Aa
Xifaxan
Has anyone been prescribed Xifaxan as treatment for HE?
If so, is it as big a life changer as it claims? And does anyone know if the costs are better around the world?
( I can get it in Canada but it is not approved so 1000 per month is our cost) US is worst and so far can't find it in Mexico online, I have some family in the Netherlands for the next few weeks but not sure if they can get it without a prescription there:(
If so, is it as big a life changer as it claims? And does anyone know if the costs are better around the world?
( I can get it in Canada but it is not approved so 1000 per month is our cost) US is worst and so far can't find it in Mexico online, I have some family in the Netherlands for the next few weeks but not sure if they can get it without a prescription there:(
My husband was prescribed Xifaxan 3 years ago. He also is taking pantaprazole, furosemide, spironolactone, enclose, and midodrine. He is doing somewhat better- I see the positive change of the xifaxan, and the Drs say we are doing everything right. Our pharmacy contacted the company and they covered half of the cost
I've been getting it free from the pharmacial company. They have an assistance program.
So sorry you are having this problem. I know how difficult HE can be.
I sincerely hope you will find a way to get that Xifaxin. You really do need it.
I hope you have someone who is helping you with this.
Nan
I sincerely hope you will find a way to get that Xifaxin. You really do need it.
I hope you have someone who is helping you with this.
Nan
The xifaxan is covered in my part D plan but it puts me in the donut hole in 2 months. The company will give it to you for $35 a month while you are in the donut hole, but then I have to pay for all my meds during that time. I haven't figured it all out yet. I don't think I can afford that. I really do need to be on it. I've been on lactulose for 3 years now. The smallest dose gives me diarrhea and I have a lot of symptoms of confusion and such. Sometimes figuring it all out is too much for me and I just let it go....
re: This quote from VA info:
"Some patients absolutely cannot tolerate lactulose. Even the minimal dosage of lactulose will give them diarrhea. In such cases, you have to switch to an antibiotic, which would be neomycin"
Neomycin can cause kidney injury. Happened to my husband pre-transplant unfortunately. Luckily his kidneys recovered.Xifaxin is the newer antibiotic that is preferred though it is much more expensive.
Nan
"Some patients absolutely cannot tolerate lactulose. Even the minimal dosage of lactulose will give them diarrhea. In such cases, you have to switch to an antibiotic, which would be neomycin"
Neomycin can cause kidney injury. Happened to my husband pre-transplant unfortunately. Luckily his kidneys recovered.Xifaxin is the newer antibiotic that is preferred though it is much more expensive.
Nan
COMMUNITY LEADER
As Nan said lactulose needs a lot of tweaking to get the dose just right. "Titration is the process of gradually adjusting the dose of a medication until optimal results are reached." It took me many months to find just the right dose for me at various points of my illness. Too much and I would get diarrhea and the runs. Too little and my HE would get worse. It is a fine balance and it take time to fine tune it.
In reality the dose is different each day depending on what and how much one eats. Which determines who much toxin are created during digestion. But I believe by experimentation there is a dose that is pretty much just right for everyone at various points in their illness.
Here is how the VA website describes the process...
"Lactulose causes severe diarrhea in these patients, so you have to adjust the lactulose intake to dosages that result in only 2-3 bowel movements a day. You do not want these patients to have diarrhea because that leads to more complications, including prerenal azotemia. For dosing, you need to instruct the patient and the patient's family to find a dosage that results in 2-3 bowel movements a day. We usually start with 30 cc twice a day; if that causes diarrhea, the dosage is reduced. If the patient is not having a bowel movement, the dosage is increased. So you work on that, but it is more the patient and the patient's family who make the adjustments.
Some patients absolutely cannot tolerate lactulose. Even the minimal dosage of lactulose will give them diarrhea. In such cases, you have to switch to an antibiotic, which would be neomycin."
The key idea is to dose lactulose so the person has 2-4 soft stool bowel moments per day. Not watery diarrhea but soft stools.
As Nan mentioned there are factors that can increase or trigger HE episodes as well including diarrhea, constipation...
* Dehydration (can be caused by diarrhea)
* Electrolyte abnormalities (especially a decrease in potassium) from vomiting, or from treatments such as paracentesis or taking diuretics
* Bleeding from the intestines, stomach, or esophagus (variceal bleed)
* Infections
* Eating too much protein
* Kidney problems
* Shunt placement or complications (TIPS)
* Surgery
* Use of medications that suppress the central nervous system (such as barbiturates or benzodiazepine tranquilizers)
* Low oxygen levels in the body
Take care.
Hector
In reality the dose is different each day depending on what and how much one eats. Which determines who much toxin are created during digestion. But I believe by experimentation there is a dose that is pretty much just right for everyone at various points in their illness.
Here is how the VA website describes the process...
"Lactulose causes severe diarrhea in these patients, so you have to adjust the lactulose intake to dosages that result in only 2-3 bowel movements a day. You do not want these patients to have diarrhea because that leads to more complications, including prerenal azotemia. For dosing, you need to instruct the patient and the patient's family to find a dosage that results in 2-3 bowel movements a day. We usually start with 30 cc twice a day; if that causes diarrhea, the dosage is reduced. If the patient is not having a bowel movement, the dosage is increased. So you work on that, but it is more the patient and the patient's family who make the adjustments.
Some patients absolutely cannot tolerate lactulose. Even the minimal dosage of lactulose will give them diarrhea. In such cases, you have to switch to an antibiotic, which would be neomycin."
The key idea is to dose lactulose so the person has 2-4 soft stool bowel moments per day. Not watery diarrhea but soft stools.
As Nan mentioned there are factors that can increase or trigger HE episodes as well including diarrhea, constipation...
* Dehydration (can be caused by diarrhea)
* Electrolyte abnormalities (especially a decrease in potassium) from vomiting, or from treatments such as paracentesis or taking diuretics
* Bleeding from the intestines, stomach, or esophagus (variceal bleed)
* Infections
* Eating too much protein
* Kidney problems
* Shunt placement or complications (TIPS)
* Surgery
* Use of medications that suppress the central nervous system (such as barbiturates or benzodiazepine tranquilizers)
* Low oxygen levels in the body
Take care.
Hector
It's definitely a delicate balance. Too much lactulose can cause diarrhea which can lead to dehydration which can cause more HE.
You said she went from 25 ml 3x a day - that's 75 ml a day
Now on 15 ml 2X a day - that's 30 ml. a day (or less than half what she was taking)
My husband takes 30 ml twice a day ( 60 ml a day )
My advice is try to work out a dosage that works for her.
This is very hard for her for sure, and its hard for you too.
Unfortunately, I know exactly what she and you are going through.
Big hug,
Nan
You said she went from 25 ml 3x a day - that's 75 ml a day
Now on 15 ml 2X a day - that's 30 ml. a day (or less than half what she was taking)
My husband takes 30 ml twice a day ( 60 ml a day )
My advice is try to work out a dosage that works for her.
This is very hard for her for sure, and its hard for you too.
Unfortunately, I know exactly what she and you are going through.
Big hug,
Nan
Thank you so much Hector. The savings plan you quoted is unfortunately only available in the us, and we are in canada. I was considering a trip to Mexico but haven't found in at any online pharmacies there yet.
My mom was taking 25ml 3x a day of lactulose, but was going too often and very watery so it was decreased to 15 ml twice per day, but I have noticed a delay in her reaction time, slurring speech, and as I mentioned in a previous post blood pressure 80/30. The doctor says xifaxan won't help her prognosis but can improve quality of life.
My mom was taking 25ml 3x a day of lactulose, but was going too often and very watery so it was decreased to 15 ml twice per day, but I have noticed a delay in her reaction time, slurring speech, and as I mentioned in a previous post blood pressure 80/30. The doctor says xifaxan won't help her prognosis but can improve quality of life.
COMMUNITY LEADER
Yes, I was prescribed it during my cirrhosis in addition Lactulose which is the first line of treatment for HE. It is normally taken with lactulose as each drug has different ways of preventing HE episodes.
------------------------------------------------------------------------------------------------
Am J Gastroenterol. 2013 Sep;
A randomized, double-blind, controlled trial comparing rifaximin plus lactulose with lactulose alone in treatment of overt hepatic encephalopathy.
OBJECTIVES:
Hepatic encephalopathy (HE) is associated with poor prognosis in cirrhosis. Drugs used in the treatment of HE are primarily directed at the reduction of the blood ammonia levels. Rifaximin and lactulose have shown to be effective in HE. We evaluated the efficacy and safety of rifaximin plus lactulose vs. lactulose alone for treatment of overt HE.
CONCLUSION:
Combination of lactulose plus rifaximin is more effective than lactulose alone in the treatment of overt HE.
-----------------------------------------------------------------------------------------------
I took Xifaxan for about two years before my health insurance changed and I could not afford the cost of Xifaxan which was near $1,000 per month. So I had to manage without it. I increased my Lactulose instead (3 times a day at various times) and was able to achieve good management of my HE.
NOTE: We are all different so I can not say how anyone else's HE will respond to the different treatments for HE. Of course no red meat and preventing the various triggers for HE are also very important as well as Lactulose and Xifaxan. Treatments for complications of cirrhosis are not cure alls but for many people they can make the symptoms a lot more bearable.
Xifaxan is the only manufacturer of Rifaximin. I don't know anywhere to get it cheaper.
Patent expiration dates: October 2, 2029
Patent use: REDUCTION IN RISK OF OVERT HEPATIC ENCEPHALOPATHY (HE) RECURRENCE
Treats traveler's diarrhea caused by a bacteria called Escherichia coli. It is also used to prevent hepatic encephalopathy, which is a condition that occurs when your liver does not work normally. This is an antibiotic. XIFAXAN tablets contain rifaximin, a non-aminoglycoside semi-synthetic, nonsystemic antibiotic derived from rifamycin SV.
http://www.rxlist.com/xifaxan-drug.htm
I would recommend looking into various ways to obtain Xifaxan from Salix, the manufacturer.
You can find.....
The Xifaxan 550 mg Instant Savings Card program provides eligible patients help with their monthly copays for Xifaxan 550 mg. Eligible patients will pay no more than $10 per month for their prescriptions.* The Xifaxan 550 mg Instant Savings Card can be activated by calling 1-866-XIFAXAN (943-2926) or online at Xifaxan550.com.
If you have patients who need assistance with their monthly copays for Xifaxan 550 mg, call 1-866-XIFAXAN (943-2926).
*Maximum monthly benefit of up to $500. This offer is valid for one use per month until 3/31/15. This offer is not valid if your prescription plan is paid/partially paid by Medicaid, Medicare, or federal or state government programs. Not valid if reproduced or submitted to the other payer. Salix Pharmaceuticals reserves the right to rescind, revoke or amend this offer without notice. Offer good only in the USA. Void where prohibited by law.
The Salix Patient Assistance Program (PAP)
Salix Patient Assistance Program (PAP), a resource that provides free product for both uninsured and underinsured (insured but without coverage for Xifaxan 550 mg) patients who meet the predetermined eligibility criteria. Our access coordinators will work with your patients to determine eligibility for the program, and if interim product support may be available.
To speak with a Salix access coordinator, call 1-866-XIFAXAN (943-2926) for more information.
All this info can be found on their website.
http://www.xifaxan550.com/hepatic-encephalopathy-resources#cost_insurance_support
Best of luck to you.
Hector
------------------------------------------------------------------------------------------------
Am J Gastroenterol. 2013 Sep;
A randomized, double-blind, controlled trial comparing rifaximin plus lactulose with lactulose alone in treatment of overt hepatic encephalopathy.
OBJECTIVES:
Hepatic encephalopathy (HE) is associated with poor prognosis in cirrhosis. Drugs used in the treatment of HE are primarily directed at the reduction of the blood ammonia levels. Rifaximin and lactulose have shown to be effective in HE. We evaluated the efficacy and safety of rifaximin plus lactulose vs. lactulose alone for treatment of overt HE.
CONCLUSION:
Combination of lactulose plus rifaximin is more effective than lactulose alone in the treatment of overt HE.
-----------------------------------------------------------------------------------------------
I took Xifaxan for about two years before my health insurance changed and I could not afford the cost of Xifaxan which was near $1,000 per month. So I had to manage without it. I increased my Lactulose instead (3 times a day at various times) and was able to achieve good management of my HE.
NOTE: We are all different so I can not say how anyone else's HE will respond to the different treatments for HE. Of course no red meat and preventing the various triggers for HE are also very important as well as Lactulose and Xifaxan. Treatments for complications of cirrhosis are not cure alls but for many people they can make the symptoms a lot more bearable.
Xifaxan is the only manufacturer of Rifaximin. I don't know anywhere to get it cheaper.
Patent expiration dates: October 2, 2029
Patent use: REDUCTION IN RISK OF OVERT HEPATIC ENCEPHALOPATHY (HE) RECURRENCE
Treats traveler's diarrhea caused by a bacteria called Escherichia coli. It is also used to prevent hepatic encephalopathy, which is a condition that occurs when your liver does not work normally. This is an antibiotic. XIFAXAN tablets contain rifaximin, a non-aminoglycoside semi-synthetic, nonsystemic antibiotic derived from rifamycin SV.
http://www.rxlist.com/xifaxan-drug.htm
I would recommend looking into various ways to obtain Xifaxan from Salix, the manufacturer.
You can find.....
The Xifaxan 550 mg Instant Savings Card program provides eligible patients help with their monthly copays for Xifaxan 550 mg. Eligible patients will pay no more than $10 per month for their prescriptions.* The Xifaxan 550 mg Instant Savings Card can be activated by calling 1-866-XIFAXAN (943-2926) or online at Xifaxan550.com.
If you have patients who need assistance with their monthly copays for Xifaxan 550 mg, call 1-866-XIFAXAN (943-2926).
*Maximum monthly benefit of up to $500. This offer is valid for one use per month until 3/31/15. This offer is not valid if your prescription plan is paid/partially paid by Medicaid, Medicare, or federal or state government programs. Not valid if reproduced or submitted to the other payer. Salix Pharmaceuticals reserves the right to rescind, revoke or amend this offer without notice. Offer good only in the USA. Void where prohibited by law.
The Salix Patient Assistance Program (PAP)
Salix Patient Assistance Program (PAP), a resource that provides free product for both uninsured and underinsured (insured but without coverage for Xifaxan 550 mg) patients who meet the predetermined eligibility criteria. Our access coordinators will work with your patients to determine eligibility for the program, and if interim product support may be available.
To speak with a Salix access coordinator, call 1-866-XIFAXAN (943-2926) for more information.
All this info can be found on their website.
http://www.xifaxan550.com/hepatic-encephalopathy-resources#cost_insurance_support
Best of luck to you.
Hector
Before his transplant, my husband had end stage liver disease. His Meld score fluctuated between 24-3. He had decompensated cirrhosis including HE, edema, esophageal varies, and portal hypertension.
Xifaxin was prescribed for his HE. Unfortunately he had to stop it because his edema worsened greatly. The Xifaxin website says it had not been studied in patients with MELD scores >25. Based on my husband's experience if your Mom's meld score is higher than 25, 8 would proceed with caution.
My husband is now post transplant with cirrhosis of the new liver. He has symptoms of HE and portal hypertension. His MELD score fluctuates from 13-19. He is taking Xifaxin 550 mg twice daily. It is helping him along with the daily lactulose doses. He has no edema.
So based on his two experiences with Xifaxin pre and post - transplant
I would say if your Mom's Meld score is below 25 and she does not have edema, you may want to contact the company for free samples and try it out.
Contact the company for help with this decision.
Nan
Xifaxin was prescribed for his HE. Unfortunately he had to stop it because his edema worsened greatly. The Xifaxin website says it had not been studied in patients with MELD scores >25. Based on my husband's experience if your Mom's meld score is higher than 25, 8 would proceed with caution.
My husband is now post transplant with cirrhosis of the new liver. He has symptoms of HE and portal hypertension. His MELD score fluctuates from 13-19. He is taking Xifaxin 550 mg twice daily. It is helping him along with the daily lactulose doses. He has no edema.
So based on his two experiences with Xifaxin pre and post - transplant
I would say if your Mom's Meld score is below 25 and she does not have edema, you may want to contact the company for free samples and try it out.
Contact the company for help with this decision.
Nan
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