II. Indications
- Prophylaxis of Mycobacterium Avium Complex Infection in AIDS
- Treatment of Mycobacterium Avium Complex Infection in AIDS
- See other references for multi-drug treatment regimens that include Rifabutin
III. Mechanism
- Semisynthetic Rifamycin derivative active against Mycobacteria
- Rifamycin is produced by Streptomyces mediterranei
-
Rifamycins inhibit Bacterial DNA-dependent RNA Polymerase, blocking Bacterial RNA formation and transcription
- Increased activity against Mycobacterium Avium Complex compared with other Rifamycins
IV. Dosing: Prophylaxis Mycobacterium Avium Complex Infection in AIDS
- Adult (and age >6 years)
- Take 300 mg orally daily OR
- Take 150 mg orally twice daily (if gi irritation with 300 mg dose)
- Child (age < 6 years, off label)
- Give 5 mg/kg (up to 300 mg) orally daily
- Indications to decrease dosing (e.g. 50% reduction)
- Hepatic dysfunction
- eGFR <30 ml/min
- Toxicity suspected
V. Safety
- Pregnancy Category B
- Considered safe in Lactation
VI. Adverse Effects
-
Uveitis
- Risk increases with higher dose
- Hepatotoxicity
- Thrombocytopenia
- Neutropenia
- Skin Hyperpigmentation
- Body fluid discoloration (orange or brown)
- Urine
- Sweat
- Contact Lenses
VII. Monitoring
- Baseline
- Complete Blood Count with Platelets
- Liver Function Tests (LFTs)
- Periodic lab monitoring indications
- Abnormal baseline Liver Function Test
- History suggestive of Possible liver disorder or Chronic Liver Disease
- Human Immunodeficiency Virus (HIV)
- Pregnancy
VIII. Drug Interactions
-
CYP3A4 Inducer and CYP3A4 Substrate
- Oral Contraceptives (decreased efficacy)
- Imidazole Antifungal
- Clarithromycin
IX. Resources
X. References
- (2012) Med Lett Drugs Ther 10(116): 29-36
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| rifabutin (on 5/17/2023 at Medicaid.Gov Survey of pharmacy drug pricing) | ||
| RIFABUTIN 150 MG CAPSULE | Generic | $10.76 each |