannot remove toxic substances from the body) in adults who have liver disease or liver failure
• Rifaximin 550 mg tablets, one three times a day for 14 days to treat irritable bowel syndrome with diarrhea. In children, the dose must be determined by your doctor

Do not take a double dose to make up for a missed dose. Take your next dose as usual. If you are not sure what to do after missing a dose, contact your healthcare provider.

The most common side effects of rifaximin include:

• Nausea
• Headache
• Dizziness
• Tiredness

Always consult a healthcare professional for medical advice if more serious side effects occur such as severe stomach pain along with watery or bloody diarrhea, or an allergic reaction to the drug causing hives on the skin.

What should I tell my doctor about before starting Xifaxan?

• To minimize drug interactions inform your doctor about other prescribed medications and over-the-counter medications you may be taking to treat other medical conditions.   Cyclosporine is an important drug to mention. Any nutritional supplements and herbal products should be mentioned too
• Inform your doctor if you have or have ever had liver disease
• If you are pregnant, planning a pregnancy, or are breastfeeding

Is Xifaxan safe with alcohol?

Yes but pharmacists and healthcare professionals advise against it. A retrospective study by The American College of Gastroenterology showed an association between moderate alcohol consumption and small intestinal bacterial overgrowth. Just one drink per day for women and two for men is linked to small intestinal bacterial overgrowth leading to gastrointestinal symptoms like bloating, gas, abdominal pain, constipation, and diarrhea. This highlights that consuming even the slightest amount of alcohol could have an impact on your gut health.

Therefore drinking alcohol will impact negativity on the conditions Xifaxan is used to treat, particularly IBS-D and traveler’s diarrhea. Patients with cirrhosis i.e. liver disease are predisposed to intestinal bacterial overgrowth meaning patients with hepatic encephalopathy need to think carefully before drinking alcohol.