Classes
DEA Class; Rx
Common Brand Names; Rifadin, Rimactane
- Antitubercular Agents
Description
Semisynthetic rifamycin antibiotic
Primarily used as part of first-line, combination therapy for the treatment of tuberculosis and also used to treat asymptomatic carriers of Neisseria meningitidis
Potent inducer of hepatic microsomal enzymes and associated with many significant drug interactions
Indications
Contraindications
Hypersensitivity to rifamycins or excipients
Coadministration with atazanavir, darunavir, fosamprenavir, ritonavir/saquinavir, sazuinavir, or tipranavir
Adverse Effects
- Elevated liver function test (LFT) results (up to 14%)
- Rash (1-5%)
- Epigastric distress (1-2%)
- Anorexia (1-2%)
- Nausea (1-2%)
- Vomiting (1-2%)
- Diarrhea (1-2%)
- Cramps (1-2%)
- Pseudomembranous colitis (1-2%)
- Pancreatitis (1-2%)
- Muscular weakness
- Edema
- Flushing
- Ataxia
- Impaired concentration
- Fever
- Fatigue
- Headache
- Numbness
- Behavioral changes
- Dizziness
Warnings
May decrease the effectiveness of oral contraceptive pills (OCPs)
Do not administer parenteral preparation IM or SC
Patients on regimens of >600 mg once or twice weekly may experience adverse reactions, including flulike syndrome
History of diabetes mellitus (rifampin may make diabetes management more difficult)
Regimens of >600 mg once or twice weekly may cause leukemia, anemia, or thrombocytopenia
Discontinue therapy if patient develops any signs of hepatocellular damage, including hyperbilirubinemia
Prolonged use may result in bacterial or fungal superinfection
Use with caution in patients with liver impairment and porphyria
Not for use in meningococcal disease; may be suitable for short-term use in asymptomatic carriers
Mild to severe cholestasis reported; discontinue therapy if confirmed
Use with caution in patients with history of alcoholism and patients receiving additional medications that may cause hepatotoxicity; advise patients to abstain from alcohol, hepatotoxic medications or herbal products while taking drug
Rifampin is not recommended for intermittent therapy; caution patient against intentional or accidental interruption of daily dosage regimen; rare renal hypersensitivity reactions have been reported when therapy was resumed in such cases
Rifampin has enzyme-inducing properties that can enhance metabolism of endogenous substrates, including adrenal hormones, thyroid hormones, and vitamin D
Pregnancy and Lactation
No adequate and well-controlled studies have been performed in pregnant women; has been shown to be teratogenic in rodents
Rifampin has been reported to cross the placental barrier and appear in cord blood
Because of potential for tumorigenicity shown for rifampin in animal studies, a decision should be made whether to discontinue nursing or discontinue drug, taking into account importance of drug to mother
Maximum Dosage
10 mg/kg/day (Max: 600 mg/day) PO/IV for tuberculosis treatment; 1,200 mg/day PO/IV for meningococcal prophylaxis.
10 mg/kg/day (Max: 600 mg/day) PO/IV for tuberculosis treatment; 1,200 mg/day PO/IV for meningococcal prophylaxis.
20 mg/kg/day PO/IV (Max: 600 mg/day PO/IV for tuberculosis treatment; 1,200 mg/day PO/IV for meningococcal prophylaxis).
20 mg/kg/day PO/IV (Max: 600 mg/day PO/IV for tuberculosis treatment; 1,200 mg/day PO/IV for meningococcal prophylaxis).
20 mg/kg/day PO/IV.
20 mg/kg/day PO/IV for tuberculosis treatment has been used off-label; 10 mg/kg/day PO/IV for meningococcal prophylaxis.
How supplied
Rifampin
capsule
- 150mg
- 300mg
injectable powder
- 600mg
