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Rifaximin Side Effects

Medically reviewed by Last updated on Sep 26, 2022.


Commonly reported side effects of rifaximin include: flatulence. Other side effects include: abdominal pain, bowel urgency, headache, nausea, and rectal tenesmus. Continue reading for a comprehensive list of adverse effects.

Applies to rifaximin: oral tablets.

Side effects include:

Hepatic encephalopathy: Peripheral edema, nausea, dizziness, fatigue, ascites, muscle spasms, pruritus, abdominal pain, anemia, depression, nasopharyngitis, upper abdominal pain, arthralgia, dyspnea, pyrexia, rash.

IBS with diarrhea: Nausea, increased ALT concentrations.

Travelers' diarrhea: Headache.

For Healthcare Professionals

Applies to rifaximin: oral tablet.


When used for the treatment of travelers' diarrhea, the most common side effect was headache. This drug was discontinued due to side effects in 0.4% of patients; such side effects were taste loss, dysentery, decreased weight, anorexia, nausea, and nasal passage irritation.

When used for reduction in risk of overt hepatic encephalopathy recurrence, the most common side effects were peripheral edema, nausea, dizziness, fatigue, and ascites.

When used for the treatment of irritable bowel syndrome with diarrhea, the most common side effects were nausea and increased ALT.[Ref]


Very common (10% or more): Nausea (up to 14.3%), ascites (11.4%), flatulence (up to 11%)

Common (1% to 10%): Abdominal pain, abdominal distension, rectal tenesmus, upper abdominal pain, defecation urgency, constipation, stomach discomfort, vomiting, lower abdominal pain, abdominal tenderness, dry mouth, esophageal variceal bleed, diarrhea, bloating and distension, nausea and vomiting symptoms

Uncommon (0.1% to 1%): Dry lips, dyspepsia, gastrointestinal motility disorder, hard feces, hematochezia, mucous stools, taste disorders

Frequency not reported: Blood in stool, dysentery, fecal abnormality, gingival disorder, inguinal hernia, straining, bad taste in mouth, Clostridium colitis

Postmarketing reports: Clostridioides difficile-associated colitis[Ref]


Very common (10% or more): Peripheral edema (15%), fatigue (up to 12.1%)

Common (1% to 10%): Pyrexia, chest pain, pain, generalized edema, influenza-like illness, contusion, fall, procedural pain

Uncommon (0.1% to 1%): Ear pain, candidiasis, hot flush, edema, herpes simplex, asthenic conditions, pain and discomfort, chills

Rare (less than 0.1%): Asthenia

Frequency not reported: Motion sickness, malaise, hot flashes

Postmarketing reports: Clostridial infections (C difficile)[Ref]

Nervous system

Very common (10% or more): Dizziness (up to 13%), headache (10%)

Common (1% to 10%): Vertigo, amnesia, disturbance in attention, hypoesthesia, memory impairment, tremor

Uncommon (0.1% to 1%): Balance disorders, convulsion, attention disorders, migraine, paresthesia, sinus headache, somnolence

Frequency not reported: Syncope, tinnitus, loss of taste

Postmarketing reports: Presyncope, syncope[Ref]


Hypersensitivity reactions have occurred as early as within 15 minutes of drug administration.[Ref]

Frequency not reported: Anaphylactic reactions

Postmarketing reports: Hypersensitivity reactions (including exfoliative dermatitis, rash, angioneurotic edema [swelling of face and tongue and difficulty swallowing], urticaria, pruritus, flushing, anaphylaxis), anaphylactic responses, angioedemas, hypersensitivity[Ref]


Common (1% to 10%): Pruritus, rash, cellulitis

Uncommon (0.1% to 1%): Eruptions and exanthemas, sunburn, hyperhidrosis/increased sweating, cold sweat

Frequency not reported: Clamminess

Postmarketing reports: Angioedema, dermatitis, exfoliative dermatitis, eczema, erythemas, pruritus, purpura, urticarias[Ref]


Rhabdomyolysis has been reported in patients with cirrhosis (with and without concurrent statin use).[Ref]

Common (1% to 10%): Muscle spasms, arthralgia, back pain, myalgia, pain in extremity

Uncommon (0.1% to 1%): Neck pain, muscular weakness

Frequency not reported: Increased blood creatine phosphokinase

Postmarketing reports: Rhabdomyolysis[Ref]


Common (1% to 10%): Anemia

Uncommon (0.1% to 1%): Lymphocytosis, monocytosis, neutropenia

Postmarketing reports: Thrombocytopenia, INR abnormalities[Ref]


Common (1% to 10%): Cough, nasopharyngitis, dyspnea, upper respiratory tract infection, rhinitis, pneumonia, epistaxis

Uncommon (0.1% to 1%): Pleural effusion, pharyngitis, oropharyngeal pain, rhinorrhea, dry throat, nasal congestion

Rare (less than 0.1%): Chronic obstructive pulmonary disease

Frequency not reported: Respiratory tract infection, nasal passage irritation, pharyngolaryngeal pain[Ref]


Common (1% to 10%): Depression, insomnia, confusional state

Uncommon (0.1% to 1%): Anxiety, hypersomnia, abnormal dreams, depressed mood, nervousness[Ref]


Common (1% to 10%): Increased weight, anorexia, dehydration, hyperglycemia, hyperkalemia, hypoglycemia, hyponatremia

Uncommon (0.1% to 1%): Decreased appetite

Frequency not reported: Decreased weight[Ref]


Common (1% to 10%): Hypotension

Uncommon (0.1% to 1%): Palpitations, increased blood pressure

Rare (less than 0.1%): Hypertension[Ref]


Uncommon (0.1% to 1%): Urinary tract infection, dysuria, polyuria, proteinuria, pollakiuria, blood in urine present, glycosuria, polymenorrhea

Frequency not reported: Choluria, hematuria, urinary frequency[Ref]


Common (1% to 10%): Increased ALT

Uncommon (0.1% to 1%): Increased AST

Postmarketing reports: Liver function test abnormalities[Ref]


Uncommon (0.1% to 1%): Diplopia[Ref]


1. "Product Information. Xifaxan (rifaximin)." Salix Pharmaceuticals (2004):

2. Cerner Multum, Inc. "Australian Product Information." O 0

3. Cerner Multum, Inc. "UK Summary of Product Characteristics." O 0

4. Pimentel M, Park S, Mirocha J, Kane SV, Kong Y "The effect of a nonabsorbed oral antibiotic (rifaximin) on the symptoms of the irritable bowel syndrome: a randomized trial." Ann Intern Med 145 (2006): 557-63

5. Trapnell CB, Connolly M, Pentikis H, Forbes B, Bettenhausen DK "Absence of effect of oral rifaximin on the pharmacokinetics of ethinyl estradiol/norgestimate in healthy females." Ann Pharmacother 41 (2007): 222-8

6. Juillerat P, Pittet V, Felley C, et al. "Drug safety in Crohn's disease therapy." Digestion 76 (2007): 161-8

7. Garey KW, Salazar M, Shah D, Rodrigue R, Dupont HL "Rifamycin antibiotics for treatment of Clostridium difficile-associated diarrhea." Ann Pharmacother 42 (2008): 827-35

8. "Rifaximin (Xifaxan 550) for hepatic encephalopathy." Med Lett Drugs Ther 52 (2010): 87

9. Hynicka LM, Silva KN "Probable rifaximin-induced neutropenia." Am J Health Syst Pharm 69 (2012): 583-6

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

Some side effects may not be reported. You may report them to the FDA.