Matching articles for "Xifaxan"
Treatment of Clostridioides difficile Infection
The Medical Letter on Drugs and Therapeutics • September 6, 2021; (Issue 1632)
Clostridioides (formerly Clostridium) difficile infection
(CDI) is the most common infectious cause of
healthcare-associated diarrhea in adults. Guidelines
on management of CDI have recently been...
Clostridioides (formerly Clostridium) difficile infection
(CDI) is the most common infectious cause of
healthcare-associated diarrhea in adults. Guidelines
on management of CDI have recently been updated.
Drugs for Irritable Bowel Syndrome
The Medical Letter on Drugs and Therapeutics • March 23, 2020; (Issue 1594)
Irritable bowel syndrome (IBS) is a common disorder
characterized by recurrent abdominal pain and altered
bowel habits, often accompanied by bloating.IBS
is classified according to the predominant...
Irritable bowel syndrome (IBS) is a common disorder
characterized by recurrent abdominal pain and altered
bowel habits, often accompanied by bloating.IBS
is classified according to the predominant bowel
symptom as IBS with constipation (IBS-C), IBS with
diarrhea (IBS-D), mixed type (IBS-M), or unclassified
(IBS-U). Alterations in the microbiome, stress
responses, sensory and motor function of the gut,
and host genetic factors may be contributing factors.
Since the exact cause of IBS is unknown, the goal of
treatment is symptom control.
Table: Safety of Drugs for IBS in Pregnancy and Lactation (online only)
The Medical Letter on Drugs and Therapeutics • March 23, 2020; (Issue 1594)
...
View the Table: Safety of Drugs for IBS in Pregnancy and Lactation
Advice for Travelers
The Medical Letter on Drugs and Therapeutics • October 7, 2019; (Issue 1582)
Patients who receive pretravel advice can reduce their
risk for many travel-related conditions. Vaccines recommended
for travelers are reviewed in a separate...
Patients who receive pretravel advice can reduce their
risk for many travel-related conditions. Vaccines recommended
for travelers are reviewed in a separate issue.
Expanded Table: Antibiotics for Travelers' Diarrhea (online only)
The Medical Letter on Drugs and Therapeutics • October 7, 2019; (Issue 1582)
...
View the Expanded Table: Antibiotics for Travelers' Diarrhea
Rifamycin (Aemcolo) for Treatment of Travelers' Diarrhea
The Medical Letter on Drugs and Therapeutics • March 11, 2019; (Issue 1567)
The FDA has approved rifamycin (Aemcolo – Cosmo/
Aries), a minimally absorbed oral antibiotic, for
treatment of adults with travelers' diarrhea (TD)
caused by noninvasive strains of Escherichia coli....
The FDA has approved rifamycin (Aemcolo – Cosmo/
Aries), a minimally absorbed oral antibiotic, for
treatment of adults with travelers' diarrhea (TD)
caused by noninvasive strains of Escherichia coli. It
is not recommended for treatment of diarrhea that is
complicated by fever and/or bloody stools. Topical
and injectable formulations of rifamycin have been
used in Europe for other indications for many years.
In Brief: Pancreatitis with Eluxadoline (Viberzi) in Patients without a Gallbladder
The Medical Letter on Drugs and Therapeutics • April 24, 2017; (Issue 1519)
The FDA has warned that eluxadoline (Viberzi – Allergan), a mu-opioid receptor agonist and delta-opioid receptor antagonist approved in 2015 for treatment of irritable bowel syndrome with diarrhea (IBS-D),1...
The FDA has warned that eluxadoline (Viberzi – Allergan), a mu-opioid receptor agonist and delta-opioid receptor antagonist approved in 2015 for treatment of irritable bowel syndrome with diarrhea (IBS-D),1 should not be used in patients without a gallbladder because of an increased risk of serious pancreatitis.2
As of February 2017, the FDA had received reports of 118 cases of serious, nonfatal pancreatitis and 2 deaths associated with use of eluxadoline. Both deaths occurred in patients without a gallbladder who developed severe abdominal pain and vomiting shortly after taking the first dose. At least 48 of the cases occurred after only 1 or 2 doses of eluxadoline. Of the 68 patients whose gallbladder status was reported, 56 did not have a gallbladder. Most of the patients without a gallbladder (44/56) were taking the reduced dosage of eluxadoline recommended for such patients (75 mg once/day).
Patients considered at risk for pancreatitis were excluded from the two trials that led to approval of eluxadoline. One case of pancreatitis and 8 cases of abdominal pain with hepatic enzyme elevation associated with sphincter of Oddi spasm occurred with use of eluxadoline in the trials, all in patients without a gallbladder.3
According to the current label, eluxadoline is contraindicated in patients who abuse alcohol (including those who consume >3 servings of alcohol per day) and in those with known or suspected biliary duct, pancreatic duct, or GI tract obstruction, sphincter of Oddi disease or dysfunction, or severe hepatic impairment (Child-Pugh C). It is also contraindicated in those with a history of pancreatitis, structural pancreatic disease, or chronic or severe constipation.
Some alternatives to eluxadoline, which is only modestly more effective than placebo in relieving IBS-D symptoms, are the antidiarrheal loperamide (Imodium, and generics), the non-absorbed antibiotic rifaximin (Xifaxan), and the 5-HT3 receptor antagonist alosetron (Lotronex, and generics). Taken as needed, loperamide can reduce postprandial urgency and stool frequency, but it does not improve global symptoms of IBS-D. Like eluxadoline, rifaximin has only been modestly effective in relieving symptoms. Because of concerns about severe constipation and ischemic colitis, alosetron should be used only in women with severe, chronic IBS-D that is unresponsive to other drugs.4
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As of February 2017, the FDA had received reports of 118 cases of serious, nonfatal pancreatitis and 2 deaths associated with use of eluxadoline. Both deaths occurred in patients without a gallbladder who developed severe abdominal pain and vomiting shortly after taking the first dose. At least 48 of the cases occurred after only 1 or 2 doses of eluxadoline. Of the 68 patients whose gallbladder status was reported, 56 did not have a gallbladder. Most of the patients without a gallbladder (44/56) were taking the reduced dosage of eluxadoline recommended for such patients (75 mg once/day).
Patients considered at risk for pancreatitis were excluded from the two trials that led to approval of eluxadoline. One case of pancreatitis and 8 cases of abdominal pain with hepatic enzyme elevation associated with sphincter of Oddi spasm occurred with use of eluxadoline in the trials, all in patients without a gallbladder.3
According to the current label, eluxadoline is contraindicated in patients who abuse alcohol (including those who consume >3 servings of alcohol per day) and in those with known or suspected biliary duct, pancreatic duct, or GI tract obstruction, sphincter of Oddi disease or dysfunction, or severe hepatic impairment (Child-Pugh C). It is also contraindicated in those with a history of pancreatitis, structural pancreatic disease, or chronic or severe constipation.
Some alternatives to eluxadoline, which is only modestly more effective than placebo in relieving IBS-D symptoms, are the antidiarrheal loperamide (Imodium, and generics), the non-absorbed antibiotic rifaximin (Xifaxan), and the 5-HT3 receptor antagonist alosetron (Lotronex, and generics). Taken as needed, loperamide can reduce postprandial urgency and stool frequency, but it does not improve global symptoms of IBS-D. Like eluxadoline, rifaximin has only been modestly effective in relieving symptoms. Because of concerns about severe constipation and ischemic colitis, alosetron should be used only in women with severe, chronic IBS-D that is unresponsive to other drugs.4
- Eluxadoline (Viberzi) for irritable bowel syndrome with diarrhea. Med Lett Drugs Ther 2016; 58:4.
- FDA Drug Safety Communication: FDA warns about increased risk of serious pancreatitis with irritable bowel drug Viberzi (eluxadoline) in patients without a gallbladder. Available at: www.fda.gov. Accessed April 13, 2017.
- AJ Lembo et al. Eluxadoline for irritable bowel syndrome with diarrhea. N Engl J Med 2016; 374:242.
- Drugs for irritable bowel syndrome. Med Lett Drugs Ther 2016; 58:121.
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Drugs for Irritable Bowel Syndrome
The Medical Letter on Drugs and Therapeutics • September 26, 2016; (Issue 1504)
Irritable bowel syndrome (IBS) is a common disorder
characterized by chronic, intermittent abdominal pain
or discomfort and altered bowel habits. It is subtyped
according to the predominant bowel symptom as...
Irritable bowel syndrome (IBS) is a common disorder
characterized by chronic, intermittent abdominal pain
or discomfort and altered bowel habits. It is subtyped
according to the predominant bowel symptom as IBS
with constipation (IBS-C), IBS with diarrhea (IBS-D),
mixed type (IBS-M), or unclassified (IBS-U). Since the
exact cause of IBS is unknown, the goal of treatment
is symptom control.
Eluxadoline (Viberzi) for Irritable Bowel Syndrome with Diarrhea
The Medical Letter on Drugs and Therapeutics • January 4, 2016; (Issue 1485)
The FDA has approved eluxadoline (Viberzi – Actavis),
a mu-opioid receptor agonist and delta-opioid
receptor antagonist, for oral treatment of adults with
irritable bowel syndrome with diarrhea...
The FDA has approved eluxadoline (Viberzi – Actavis),
a mu-opioid receptor agonist and delta-opioid
receptor antagonist, for oral treatment of adults with
irritable bowel syndrome with diarrhea (IBS-D).
Rifaximin (Xifaxan) for Irritable Bowel Syndrome with Diarrhea
The Medical Letter on Drugs and Therapeutics • August 3, 2015; (Issue 1474)
Rifaximin (Xifaxan – Salix), a minimally absorbed
oral antibiotic approved previously to treat travelers'
diarrhea and to reduce the risk of recurrent hepatic
encephalopathy, has now been approved by the...
Rifaximin (Xifaxan – Salix), a minimally absorbed
oral antibiotic approved previously to treat travelers'
diarrhea and to reduce the risk of recurrent hepatic
encephalopathy, has now been approved by the FDA
for treatment of irritable bowel syndrome with diarrhea
(IBS-D). Eluxadoline (Viberzi – Actavis), a mu-opioid
receptor agonist, was also recently approved for IBS-D
and will be reviewed in a future issue.
Advice for Travelers
The Medical Letter on Drugs and Therapeutics • April 13, 2015; (Issue 1466)
Patients planning to travel to other countries often
ask for information about prevention of diarrhea,
malaria, and other travel-related conditions. Vaccines
recommended for travelers based on their...
Patients planning to travel to other countries often
ask for information about prevention of diarrhea,
malaria, and other travel-related conditions. Vaccines
recommended for travelers based on their destination,
length of stay, and planned activities were reviewed in
a previous issue.
Drugs for Inflammatory Bowel Disease
The Medical Letter on Drugs and Therapeutics • August 4, 2014; (Issue 1448)
Aminosalicylates are effective for induction and maintenance
of remission in mild to moderate ulcerative
colitis. They are not recommended for treatment of
Crohn's disease.
FORMULATIONS — Oral mesalamine...
Aminosalicylates are effective for induction and maintenance
of remission in mild to moderate ulcerative
colitis. They are not recommended for treatment of
Crohn's disease.
FORMULATIONS — Oral mesalamine is rapidly absorbed in the small intestine and most of the drug does not reach the colon. Pentasa releases mesalamine gradually throughout the gastrointestinal tract. Delzicol, Asacol HD, Lialda, and Apriso delay the release of the drug until it reaches the distal ileum and colon. Sulfasalazine (Azulfidine, and generics), balsalazide (Colazal, and others), and olsalazine (Dipentum) are prodrugs; mesalamine is azo-bonded to a second moiety and released in the colon following bacterial cleavage of the bond. Mesalamine is also available as an enema (Rowasa, and generics) and as a rectal suppository (Canasa).
FORMULATIONS — Oral mesalamine is rapidly absorbed in the small intestine and most of the drug does not reach the colon. Pentasa releases mesalamine gradually throughout the gastrointestinal tract. Delzicol, Asacol HD, Lialda, and Apriso delay the release of the drug until it reaches the distal ileum and colon. Sulfasalazine (Azulfidine, and generics), balsalazide (Colazal, and others), and olsalazine (Dipentum) are prodrugs; mesalamine is azo-bonded to a second moiety and released in the colon following bacterial cleavage of the bond. Mesalamine is also available as an enema (Rowasa, and generics) and as a rectal suppository (Canasa).
Advice for Travelers
The Medical Letter on Drugs and Therapeutics • June 1, 2012; (Issue 118)
Patients planning to travel to other countries often ask
for information about appropriate vaccines and prevention
of diarrhea and malaria. More detailed advice for
travelers is available from the Centers...
Patients planning to travel to other countries often ask
for information about appropriate vaccines and prevention
of diarrhea and malaria. More detailed advice for
travelers is available from the Centers for Disease
Control and Prevention (CDC) at www.cdc.gov/travel.
Guidelines are also available from the Infectious
Diseases Society of America (IDSA).
Drugs for Irritable Bowel Syndrome
The Medical Letter on Drugs and Therapeutics • July 1, 2011; (Issue 107)
Irritable bowel syndrome (IBS) is a common disorder,
occurring in up to 15% of the US population; it is 2-2.5 times more frequent in women than in men. IBS
is characterized by chronic, intermittent...
Irritable bowel syndrome (IBS) is a common disorder,
occurring in up to 15% of the US population; it is 2-2.5 times more frequent in women than in men. IBS
is characterized by chronic, intermittent abdominal
pain or discomfort accompanied by altered bowel
habits. Since the underlying mechanisms of disease
remain unclear, management of IBS focuses on symptom
control.
Treatment of Clostridium Difficile Infection
The Medical Letter on Drugs and Therapeutics • February 21, 2011; (Issue 1358)
Clostridium difficile infection (CDI) is the most common infectious cause of healthcare-associated diarrhea in adults. The incidence and severity of CDI have increased in recent years with the emergence of an...
Clostridium difficile infection (CDI) is the most common infectious cause of healthcare-associated diarrhea in adults. The incidence and severity of CDI have increased in recent years with the emergence of an epidemic virulent strain (NAP1/BI/027). Common risk factors include admission to a healthcare facility, increasing age and severity of underlying illness, gastric acid suppression and exposure to antimicrobials, particularly clindamycin, ampicillin, cephalosporins or fluoroquinolones. Patients who develop CDI while receiving a precipitating antibiotic should have the antibiotic discontinued, if possible, or switched to another appropriate antimicrobial with a lower risk of CDI.
Rifaximin (Xifaxan 550) for Hepatic Encephalopathy
The Medical Letter on Drugs and Therapeutics • November 1, 2010; (Issue 1350)
The FDA has approved a new 550-mg tablet of rifaximin (Xifaxan – Salix), a minimally absorbed oral
antibiotic, to reduce the risk of recurrent hepatic encephalopathy (HE). A 200-mg tablet has been...
The FDA has approved a new 550-mg tablet of rifaximin (Xifaxan – Salix), a minimally absorbed oral
antibiotic, to reduce the risk of recurrent hepatic encephalopathy (HE). A 200-mg tablet has been available
for treatment of travelers’ diarrhea since 2004.
Advice for Travelers
The Medical Letter on Drugs and Therapeutics • November 1, 2009; (Issue 87)
Patients planning to travel to other countries often ask physicians for information about appropriate vaccines and prevention of diarrhea and malaria. Guidelines are also available from the Infectious Diseases...
Patients planning to travel to other countries often ask physicians for information about appropriate vaccines and prevention of diarrhea and malaria. Guidelines are also available from the Infectious Diseases Society of America (IDSA).
Drugs for Travelers' Diarrhea
The Medical Letter on Drugs and Therapeutics • July 28, 2008; (Issue 1291)
The most common cause of travelers' diarrhea, usually a self-limited illness without fever lasting several days, is infection with noninvasive enterotoxigenic (ETEC) or enteroaggregative (EAEC) strains of...
The most common cause of travelers' diarrhea, usually a self-limited illness without fever lasting several days, is infection with noninvasive enterotoxigenic (ETEC) or enteroaggregative (EAEC) strains of Escherichia coli. Campylobacter, Shigella, Salmonella, Aeromonas, viruses and parasites are less common.
Choice of Antibacterial Drugs
The Medical Letter on Drugs and Therapeutics • May 1, 2007; (Issue 57)
Information about empirical treatment of bacterial infections, emerging trends in antimicrobial resistance, new drugs and new data about older drugs continue to become available. Usual pathogens and empiric...
Information about empirical treatment of bacterial infections, emerging trends in antimicrobial resistance, new drugs and new data about older drugs continue to become available. Usual pathogens and empiric treatment for some common types of infections are summarized in the text and a table listing the drugs of choice and alternatives for each pathogen begins on page 40. The recommendations made here are based on the results of susceptibility studies, clinical trials and the opinions of Medical Letter consultants.
Treatment of Clostridium difficile-Associated Disease (CDAD)
The Medical Letter on Drugs and Therapeutics • November 6, 2006; (Issue 1247)
The gram-positive anaerobic bacillus Clostridium difficile is the most common identifiable cause of antibiotic-associated diarrhea. The antibiotics most often implicated have been ampicillin, second and third...
The gram-positive anaerobic bacillus Clostridium difficile is the most common identifiable cause of antibiotic-associated diarrhea. The antibiotics most often implicated have been ampicillin, second and third generation cephalosporins, clindamycin and fluoroquinolones. The emergence in recent years of a new, more toxic epidemic strain (BI/NAP1), possibly related to widespread use of fluoroquinolones, has caused a marked increase in the incidence and severity of C. difficile-associated disease (CDAD).
Advice for Travelers
The Medical Letter on Drugs and Therapeutics • May 1, 2006; (Issue 45)
Patients planning to travel to other countries often ask physicians for information about immunizations and prevention of diarrhea and malaria. More detailed advice for travelers is available from the Centers...
Patients planning to travel to other countries often ask physicians for information about immunizations and prevention of diarrhea and malaria. More detailed advice for travelers is available from the Centers for Disease Control and Prevention at 877-FYI-TRIP (877-394-8747) or www.cdc.gov/travel.
Drugs for Irritable Bowel Syndrome
The Medical Letter on Drugs and Therapeutics • March 1, 2006; (Issue 43)
Irritable bowel syndrome (IBS) is a common disorder, occuring in about 15% of the US population; it is 2-3 times more frequent in women than in men. IBS is characterized by chronic abdominal pain or discomfort...
Irritable bowel syndrome (IBS) is a common disorder, occuring in about 15% of the US population; it is 2-3 times more frequent in women than in men. IBS is characterized by chronic abdominal pain or discomfort and altered bowel habits.
Rifaximin (Xifaxan) for Travelers' Diarrhea
The Medical Letter on Drugs and Therapeutics • September 13, 2004; (Issue 1191)
Rifaximin (Xifaxan - Salix), a non-absorbed oral antibiotic derived from rifampin (Rifadin, and others), has been approved by the FDA for treatment of travelers' diarrhea caused by noninvasive strains of...
Rifaximin (Xifaxan - Salix), a non-absorbed oral antibiotic derived from rifampin (Rifadin, and others), has been approved by the FDA for treatment of travelers' diarrhea caused by noninvasive strains of Escherichia coli in patients 12 years of age or older. It has been available in Europe since 1987.