Limited coverage drugs – rifaximin

Last updated on September 26, 2024

Generic name

rifaximin

Strength

550 mg

Form

oral tablet

Special Authority criteria

Approval period

For reducing the risk of overt hepatic encephalopathy (HE) recurrence in patients who meet the following criteria:

  • have been hospitalized with HE associated with cirrhosis of the liver

AND

  • are unable to achieve adequate control despite taking the maximum tolerated dose of lactulose

AND

  • rifaximin must be prescribed by an internal medicine specialist or a gastroenterologist

Rifaximin should be used in combination with a maximal tolerated dose of lactulose.

6 months

Practitioner exemptions

  • No practitioner exemptions

Special notes

  • None

Special Authority requests