XIFAXAN is recommended by
both ACG and AASLD/EASL1,2,*,†
XIFAXAN is the only FDA-approved agent indicated for the reduction in risk of OHE recurrence in adults.1
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ACG Guidelines AASLD Highest Possible Recommendation Badge

Follow the guidelines

XIFAXAN earned1,2:

ACG highest GRADE recommendation (Strong, High Quality)

  • As a lactulose add-on therapy for patients who experience recurrent episodes of HE*

AASLD/EASL highest possible recommendation (GRADE I,A,1)

  • As a lactulose add-on therapy to reduce the risk of OHE after recurrence on lactulose alone†
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*Per the ACG, GRADE methodology was used to assess the quality of evidence and provide the strength of each recommendation. Strong: most patients should receive the recommended course of action; Conditional: a shared decision-making model through discussion regarding the available evidence and alternative options is appropriate. High: very confident in estimate of effect; Moderate; moderate confidence in estimate of effect; Low; limited confidence in estimate of effect; Very Low: very little confidence in estimate of effect.1

†Per the AASLD/EASL GRADE System for Evidence Grade I=randomized, controlled trials, A=evidence is "high quality," and further research is very unlikely to change our confidence in the estimated effect; and 1=recommendation is "strong," with factors influencing strength of recommendation including the quality of evidence, presumed patient-important outcomes, and costs.2

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AASLD, American Association for the Study of Liver Diseases; ACG, American College of Gastroenterology; EASL, European Association for the Study of the Liver; OHE, overt hepatic encephalopathy.

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INDICATIONS

XIFAXAN® (rifaximin) 550 mg tablets are indicated for the reduction in risk of overt hepatic encephalopathy (HE) recurrence in adults and for the treatment of irritable bowel syndrome with diarrhea (IBS-D) in adults.

XIFAXAN® (rifaximin) 550 mg tablets are indicated for the reduction in risk of overt hepatic encephalopathy (HE) recurrence in adults.

IMPORTANT SAFETY INFORMATION

  • XIFAXAN is contraindicated in patients with a hypersensitivity to rifaximin, rifamycin antimicrobial agents, or any of the components in XIFAXAN. Hypersensitivity reactions have included exfoliative dermatitis, angioneurotic edema, and anaphylaxis.
  • Clostridium difficile-associated diarrhea (CDAD) has been reported with use of nearly all antibacterial agents, including XIFAXAN, and may range in severity from mild diarrhea to fatal colitis. If CDAD is suspected or confirmed, ongoing antibiotic use not directed against C. difficile may need to be discontinued.
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INDICATIONS

XIFAXAN® (rifaximin) 550 mg tablets are indicated for the reduction in risk of overt hepatic encephalopathy (HE) recurrence in adults and for the treatment of irritable bowel syndrome with diarrhea (IBS-D) in adults.

IMPORTANT SAFETY INFORMATION

  • XIFAXAN is contraindicated in patients with a hypersensitivity to rifaximin, rifamycin antimicrobial agents, or any of the components in XIFAXAN. Hypersensitivity reactions have included exfoliative dermatitis, angioneurotic edema, and anaphylaxis.
  • Clostridium difficile-associated diarrhea (CDAD) has been reported with use of nearly all antibacterial agents, including XIFAXAN, and may range in severity from mild diarrhea to fatal colitis. If CDAD is suspected or confirmed, ongoing antibiotic use not directed against C. difficile may need to be discontinued.
  • There is an increased systemic exposure in patients with severe (Child-Pugh Class C) hepatic impairment. Caution should be exercised when administering XIFAXAN to these patients.
  • Caution should be exercised when concomitant use of XIFAXAN and P-glycoprotein (P-gp) and/or OATPs inhibitors is needed. Concomitant administration of cyclosporine, an inhibitor of P-gp and OATPs, significantly increased the systemic exposure of rifaximin. In patients with hepatic impairment, a potential additive effect of reduced metabolism and concomitant P-gp inhibitors may further increase the systemic exposure to rifaximin.
  • In clinical studies, the most common adverse reactions for XIFAXAN (alone or in combination with lactulose) were:
    – HE (≥10%): Peripheral edema (17%), constipation (16%), nausea (15%), fatigue (14%), insomnia (14%), ascites (13%), dizziness (13%), urinary tract infection (12%), anemia (10%), and pruritus (10%)
    – IBS-D (≥2%): Nausea (3%), ALT increased (2%)
  • INR changes have been reported in patients receiving rifaximin and warfarin concomitantly. Monitor INR and prothrombin time. Dose adjustment of warfarin may be required.
  • XIFAXAN may cause fetal harm. Advise pregnant women of the potential risk to a fetus.

To report SUSPECTED ADVERSE REACTIONS, contact Salix Pharmaceuticals at 1-800-321-4576 or FDA at 1-800-FDA-1088 or www.fda.gov/medwatch.

To report SUSPECTED ADVERSE REACTIONS, contact Salix Pharmaceuticals at 1-800-321-4576 or FDA at 1-800-FDA-1088 or www.fda.gov/medwatch.

Please click here for full Prescribing Information.

References: 1. Bajaj JS, Jakab SS, Jesudian AB, et al. ACG clinical guideline: Hepatic encephalopathy. Am J Gastroenterol. 2026;121-588-618 2. Vilstrup H, Amodio P, Bajaj J, et al. Hepatic encephalopathy in chronic liver disease: 2014 practice guideline by the American Association for the Study of Liver Diseases and the European Association for the Study of the Liver. Hepatology. 2014;60(2):715-735 doi:10.1002/hep.27210 3. XIFAXAN. Prescribing information. Salix Pharmaceuticals; 2023. Accessed August 12, 2026. https://shared.salix.com/globalassets/pi/xifaxan550-pi.pdf

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