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Pharmacologic class: Rifampin-related antibiotic
Therapeutic class: Anti-infective
Pregnancy risk category C
Binds to beta-subunit of bacterial DNA-dependent RNA polymerase, inhibiting bacterial RNA synthesis
Tablets: 200 mg, 550 mg
Indications and dosages
➣ Travelers' diarrhea caused by noninvasive strains of Escherichia coli
Adults and children age 12 and older: 200 mg P.O. three times daily for 3 days
➣ Reduction of risk of overt hepatic encephalopathy recurrence
Adults: 550 mg P.O. b.i.d.
• Hepatic encephalopathy
• Hypersensitivity to drug, its components, or rifamycin anti-infectives
Use cautiously in:
• elderly patients
• pregnant or breastfeeding patients
• children (safety and efficacy not established in those younger than age 12).
• Administer with or without food.
• Don't give to patients with diarrhea complicated by fever or blood in stool or to patients with suspected Campylobacter jejuni, Shigella, or Salmonella infection.
GI: nausea, vomiting, constipation, flatulence, abdominal pain, rectal tenesmus, defecation urgency, pseudomembranous colitis
Other: pyrexia, overgrowth of susceptible organisms
• Monitor for fever, blood in stools, and worsening of diarrhea.
• Monitor patient's fluid and electrolyte status.
• Monitor for new infections; if needed, consider alternative therapy.
• Tell patient drug can be taken with or without food.
☞ Advise patient to stop drug and notify prescriber if diarrhea symptoms worsen or last beyond 48 hours.
• As appropriate, review all other significant or life-threatening adverse reactions.
ClassificationTherapeutic: anti infectives
Adverse Reactions/Side Effects
Central nervous system
- dizziness (most frequent)
- peripheral edema (most frequent)
- pseudomembranous colitis (life-threatening)
Drug-Drug interactionAlthough rifaximin induces the CYP 3A4 enzyme system, since it is not absorbed, drug interactions are unlikely.
- Traveler's Diarrhea: Assess frequency and consistency of stools and bowel sounds prior to and during therapy.
- Assess fluid and electrolyte balance and skin turgor for dehydration.
- Hepatic Encephalopathy: Assess mental status periodically during therapy.
- Monitor bowel function. Diarrhea, abdominal cramping, fever, and bloody stools should be reported to health care professional promptly as a sign of pseudomembranous colitis. May begin up to several weeks following cessation of therapy.
- Lab Test Considerations: May cause lymphocytosis, monocytosis, and neutropenia.
Potential Nursing DiagnosesDiarrhea (Indications)
Risk for deficient fluid volume (Indications)
- Do not confuse rifaximin with rifampin.
- Oral: Administer with or without food.
- Instruct patient to take rifaximin as directed and to complete therapy, even if feeling better. Caution patient to stop taking rifaximin if diarrhea symptoms get worse, persist more than 24–48 hr, or are accompanied by fever or blood in the stool. Consult health care professional if these occur. Advise patient not to treat diarrhea without consulting health care professional. May occur up to several weeks after discontinuation of medication.
- May cause dizziness. Caution patient to avoid driving and other activities requiring alertness until response to medication is known.
- Advise female patients to notify health care professional if pregnant or if pregnancy is suspected, or if breast feeding.
- Decreased severity of travelers' diarrhea.
- Reduction in risk of overt hepatic encephalopathy recurrence.