Drug - Xifaxan ® (rifaximin), 200 mg tablets and 50 mg tablets [Salix Pharmaceuticals]
March 2016
Xifaxan® (rifaximin) 200 mg tablets are indicated for the treatment of patients (≥12 years of age) with travelers' diarrhea caused by non-invasive strains of Escherichia coli. The dose is 200 mg TID for 3 days.
Xifaxan® (rifaximin) 550 mg tablets are indicated to reduce the risk of overt hepatic encephalopathy (HE) recurrence in patients ≥ 18 years of age. The dose is 550 mg BID for treatment of HE. Xifaxan® (rifaximin) 550 mg tablets are also indicated in the treatment of Irritable Bowel syndrome with diarrhea in patients ≥ 18 years of age.
A quantity of 9 tablets total is allowed.
Rationale
Fluoroquinolones are the drugs of choice for Travelers’ Diarrhea. Commonly prescribed regimens are 500 mg of ciprofloxacin twice a day or 400 mg of norfloxacin twice a day for 3-5 days. Trimethoprim-sulfamethoxazole and doxycycline are no longer recommended because of the high level of resistance to these agents.
Rifaximin may be approved for a patient being treated for hepatic encephalopathy after lactulose or in combination with lactulose.
A quantity limit of 2 tablets per day is allowed.
FDA approved dosing is one tablet three times daily for 14 days. Approval will be limited to one course of treatment at a time, with a quantity limit of 42 tablets. A maximum of 3 total treatments in 730 days may be allowed.
MHCP Provider Call Center 651-431-2700 or 800-366-5411