[DavidHC]

So I was given a prescription for a new medication by my GI and I'm not sure I want to take it because of the non-medical ingredients, so I thought I'd ask you all what you think. Mrs.D (and anyone else with knowledge about this), I would particularly appreciate your input. I plan to do some research myself. Some of them are of course ones we all know about given the supplements we take.

They are: colloidal silicon dioxide, glyceryl distearate, microcrystalline cellulose, polyethylene glycol, polyvinyl alcohol, red iron oxide, sodium starch glycolate, talc, and titanium dioxide. It's the antibiotic Rifaximin.

Thank you in advance.

[en bloc]

I have taken Rifaximin many times. I occasionally get a condition called SIBO (small intestine bacterial overgrowth) which is a result of my gastroparesis. The antibiotic works only in the GI track, and very little enters the blood stream. It is also used for travelers diarrhea, IBS (with chronic diarrhea), and hepatic encephalopathy.

It is a very expensive antibiotic and often insurance won't pay for it...unless the doctor well documents certain conditions.

All medications (as far as I know) have 'other ingredients', so I'm not sure what your question is. Why are you being prescribed it?

[DavidHC]

Yes, I recall you saying you've used it in the past for that reason. We spoke about it before too in the context of SIBO and natural remedies. It seems to work well for you?

It would be for SIBO in my case too, and I've done plenty of research on it, and of course I'm aware that all meds have other ingredients, but I'm still not too keen on taking ones that are harmful to my body when I take such effort to avoid anything harmful. So I was asking if any stand out as particularly harmful to anyone. For example, titanium dioxide is in plenty of meds and supplements, but is very problematic and I avoid it at all costs. That's all.

Anyway, I'm not sure if I can get it covered, precisely for the reason you note. But in Canada, a 14 day course of 3xdaily is $420, whereas it's much more in the US I think.

Originally Posted by en bloc

I have taken Rifaximin many times. I occasionally get a condition called SIBO (small intestine bacterial overgrowth) which is a result of my gastroparesis. The antibiotic works only in the GI track, and very little enters the blood stream. It is also used for travelers diarrhea, IBS (with chronic diarrhea), and hepatic encephalopathy.

It is a very expensive antibiotic and often insurance won't pay for it...unless the doctor well documents certain conditions.

All medications (as far as I know) have 'other ingredients', so I'm not sure what your question is. Why are you being prescribed it?

[en bloc]

I order it from overseas...due to it's high cost. My insurance used to pay for it, but not anymore

I was just curious if there was a specific reason you questioned the other ingredients in this case. I'm not familiar with Titanium dioxide...but then again, I don't think I would know which ingredient is problematic when there is so many and the 'other ingredients' are typically in smaller amounts than the main ingredient.

If you have SIBO, then it is very effective for this. I have not had any side-effects from it and I'm actually taking it at the moment for the same reason.

In the US, it is $840 for 14 day at just 2 x daily (550mg)!!

[DavidHC]

Right. I recall you saying that. How much does it come out from overseas? Perhaps that's an option for me. The prices for RX in the US are insane!

Unfortunately, it's difficult to avoid since big pharma doesn't care about health and so they use all sorts of unnecessary fillers and additives. It's mostly a losing battle, if you really need something.

I'm glad to hear that it's so effective and also that there aren't many side effects. I hope I'm as fortunate, though given that it's barely absorbed in the blood stream, I'm not surprised. How long does it last before your SIBO comes back? I mean, with you condition (and a few others) it's inevitable, but I'm curious about duration of efficacy so to speak.

I was told to take it 3x daily for the 14 days, but we'll see if I can find it at a lower price and whether any of the ingredients is such that I will want to avoid it entirely.

Thanks and I hope it clears up for you soon!

Originally Posted by en bloc

I order it from overseas...due to it's high cost. My insurance used to pay for it, but not anymore

I was just curious if there was a specific reason you questioned the other ingredients in this case. I'm not familiar with Titanium dioxide...but then again, I don't think I would know which ingredient is problematic when there is so many and the 'other ingredients' are typically in smaller amounts than the main ingredient.

If you have SIBO, then it is very effective for this. I have not had any side-effects from it and I'm actually taking it at the moment for the same reason.

In the US, it is $840 for 14 day at just 2 x daily (550mg)!!

[en bloc]

60 of the 400mg tabs can be obtained from inhousepharmacy.vu for just under $100.

It comes under a different generic name (Rcifax), but I confirmed the medication with my GI doctor at Johns Hopkins before purchasing it. I have used it 3 times from this source and works just fine. They don't carry the 550 mg tabs, but I got the same good results with 400 mg.

My SIBO returns 2, maybe, 3 times a year. If I don't treat it right away and let if get bad, then symptoms might return within a week of finishing the antibiotic course...and I have to repeat the course. My doctor says this is normal when the bacterial load is high.

It is also important to avoid refined sugars and carbs...as they will 'feed' the bacteria and slow down your improvement. I also follow a gastroparesis diet to help keep symptoms at bay and SIBO from recurring more frequently.

Hope this helps.

[DavidHC]

En Bloc,

It does help. Thank you. And this site may be of use to you: Antibiotics - SIBO- Small Intestine Bacterial Overgrowth. She's quite the expert on SIBO and there is a ton of useful stuff on the site.

You're definitely right that diet is essential and that carbs and refined sugars, basically anything that can feed the bacteria, is to be avoided as much as possible. I believe SIBO is one of my problems, and SIBO can cause intestinal permeability, the two often go hand in hand, and this is likely the route through which my disease process began.

Anyway, thanks again!

Originally Posted by en bloc

60 of the 400mg tabs can be obtained from inhousepharmacy.vu for just under $100.

It comes under a different generic name (Rcifax), but I confirmed the medication with my GI doctor at Johns Hopkins before purchasing it. I have used it 3 times from this source and works just fine. They don't carry the 550 mg tabs, but I got the same good results with 400 mg.

My SIBO returns 2, maybe, 3 times a year. If I don't treat it right away and let if get bad, then symptoms might return within a week of finishing the antibiotic course...and I have to repeat the course. My doctor says this is normal when the bacterial load is high.

It is also important to avoid refined sugars and carbs...as they will 'feed' the bacteria and slow down your improvement. I also follow a gastroparesis diet to help keep symptoms at bay and SIBO from recurring more frequently.

Hope this helps.

[mrsD]

I'd follow the FODMAP diet plan....this minimizes fructose and can be very helpful.

FODMAP Food List | IBS Diets
This dietary information has shifted from alternative status to official medical status now.

This list of your inert ingredients is typical for modern tablet formulations (even for OTC products).

The only thing that strikes me at the moment is the talc.
Talc is now highly active with liability as a potential cancer causer.
However, given that most people use talc based powders, inhale the particles daily (even for babies) it still only remains controversial.

The majority of the list you included here, David, are part of the coatings of the tablets. So they won't split and leak contents into the bottles, so they dissolve properly in the GI tract at the appropriate time (pH controlled). Red iron oxide is a coloring agent. Silicon is commonly in many foods we consume daily, so this doesn't ring any alarm bells for me at all. (bananas, beer, green beans as examples)

If you believe that you cannot consume these additives or you don't want to (in the tiny amounts present in current tablet formulations), you will simply not be able to use much of any medication when you need it. From Benadryl, Tylenol, or many RX tablets with film coatings.

You can plug in each ingredient to Wiki and get a monograph on each.

[DavidHC]

Thanks, MrsD.

Yes, I'm aware of the FODMAP diet. I'm not the biggest fan of aspects of it, and think it's wrong on others, but it has some of the right ideas, and it has provided relief for some people I've met. My own diet shares some of the same principles. Mine is in fact even lower in foods that feed the bacteria. It's ketogenic and so is very low in carbohydrates in general. I have been cheating now and then the last 6 months after following it religiously for the first 6 months, but since my symptoms have become worse and the nerve damage has spread, a few days ago I went back on it and will simply stick to it permanently. It's not the easiest diet but it is the only thing that have given me relief and in fact seemed to be improving the nerve damage or at least halting it, or perhaps just slowing it down.

And after some research I've come to see you're right, they are typical ingredients. There is evidence of potential harm from talc, the iron oxide and titanium dioxide, but it's all over the place. I just didn't know because I have never really taken too much meds given my age, but especially recently, since I avoided it all like the plague. I don't take any tablets really, perhaps once every few years, if something comes up. But you're right, and they are unavoidable in pretty much any tablet formation. I'm just more health conscious these days, after having become ill.

Thank you again for this information and for your input.

Originally Posted by mrsD

I'd follow the FODMAP diet plan....this minimizes fructose and can be very helpful.

FODMAP Food List | IBS Diets
This dietary information has shifted from alternative status to official medical status now.

This list of your inert ingredients is typical for modern tablet formulations (even for OTC products).

The only thing that strikes me at the moment is the talc.
Talc is now highly active with liability as a potential cancer causer.
However, given that most people use talc based powders, inhale the particles daily (even for babies) it still only remains controversial.

The majority of the list you included here, David, are part of the coatings of the tablets. So they won't split and leak contents into the bottles, so they dissolve properly in the GI tract at the appropriate time (pH controlled). Red iron oxide is a coloring agent. Silicon is commonly in many foods we consume daily, so this doesn't ring any alarm bells for me at all. (bananas, beer, green beans as examples)

If you believe that you cannot consume these additives or you don't want to (in the tiny amounts present in current tablet formulations), you will simply not be able to use much of any medication when you need it. From Benadryl, Tylenol, or many RX tablets with film coatings.

You can plug in each ingredient to Wiki and get a monograph on each.

[mrsD]

If you believe you are "feeding" intestinal" bacteria, I'd strongly suggest you avoid all "gums" which are common food additives today.

They are in alot of foods.... ice cream, other dairy including Greek style yogurts and sour creams, cheeses etc., salad dressings, or any food that you pour or needs to be uniform in appearance.

Carob bean gum (aka locust bean gum) is the absolute worst for me. The guar gum and xanthan gum I can manage in tiny amounts sometimes. I believe these "natural" additives are feeding harmful types of bacteria in the bowel.

I have to read labels on everything I buy, otherwise I will have
nasty GI consequences (gas, bloating, and diarrhea).

I believe that the inert ingredients in medications are present in very tiny amounts compared to the gums which are in foods.
I have yet to see any negative results from medications (yet).