Rifaximin and Iron Supplementation in Patients with Cirrhosis

Clinical Recommendations

The American Association for the Study of Liver Diseases recommends administering both rifaximin (550 mg twice daily) and iron supplementation concurrently to address neuropsychiatric complications and anemia in patients with cirrhosis, with a strong evidence level 1, 2
For patients with cirrhosis, each 1 g/dL increase in hemoglobin over 6 months is associated with improved survival (HR = 0.72, 95% CI [0.63, 0.83], p <0.001), according to the Clinical and Molecular Hepatology guidelines 1, 2

The concurrent use of rifaximin and iron supplementation has an additive effect on improving hemoglobin levels, which correlates with improved transplant-free survival in patients with cirrhosis, based on a 2023 study 1, 2
Rifaximin does not require a 2-hour separation from iron supplements, unlike tetracyclines or fluoroquinolones, as stated by the Journal of Travel Medicine 3
Iron can be continued during short-term rifaximin courses (3-14 days) without concern for reduced efficacy, according to the Journal of Travel Medicine 3