Generic Xifaxan ( Rifaximin )

Buy Generic Xifaxan (Rifaximin) without prescription in Canada

At our Canadian pharmacy, you can purchase Xifaxan (rifaximin) 200 mg and 550 mg tablets without a prescription, with discreet and anonymous packaging delivered within 5-14 days across Canada.
Xifaxan is a gut-selective antibiotic used to treat travelers' diarrhea caused by noninvasive strains of E. coli, to reduce the risk of overt hepatic encephalopathy recurrence in adults, and to treat irritable bowel syndrome with diarrhea (IBS-D) in adults. The medication works by stopping bacterial protein synthesis inside the gut, and because it is poorly absorbed into the bloodstream, most of its action stays in the digestive tract.
A note on availability: Xifaxan is the U.S. brand name for rifaximin. In Canada, the same medication is marketed under the brand name Zaxine® by Lupin Pharma Canada Limited, along with a generic version, Lupin-Rifaximin. The 550 mg strength is the one approved and marketed in Canada. The 200 mg strength, used for travelers' diarrhea in the U.S. and other markets, is not currently available as a Canadian product but can be sourced through international channels. The dosing and safety information below reflects the product monographs and clinical data that apply to rifaximin.
The usual dose for travelers' diarrhea is 200 mg taken three times a day for 3 days. For hepatic encephalopathy, the dose is 550 mg taken twice a day. For IBS-D, the dose is 550 mg taken three times a day for 14 days, and patients who experience a recurrence can be retreated up to two times with the same regimen.
The administration form is film-coated tablets containing 200 mg or 550 mg of rifaximin. The 550 mg tablet is oval, biconvex, and pink, marked with "RX" on one side.
Xifaxan does not work overnight. For travelers' diarrhea, improvement is often seen within 24 to 48 hours, but the full 3-day course should be completed. For hepatic encephalopathy, the benefit builds over weeks of twice-daily dosing. For IBS-D, the 14-day course may produce improvement in diarrhea and abdominal discomfort, though symptoms can return after treatment ends.
Alcohol should be avoided during treatment. Rifaximin is not expected to interact with alcohol in a dangerous way, but drinking can worsen diarrhea and dehydration, and it can add to liver strain in people with hepatic encephalopathy.
The most common side effects are headache, nausea, and abdominal pain. For hepatic encephalopathy, peripheral edema, dizziness, fatigue, and constipation are also common.

Common Use Xifaxan

Rifaximin is a semi-synthetic rifamycin antibiotic. It works by binding to the bacterial DNA-dependent RNA polymerase, which blocks the production of proteins the bacteria need to survive. What makes rifaximin unusual among antibiotics is how little of it gets absorbed. Less than 0.4% of an oral dose reaches the bloodstream, so it concentrates in the gut and acts on bacteria there while sparing the rest of the body. Health Canada has approved rifaximin 550 mg for reducing the risk of overt hepatic encephalopathy recurrence in adults, and for the treatment of irritable bowel syndrome with diarrhea (IBS-D) in adults. The U.S. Food and Drug Administration has also approved rifaximin 200 mg for travelers' diarrhea caused by noninvasive strains of E. coli in adults and children 12 years and older. Rifaximin is not effective against diarrhea complicated by fever or blood in the stool, or against diarrhea caused by pathogens other than E. coli, such as Campylobacter, Shigella, or Salmonella.

Basic Xifaxan Information

• INN (International Nonproprietary Name): Rifaximin
• Brand names available in Canada: Zaxine® (Lupin Pharma Canada Limited, DIN 02410702 for 550 mg); generic Lupin-Rifaximin (Lupin Pharma Canada Limited, DIN 02561549 for 550 mg). Xifaxan is the U.S. brand name and is not marketed in Canada. A 200 mg strength is not currently available as a Canadian product.
• ATC Code: A07AA11
• Forms and dosages: Film-coated tablets – 200 mg and 550 mg. In Canada, only the 550 mg tablet is marketed.
• Manufacturers in Canada: Lupin Pharma Canada Limited holds the DIN for Zaxine 550 mg (DIN 02410702, market status: Marketed since 2013-11-07) and Lupin-Rifaximin 550 mg (DIN 02561549, status: Approved). The U.S. product Xifaxan is manufactured by Salix Pharmaceuticals, a division of Bausch Health, with manufacturing at Patheon Whitby Operations in Ontario.
• Registration status in Canada: Approved by Health Canada. Zaxine 550 mg is listed under DIN 02410702. Lupin-Rifaximin 550 mg is listed under DIN 02561549. Health Canada issued a Notice of Compliance for Zaxine on August 13, 2013, and approved the IBS-D indication in December 2018.
• OTC / Rx classification: Prescription only (Rx) – not legally sold over-the-counter in Canadian pharmacies

Dosage & Direction

Take Xifaxan exactly as your doctor prescribes. The dose depends on what is being treated. For travelers' diarrhea in adults and children 12 years and older, the recommended dose is 200 mg taken orally three times a day for 3 days. If diarrhea symptoms get worse or persist for more than 24 to 48 hours, stop the medication and contact your doctor, because the infection may be caused by a pathogen that rifaximin does not cover. For hepatic encephalopathy, the recommended dose is 550 mg taken orally twice a day. In the pivotal trial for this indication, 91% of patients were also taking lactulose. Because rifaximin has limited systemic absorption, no specific dose adjustment is needed for patients with hepatic impairment, but caution is advised in those with severe (Child-Pugh Class C) liver disease. For irritable bowel syndrome with diarrhea (IBS-D), the recommended dose is 550 mg taken orally three times a day for 14 days. Patients who experience a recurrence of symptoms after the initial course can be retreated up to two times with the same 14-day regimen. Xifaxan can be taken with or without food. Swallow the tablet whole with water. Do not crush or chew it. If you miss a dose, take it as soon as you remember. If it is almost time for your next dose, skip the missed one and continue with your regular schedule. Do not take two doses at once. If you are taking Xifaxan for travelers' diarrhea, complete the full 3-day course even if you feel better sooner. For hepatic encephalopathy and IBS-D, take the medication for the full prescribed duration unless your doctor tells you to stop.

Precautions

Xifaxan is not effective for diarrhea caused by pathogens other than E. coli, or for diarrhea complicated by fever or blood in the stool. If your diarrhea does not improve within 24 to 48 hours, or if it gets worse, stop the medication and talk to your doctor about other treatment options. Clostridium difficile-associated diarrhea (CDAD) has been reported with the use of nearly all antibacterial agents, including rifaximin. It can range from mild diarrhea to fatal colitis. If you develop watery or bloody diarrhea, stomach cramps, or fever during or after treatment, contact your doctor. Do not self-treat with anti-diarrheal medications without medical advice, because they can worsen CDAD. Severe cutaneous adverse reactions, including Stevens-Johnson syndrome and toxic epidermal necrolysis, have been reported in patients with cirrhosis taking rifaximin. If you develop a rash, blisters, peeling skin, or sores in your mouth or eyes, stop the medication and seek emergency care right away. Rifaximin should be used with caution in patients with severe liver impairment. Your doctor may want to monitor you more closely. Because rifaximin is a P-glycoprotein substrate, its blood levels can increase significantly when it is taken with P-glycoprotein inhibitors such as cyclosporine. This interaction can raise the risk of systemic side effects, so caution is advised if you take both. Rifaximin can affect warfarin metabolism, and both increases and decreases in INR have been reported. If you take warfarin, your doctor should monitor your INR closely when you start or stop rifaximin. Rifaximin may reduce the effectiveness of oral estrogen-containing contraceptives because it alters the gut flora that help recycle these hormones. This interaction has not been commonly reported, but it is a theoretical risk. If you rely on oral contraceptives, consider a backup method during treatment. The safety and effectiveness of rifaximin for hepatic encephalopathy have not been established in patients under 18 years of age. In the controlled trial for hepatic encephalopathy, 19.4% of patients were 65 years or older and 2.3% were 75 or older, with no overall differences in safety or effectiveness observed between older and younger patients, but greater sensitivity in some older individuals cannot be ruled out. Rifaximin should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. There are no adequate and well-controlled studies in pregnant women, and animal studies have shown teratogenic effects at doses that caused maternal toxicity. It is not known whether rifaximin is excreted in human milk. Because many drugs are excreted in human milk, caution should be exercised when rifaximin is given to a breastfeeding woman.

Contraindications

Do not take Xifaxan if you have had an allergic reaction to rifaximin, any of the rifamycin antimicrobial agents, or any of the inactive ingredients in the tablet. Hypersensitivity reactions have included exfoliative dermatitis, angioneurotic edema (swelling of the face and tongue and difficulty swallowing), urticaria, flushing, pruritus, and anaphylaxis. Xifaxan is also contraindicated in patients with intestinal obstruction. If you are unsure whether any of these apply to you, check with your doctor or pharmacist.

Possible Side Effects

In clinical trials for travelers' diarrhea, the most common side effect was headache, occurring in about 6% of patients. In the hepatic encephalopathy trials, side effects occurring in 10% or more of patients included peripheral edema, nausea, constipation, dizziness, fatigue, urinary tract infection, insomnia, anemia, pruritus, and ascites. In the IBS-D trials, the most common side effects were ALT increased and nausea, each occurring in about 2% of patients. Less common side effects reported in IBS-D trials included flatulence (about 20% in some analyses), headache (about 9%), abdominal pain (about 9%), defecation urgency (about 9%), and nausea (about 8%). Serious side effects that require immediate medical attention include severe allergic reactions (rash, hives, swelling of the face or throat, difficulty breathing), severe skin reactions (Stevens-Johnson syndrome, toxic epidermal necrolysis), and Clostridium difficile-associated diarrhea (watery or bloody diarrhea, stomach cramps, fever). If you develop any of these, stop the medication and seek medical help right away. Most side effects from rifaximin are mild and go away on their own, but any symptom that concerns you should be reported to your doctor.

Drug Interaction

Rifaximin is a substrate of P-glycoprotein and is metabolized to a small extent by CYP3A4. Because it is poorly absorbed, it has a low potential for systemic drug interactions, but there are important exceptions. Cyclosporine, a potent P-glycoprotein inhibitor, significantly increases the systemic exposure to rifaximin when the two are taken together. In one study, a single 600 mg dose of cyclosporine increased rifaximin exposure 83-fold in healthy volunteers. If you take cyclosporine or another P-glycoprotein inhibitor, your doctor should use rifaximin with caution. Warfarin INR can be affected by rifaximin, with both increases and decreases reported. If you take warfarin, monitor your INR closely when starting or stopping rifaximin, and your doctor may need to adjust your anticoagulant dose. Rifaximin may reduce the effectiveness of oral contraceptives containing estrogen because it can alter the gut bacteria that help recycle these hormones. This interaction has not been commonly reported, but a backup method of contraception is prudent during treatment. In vitro studies show that rifaximin does not significantly inhibit the major cytochrome P450 enzymes, so it is unlikely to affect the metabolism of most other drugs. It does not alter the pharmacokinetics of a single dose of ethinyl estradiol and norgestimate. Tell your doctor and pharmacist about every medication you take, including over-the-counter products, vitamins, and herbal supplements.

Missed Dose

If you miss a dose of Xifaxan, take it as soon as you remember. If it is almost time for your next dose, skip the missed one and continue with your regular schedule. Do not take two doses at once to make up for a missed one. If you miss several doses in a row, contact your doctor before restarting. Missing doses can reduce the effectiveness of the treatment, so try to take the medication at the same times each day.

Overdose

Overdose with Xifaxan is unlikely to cause serious harm because the drug is poorly absorbed from the gut. In clinical studies, doses up to 2,400 mg per day for 10 days have been tolerated. Symptoms of a large overdose may include nausea, vomiting, and diarrhea. There is no specific antidote. Treatment is supportive and may include activated charcoal if the overdose was recent. Contact a poison control centre or go to an emergency department if you or someone else has taken more than the prescribed dose. Do not try to manage an overdose at home.

Storage

Store Xifaxan tablets at room temperature between 20 and 25 degrees Celsius (68 and 77 degrees Fahrenheit). Brief exposure to temperatures between 15 and 30 degrees Celsius (59 and 86 degrees Fahrenheit) is acceptable. Keep the container tightly closed and protect it from light and moisture. Do not store in the bathroom or near a sink. Keep out of reach of children and pets. Do not use after the expiry date on the label. Dispose of unused medication according to local guidelines. Do not flush rifaximin down the toilet or pour it down the sink.

Disclaimer

We provide only general information about medications which does not cover all directions, possible drug integrations, or precautions. Information at the site cannot be used for self-treatment and self-diagnosis. Any specific instructions for a particular patient should be agreed with your health care adviser or doctor in charge of the case. We disclaim reliability of this information and mistakes it could contain. We are not responsible for any direct, indirect, special or other indirect damage as a result of any use of the information on this site and also for consequences of self-treatment.