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Should I Take a Probiotic While Taking Xifaxan?

Key Takeaways

  • Probiotics are sometimes used alongside Xifaxan, especially for conditions like IBS-D, SIBO (small intestinal bacterial overgrowth), and traveler’s diarrhea, but the decision depends on your health condition and your healthcare provider’s recommendation.
  • Research shows that probiotics may help support the gut microbiome, reduce gastrointestinal symptoms, and prevent recurrence after antibiotic treatment, but evidence varies by strain and condition.
  • Some people benefit from taking probiotics after finishing Xifaxan, while others may take them during treatment, depending on tolerance and medical advice.
  • Common strains studied in gastroenterology include Lactobacillus, Bifidobacterium, and multi-strain blends.
  • Xifaxan has minimal systemic absorption and fewer microbiome-disrupting effects than broad-spectrum antibiotics like metronidazole, but it can still alter gut bacteria.

What Is Xifaxan and Why Might You Consider a Probiotic?

Xifaxan (rifaximin) is a minimally absorbed antibiotic used for:

  • IBS-D (irritable bowel syndrome with diarrhea)
  • SIBO (small intestinal bacterial overgrowth)
  • Hepatic encephalopathy
  • Traveler’s diarrhea

Because rifaximin targets harmful bacteria in the digestive system, it may also affect some beneficial bacteria. This is why many patients consider adding a probiotic supplement to support gut health.

Should You Take a Probiotic While Taking Xifaxan?

Maybe, depending on your condition and tolerance.

Whether you should take a probiotic at the same time as Xifaxan depends on:

  • Your diagnosis (IBS-D vs SIBO vs hepatic encephalopathy)
  • Your overall gut sensitivity
  • Your past reactions to supplements
  • Your provider’s preferred treatment strategy

There is no universal rule, but there are some key considerations.

Reasons You May Want to Take a Probiotic During Xifaxan Treatment

To support the gut microbiome

Xifaxan is known to reduce levels of harmful bacteria, but even targeted antibiotics can disrupt the balance of beneficial bacteria, like:

  • Lactobacillus
  • Bifidobacterium

Probiotics may help:

  • Stabilize the gut microbiome
  • Reduce bloating and abdominal discomfort
  • Support the immune system
  • Lower the risk of gut disruption during treatment

To improve outcomes in IBS-D

Some randomized controlled trials suggest that combining probiotics with rifaximin may:

  • Improve symptom relief
  • Reduce abdominal pain
  • Improve stool consistency

Blends containing Lactobacillus and Bifidobacterium strains appear most studied for IBS.

To reduce recurrence after SIBO

SIBO frequently returns after antibiotic therapy. A meta-analysis showed probiotics may help reduce relapse rates when used after or alongside antibiotic treatment such as rifaximin.

To promote gut health long-term

Especially after repeated rounds of Xifaxan treatment, probiotics may help maintain a healthier gut environment.

Reasons You May Not Want to Take a Probiotic During Xifaxan

Sensitive digestive systems may react poorly

Some people with IBS-D experience more gas, bloating, and cramping when starting probiotics. Xifaxan is often prescribed to reduce these symptoms, so adding probiotics may interfere with its effectiveness.

Strains matter

Not all probiotics work the same. Some strains may worsen symptoms, especially in people with:

  • Severe IBS-D
  • Active SIBO
  • Poor tolerance to fermenting bacteria

Choosing the wrong strain can lead to more gastrointestinal symptoms.

Some providers prefer waiting until after antibiotics

Certain healthcare professionals recommend finishing Xifaxan first to “clear the slate” before reintroducing probiotic supplements to rebuild healthy flora.

Do Probiotics Interfere With Xifaxan?

No. There are no known harmful drug interactions between Xifaxan and probiotics.
Xifaxan kills bacteria in the gut but does not impact probiotic supplement absorption.

However, probiotics may affect symptom perception or stool consistency during treatment.

Which Probiotics Are Commonly Used With Xifaxan?

Lactobacillus strains

It is helpful for diarrhea, IBS-D, and gut immune regulation.

Bifidobacterium strains

These strains may reduce bloating, gas, and abdominal pain.

Multi-strain formulas

Blends containing both Lactobacillus and Bifidobacterium may offer broader benefits.

What About Diet While Using Xifaxan?

Some individuals pair Xifaxan with dietary changes such as:

  • A low-FODMAP diet
  • Temporary reduction of greasy, spicy, and fried foods
  • Increased hydration
  • Avoiding trigger foods

Diet + probiotics + Xifaxan can sometimes provide better results.

Special Considerations

Breastfeeding

There is limited data on rifaximin during breastfeeding, but probiotics are generally considered low-risk. Always confirm with your healthcare provider.

Liver disease or hepatic encephalopathy

Patients taking rifaximin long-term may already be on additional therapies.
Probiotics may be beneficial, but discuss with your doctor due to the complexity of these conditions.

Drug interactions

Xifaxan has few systemic interactions, but be mindful of:

  • Cyclosporine
  • Warfarin
  • Other prescription drugs

Probiotics do not worsen drug interactions but may influence digestion.

Side effects of Xifaxan

Some common side effects include:

  • Bloating
  • Abdominal pain
  • Constipation
  • Nausea
  • Flatulence (gas)
  • Headache
  • Fatigue

These are usually mild and temporary.

Bottom Line

Yes, you can often take a probiotic while taking Xifaxan, but whether you should depends on your condition and how your body responds.
Many patients with IBS-D, SIBO, or traveler’s diarrhea find probiotics helpful, while others prefer starting them after antibiotic therapy.

For best results:

  • Talk to a healthcare provider
  • Choose evidence-backed strains
  • Monitor your gastrointestinal symptoms
  • Avoid assuming all probiotics work the same

FAQs

Should I take probiotics during or after Xifaxan?
It depends on your symptoms and diagnosis. Some providers recommend starting after completing treatment with Xifaxan, while others will tell you to take them together.

Can probiotics make IBS-D worse?
Some individuals experience more gas or bloating, depending on the strain.

Do probiotics stop Xifaxan from working?
No, there are no harmful interactions between Xifaxan and probiotics.

Which probiotic is best with rifaximin?
Strains from Lactobacillus or Bifidobacterium were the most common ones used in clinical studies. Talk with your provider to see which strain, if any, is right for you.

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