Xifaxan for SIBO

@maryd
Hi Mary,
I don’t have IBS-D but IBS-C.
I used to take Xifaxan often years ago- sometimes it worked, sometimes not.
For SIBO now I try to control it taking PeptoBismol. Recently, I was very miserable after 2 back to back treatments for sinusitis.
I then remembered the probiotic Florastor that was recommended years ago. I never bought it because it was a little more expensive.
I decided to try it and after first dose the severe discomfort was gone. It has different ingredients than my regular probiotics.
I’m not sure if it will help you but I would say it’s worth a try.

You can go to their website and get the Xifaxan card and bring to pharmacy. It’s 0 co - pay .
Or see if you can get generic of it ?

Unfortunately, if someone uses Medicare Ins. to buy it, pharmacy doesn't accept the manufacturer's coupon, unless you pay without using Medicare.

Well use the card w/o the Medicare insurance. It’s 0 co pay .
No ?

I recently had a positive SIBO test and my GI prescribed Xifaxan with Neomycin. Since I have mild tinnitus I was very reluctant to take the Neomycin due to its side effects regarding hearing loss. My hearing is good and I didn’t want to mess with that so he agreed that I should take the Xifaxan alone. I didn’t have any adverse reactions and I do think I felt better for the two weeks. I also maintained a low FODMAP diet (I know there are differing opinions about whether or not to eat FODMAPS during antibiotic treatment) but he told me to stay on the diet but to stop taking my Florastor for the duration. It cost me $700 even with my Medicare Advantage PPO co-pay.

I’ve been taking Flagyl for months but I think I might be experiencing early symptoms of neuropathy, so I stopped the medication. I’m on Xifaxan now, and it isn’t doing anything for my symptoms! I’m being treated for SIBO so I don’t know why Xifaxan does not work and why Flagyl does. Is this normal? Or does this mean that I might not have SIBO but something else?

I need to hear some success stories. Everything I've read on the internet shows very poor efficacy of Xifaxan. My doctor has order 550 mg twice a day for 14 days along with Neomycin. Both are antibiotics. The Xifaxan is going to cost me $1,057.73. Also, I've read Xifaxan can cause C. Diff. (hospital acquired from spinal surgery) and after 3 years, I am still recovering from the damage that nasty bacteria left in my colon.

You'll find a lot of conflicting information and scare tactics about Xifaxan and people pushing "natural" treatments for SIBO, so you'll have to do your own research. I also don't want to run afoul of the proponents for natural supplements.

I will say I did a lot of research on my own and concluded that Xifaxan and Neomycin was the best route for me. This helped put things into context: https://health.usnews.com/health-news/blogs/eat-run/articles/facts-about-sibo-the-internet-keeps-getting-wrong. You can take it or leave it. I find this dietician to be very evidence-based as well as Kate Scarlata, who had SIBO herself. Another consideration is that the natural supplements are also very expensive on their own and don't have as much high-quality research to back up the efficacy.

To answer your question, I did get over SIBO with Xifaxan and neomycin. I did a SIBO breath test and it was actually negative, but they don't always exclude SIBO. Because of my symptoms (and we ruled out everything else), my doctor agreed to treat it empirically.

From my understanding, Xifaxan is more specific to the gut, so it's far less likely to impact antibiotic resistance and the risk of causing C. Diff is extremely low. I'm not totally clear on why this is, but I recall finding many sources online that explained why. But they need to include that risk on any label, including topical antibiotics. I had very few qualms about taking Xifaxan, except the risk of side effects affecting how I felt.

Neomycin is a different story--do you have a diagnosis of methane dominant SIBO? It's usually only indicated for methane-dominant SIBO. My symptoms were consistent with methane-dominant SIBO, which is more challenging to diagnose. While I tolerated Xifaxan okay, the neomycin caused me nausea I was able to manage by making sure to always take with food. It's not something you'd want to take unless you have to, and not something you'd want to repeat, whereas Xifaxan can in some cases be repeated if you have an occurrence.

I also took Florastor, upon recommendation of my doctor, which is the only evidenced-based probiotic shown to help prevent C. Diff and survive the environment in the gut when you're also taking an antibiotic. The first time I took Xifaxan without it and I immediately noticed the difference when I took Florastor. It's also pricey, but worth it to me for the peace of mind.

It is expensive if your insurance won't cover it--thankfully my insurance was willing to cover it, twice.

I haven't had a recurrence, but I took steps to improve my motility as much as I could--did pelvic PT to learn about abdominal massage, I take Iberogast which can act as a prokinetic, make sure to move around after I eat, practice diaphragmatic breathing, to try to prevent a recurrence.

I've been battling SIBO for 4 years. First 2 times with Xifaxan alone, but the DR.s I had didn't know much about SIBO. So 3rd time Xifaxan + Neomycin 14 day program killed the SIBO. The hardest part for me is the special certain foods you have to eat. Natural cures. Please read about these Wild Oregano Oil, Berberine, Neem, Triphala, Also Sibo will deplete certain Vitamins. VIT. ADK, Iron, Magnesium, D3. It's a year or so long if you do everything right. Good luck, it drains your energy too.

Sorry, no success story from me. I tested positive, "off the chart" with SIBO and I think I've been suffering from birth with it. But the Xifaxan (which cost me $1,900) didn't work for me at all. (The Florastor didn't work either.) As I heard someone here on this site say, the Xifaxan doesn't get at the cause of the SIBO so it comes right back as soon as you stop the Xifaxan. And last I heard, they still don't know what causes the SIBO, so no wonder there doesn't seem to be a cure for it.