II. Indications
- FDA approved Conditions
- Active Tuberculosis
- As part of multi-drug regimen
- Neisseria Meningitidis Carrier
- Active Tuberculosis
- Off-Label Conditions
III. Contraindications
- Multiple Drug Interactions (especially lowering the serum levels of HIV Medications)
- Use only with caution with HIV Medications
IV. 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
- Drug resistance emerges rapidly
- Must be used with other antituberculous drugs
V. Dosing
-
General
- No Renal Dosing adjustment needed
- Take oral doses on an empty Stomach
-
Active Tuberculosis (as part of multi-drug regimen)
- Adult: 10 mg/kg/day (up to 600 mg) oral or IV daily
- Child: 10 to 20 mg/kg/day (up to 600 mg) oral or IV daily
-
Neisseria Meningitidis Carrier
- Adult: 600 mg orally twice daily for 2 days
- Child: 10 mg/kg/day (up to 600 mg) orally twice daily for 2 days
- Use 5 mg/kg orally twice daily for 2 days IF age <1 month
VI. Adverse Effects: General
- Drug-Induced Hepatitis (see hepatotoxicity risks below)
- Hyperbilirubinemia (transient)
- Nephritis or Acute Renal Failure
- Pruritus with or without Rash
- Thrombocytopenia
- Hemolytic Anemia
-
Influenza-like Syndrome
- Associated with infrequent dosing
- Immune Reconstitution Inflammatory Syndrome (HIV patients)
- False Positive on drug screening for Opiates
- Body fluids become orange-brown tinged
- Urine
- Sweat
- Dentures
- Tears (may discolor Contact Lenses)
VII. Adverse Effects: Hepatotoxicity - Risk Factors
- Slow acetylators
- Hepatitis C
- Hepatitis B
- Concurrent Hepatotoxin exposure
- Age over 50 years
- Pregnancy and postpartum (within 3 months)
- Malnutrition
- HIV Infection
- Alcoholism
VIII. Safety
- Considered safe in Lactation
- Pregnancy
- Benefit typically outweighs risk
- Risk of Hemorrhagic Diathesis of the Newborn (Neonatal Vitamin K Deficiency)
- Give Vitamin K 10 mg IM to newborns
IX. Drug Interactions
- Background
- Strong CYP450 enzyme inducer
- Increases other drug elimination, decreased levels and decreased efficacy
-
Warfarin (Coumadin)
- Obtain INR weekly until stable and then for at least one month after stopping Rifampin
- Warfarin dose may need to increase up to 5x while on Rifampin
- (2014) Presc lett 21(8): 47
- Phenytoin (Dilantin)
-
Oral Contraceptives (as well as Contraceptive Patch, Estrogen Ring)
- Consider alternative contraceptives (e.g. Depo Provera, IUD)
- Use barrier Contraception with Oral Contraceptives
- Ketoconazole
- Chloramphenicol
- Methadone
-
Antiretroviral therapy (HIV)
- Protease Inhibitors (reduced drug level and efficacy)
- Nonnucleoside reverse transcriptase inhibitors (reduced drug level and efficacy)
X. Monitoring
- Complete Blood Count with Platelets
- Baseline Liver Function Tests
- Periodic LFT testing
- Liver Function Tests repeated 1-2 times monthly if risks for hepatotoxicity
- Stop if LFTs >3x baseline if sympomatic (>5x baseline if asymptomatic)
- Indications for Liver Function Test monitoring as above (see hepatotoxicity risks)
- Follow labs if abnormal or Active Tuberculosis develops
XI. Resources
- Rifampin Capsule (DailyMed)
XII. References
- (2019) Presc Lett, Resource #350309, Tuberculosis Treatment in Adults: FAQ
- (2012) Med Lett Drugs Ther 10(116): 29-36
- (2000) MMWR Recomm Rep 49(RR-6): 1-51 [PubMed]
- Hartman-Adams (2014) Am Fam Physician 89(11): 889-96 [PubMed]
Images: Related links to external sites (from Bing)
Related Studies
| rifampin (on 12/21/2022 at Medicaid.Gov Survey of pharmacy drug pricing) | ||
| RIFAMPIN 150 MG CAPSULE | Generic | $0.83 each |
| RIFAMPIN 300 MG CAPSULE | Generic | $0.73 each |
Ontology: Rifampin (C0035608)
| Definition (CHV) | a kind of antibiotics |
| Definition (CHV) | a kind of antibiotics |
| Definition (NCI_NCI-GLOSS) | A drug used in the treatment of infections caused by bacteria. It belongs to the family of drugs called antibiotics. |
| Definition (NCI) | A semisynthetic derivative of rifamycin with broad antibacterial activity. Rifampin inhibits DNA-dependent RNA polymerase in susceptible bacteria and is often used in combination with other antibiotics for various infections including tuberculosis. |
| Definition (MSH) | A semisynthetic antibiotic produced from Streptomyces mediterranei. It has a broad antibacterial spectrum, including activity against several forms of Mycobacterium. In susceptible organisms it inhibits DNA-dependent RNA polymerase activity by forming a stable complex with the enzyme. It thus suppresses the initiation of RNA synthesis. Rifampin is bactericidal, and acts on both intracellular and extracellular organisms. (From Gilman et al., Goodman and Gilman's The Pharmacological Basis of Therapeutics, 9th ed, p1160) |
| Concepts | Antibiotic (T195) , Organic Chemical (T109) |
| MSH | D012293 |
| SnomedCT | 387159009, 29175007 |
| LNC | LP16274-0, MTHU008474 |
| English | Benemycin, Rifampicin, Rifamycin, 3-(((4-methyl-1-piperazinyl)imino)methyl)-, rifampin, Rifampin, rifampin (medication), RIFAMPIN, Rifampin [Chemical/Ingredient], rifampicin, Rifampicin product, Rifampin (product), Rifampin (substance), RIF |
| Swedish | Rifampin |
| Czech | rifampin, rifampicin |
| Finnish | Rifampisiini |
| Russian | RIFAMPIN, RIFAMPITSIN, RIFADIN, РИФАДИН, РИФАМПИН, РИФАМПИЦИН |
| Japanese | リマクタン, リファジン, リファンピン, アプテシン, リファンピシン |
| Italian | Rifampicina, Rifampina |
| Polish | Rifampicyna |
| Spanish | rifampicina (producto), rifampicina (sustancia), rifampicina, rifampina, Rifampicina, Rifampin |
| French | Rifampicine |
| German | Rifampicin, Rifampin |
| Portuguese | Rifampicina, Rifampina |
Ontology: Rifamycins (C0035609)
| Definition (NCI) | A natural antibiotic produced by Streptomyces mediterranei, Rifamycin (Ansamycin Family) is a commonly used antimycobacterial drug that inhibits prokaryotic DNA-dependent RNA synthesis and protein synthesis; it blocks RNA-polymerase transcription initiation. Rifamycin has an activity spectrum against Gram-positive and Gram-negative bacteria, but is mainly used against Mycobacterium sp. (especially M. tuberculosis) in association with other agents to overcome resistance. (NCI04) |
| Definition (MSH) | A group of ANTI-BACTERIAL AGENTS characterized by a chromophoric naphthohydroquinone group spanned by an aliphatic bridge not previously found in other known ANTI-BACTERIAL AGENTS. They have been isolated from fermentation broths of Streptomyces mediterranei. |
| Definition (CSP) | family of antibiotics biosynthesized by a strain of Streptomyces mediterranei, effective against a broad spectrum of bacteria. |
| Concepts | Antibiotic (T195) , Organic Chemical (T109) |
| MSH | D012294 |
| SnomedCT | 406756000 |
| English | Rifamycins, Rifomycins, Rifamycin, rifamycins (medication), rifamycins, Rifamycin SV, Rifamycins [Chemical/Ingredient], rifamycin, M-14, 5,6,9,17,19,21-hexahydroxy-23-methoxy-2,4,12,16,18,20,22-heptamethyl-2,7-(epoxypentadeca(1,11,13)trienimino)naphtho(2,1-B)furan-1,11(2h)-dione 21-Acetate, Rifamycins (substance) |
| Swedish | Rifamyciner |
| Czech | rifamyciny |
| Finnish | Rifamysiinit |
| Russian | RIFAMITSINY, RIFOMITSINY, РИФАМИЦИНЫ, РИФОМИЦИНЫ |
| Japanese | リファマイシン, リファマイシンB, リファマイシンO, リファマイシンSV, リファマイシンS, リフォマイシン |
| Polish | Rifamycyny |
| Spanish | rifamicina (sustancia), rifamicina, Rifamicinas, Rifomicinas |
| French | Rifamycine |
| German | Rifamycine, Rifomycine |
| Italian | Rifamicine |
| Portuguese | Rifamicinas, Rifomicinas |
