Worse after Xifaxan - please help
#368030 - 08/09/12 05:42 AM
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I've had a pretty good handle on my IBS-D for 4 or 5 years. I've been following a heavy soluble fiber, low insoluble fiber, low meat, low fat diet. It's the diet outlined by Heather Von Vorous in "Eating for IBS" and it's worked pretty well for me. A lot of rice and bread. However, recently I was eating things that I thought were ok but they were making me sick, so I went to my GI to see what we could do. He suggested xifaxan - 550 mg 3 times a day for 14 days. During the 14 days I was constipated and gassy most of the time, but I thought I'd let it run its course.
Here's the problem: I finished the 14 day prescription 5 days ago and have been feeling terrible ever since. Alternating IBS-C and IBS-D, gassiness, and every time I eat anything I immediately get bloated and feel sick. I almost constantly feel pressure in my stomach and the sensation that I need to use the toilet. And while I had a pretty good handle on what I could and could not eat before xifaxan, now everything seems to make me sick. It's like all the hard work and pain i went through figuring out a stable diet has been thrown out the window because of 2 weeks of antibiotic. I'm extremely frustrated and worried.
I called my GI and he seemed surprised. He said I should take Florastor, but it has lactose in it and I'm lactose intolerant, so I'm taking Align (and crossing my fingers because it has milk protein).
Has anyone else had a similar experience? Has anyone felt worse after xifaxan? Will the effects of xifaxan wear off eventually? Will probiotics help? I feel like my IBS world and knowledge about my body and digestion has been flipped upside down.
Any help is extremely welcome. Thanks.
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The most common side effects are flatulence, headache, abdominal pain and nausea. The antibiotic Xifaxan is not absorbed into the body so it works in the GI tract only. It is possible that it upset the composition of the bacteria flora in the colon. Hopefully the effects will pass with time.
Did you GI doctor talk you about the FODMAP approach to managing IBS symptoms. It not then read the first two links in my signature.
Since finishing the course of Xifaxan what diet have you been following? It would be helpful if you could give us a list of the foods and snacks you have eaten in the past 2-3 days.
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STABLE: ♂, IBS-D 50+ years - Science of IBS
The FODMAP Approach to Managing IBS Symptoms
Evidence-based Dietary Management of Functional GI Symptoms: The FODMAP Approach
FODMAP Chart & Cheatsheet
The Role of Food & Dietary Intervention in IBS
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Thanks for your help. Yes, I spoke to my doctor about FODMAP and just started readingPatsy Catsos' book "IBS: Free at Last." As I said, I was so used to a high soluble fiber diet, and it worked fairly well, that right now I'm not sure what i should be eating.
I had soup with rice noodles along with white rice on Monday and was sick the next morning.
Tuesday:
Breakfast: I had a banana, a Nature Valley Oats and Honey Granola Bar
Lunch: Turkey Sandwich on White with Pop Chips
Dinner: Trade Joe's mini chicken tacos with rice, tofuti sour cream, guacamole and spinach salad.
I immediately felt bloated and gassy. The next morning I felt very sick with gass and D.
Wednesday - felt bloated whenever I ate anything, had D 3-4 times.
Breakfast: Banana
Lunch: Turkey with only one piece of white bread and Pop Chips
Dinner: A plain baked potato and plain grilled chicken
At this point, I was trying to be as bland as possible. Didn't work. Had D when i woke up in the morning.
Thursday (today)
Breakfast: (not until 11:20 ish) Banana - D a couple hours later
Granola Bar around 1:30
Lunch: Plain grilled chicken - some rumbling and bloat
Dinner: Plain grilled tilapia (white fish) and small spinach salad. Some rumbling as a type and bloat. We will see tomorrow.
I also take 2 Citrucel pills before lunch and 2 before dinner every day.
After I told the GI who gave me Xifaxan that i was feeling sicker he said "Go get any probiotic." (that made me never want to go to him again. Any probiotic? From what i understand, they are quite different.) I bought Align and have been taking it the last 2 days. I also called a different GI and he called for a stool sample and I have an appointment with him next week.
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A couple of years ago, I took a massive dose of antibiotics for h. pylori. I was terrified to do it, but terrified not to, because it was pretty clear h. pylori was causing some upper GI symptoms, it's connected to gastric cancers. But I hated the idea of blasting away at my already-sensitive gut with a stew of three antibiotics (tetracycline, Flagyl and bismuth) four times a day for two weeks. Broad-spectrum, hard-core weapons of mass destruction. Also, with antibiotics for gut infections like that, there comes a risk of post-"therapy" c. difficile, an opportunistic bacteria that can cause serious, serious problems.
So I went to this doc who walks the line between Western and alternative medicine and sought his advice. He said take the antibiotics. He also advised me to take a high-level, 85 billion-plus probiotic between each dose of antibiotics. He acknowledged that it might just all get killed, but figured it couldn't hurt. Once I was done with the antibiotics, he said, immediately start taking S. Boulardii and continue the high-level probiotic. He explained that the S. Boulardii had been shown in studies to be helpful against c. diff and post-antibiotic dysbiosis. At the time, I had to get S. Boulardii online, but I just saw the other day that Whole Foods carries it.
I got through the two weeks of antibiotic "therapy" with some general discomfort, one very bad night, and the whole time I had not-quite diarrhea (soft serve) and my whole body felt stripped of any bacteria, good or bad. It took two weeks to a month for things to feel back to normal, and I was taking the general high-level probiotics and s. boulardii several times a day. I even had some cultured foods, which to me taste like, well, vomit.
You might want to follow up on that stool test, just to make sure that you find out ASAP whether you've got any c. diff going on. From what I understand, that requires treatment right away. But if it's "just" dysbiosis from the antibiotics, hang on and be patient. I had a friend who did three rounds of Cipro for a bug she picked up in Mexico, and it took her several months of probiotics, no dairy, no wheat, a very low-residue diet (rice, rice and more rice!), to get back on track.
Good luck! I hope you're feeling better today.
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I have read about c diff over the past couple of days of mad internet searching and I keep seeing that xifaxan is actually used to treat c diff. So, could xifiaxn really lead to c diff? I just made a "deposit" at the lab, so I guess I'll find out soon enough. This morning's bm was pasty, not liquid, after fish and spinach last night, so maybe progress?
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Seems like you would be a lot sicker if you had c. diff. What you're describing reminds me a lot of my friend who got sick after she went to Mexico, the one who took all the Cipro. All her samples were negative, yet she kept having bad mornings, with no solid (no pun) explanation for why. I remember she was advised, as I was after my WMDs, to take very high-level probiotics and to mix them up--brand loyalty is not a good thing in this case, because you want a wide range of "bugs," said my alternative doc. And if you can get some s. boulardii, that's supposed to be great for rebuilding flora. When I was on the rebuilding plan, I was taking the 85 billion caps after every meal, and s boulardii twice a day. Biggest drawback was that it cost me a fortune!
Sounds like you might be making some progress. It might just take some time to get back to normal after the Xifaxan cleaned things out. So frustrating when something that is supposed to help just seems to cause more trouble!
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The sickness after Tuesday's meal and subsequent gas and D might have been caused by the guacamole which is made from avocados. Avocados also contain polyols which is one of the FODMAP groups.
Heather explains that polyols such as sorbitol and mannitol used as sweeteners in gum can worsen IBS symptoms. In fact polyols found in fruit like peaches, plums and avocados can do exactly the same thing.
Something else you might consider is that Heather points out that raw veggies like spinach are more difficult for individuals with IBS to handle than cooked one.
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STABLE: ♂, IBS-D 50+ years - Science of IBS
The FODMAP Approach to Managing IBS Symptoms
Evidence-based Dietary Management of Functional GI Symptoms: The FODMAP Approach
FODMAP Chart & Cheatsheet
The Role of Food & Dietary Intervention in IBS
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SYL - thanks for your FODMAP help. I am speedreading the book and plan on doing a 2 week elimination soon.
dogsled - You are prob right, and things seem better today. The GI doc I have an appointment with on Wednesday is said to be very knowledgeable in probiotics, so I will ask him about your suggestions. Thanks for all your help.
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Hello jorichma,
I had exactly the same problem five years ago when I went through a two-week Xifaxan treatment, it basically created on me a chronic IBS-C problem ever since.
I'm curious if you finally managed to get better and if so how did you did it.
Thanks!
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It really seems that NO ONE has a decent medication to really help IBS D or C, and the so-called gastroenterologists really DON'T CARE either!!! 
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Originally diagnosed with IBS-C in Spring, 2008. During spring to fall of 2008, had at least 10 acupuncture treatments and Chinese herbs. IBS went into remission. IBS returned in late July 2013 after taking 2 oral contrasts for a CT scan for cancer follow up. Had more acupuncture with different practitioner in summer 2014, but received little benefit.
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