II. Background

  1. Semisynthetic derivative of rifamycin
  2. Rifamycin produced by Streptomyces mediterranei
  3. Drug resistance emerges rapidly
    1. Must be used with other antituberculous drugs

III. Indications

IV. Contraindications

  1. Multiple Drug Interactions (especially lowering the serum levels of HIV Medications)
    1. Use only with caution with HIV Medications

V. Dosing

  1. Adult: 600 mg/day PO or IV
  2. Pediatric: 10-20 mg/kg/day (Max 600/day)
  3. No Renal Dosing adjustment needed

VI. Adverse Effects

  1. Drug-Induced Hepatitis (see hepatotoxicity risks below)
  2. Hyperbilirubinemia (transient)
  3. Nephritis or Acute Renal Failure
  4. Pruritus with or without Rash
  5. Thrombocytopenia
  6. Hemolytic Anemia
  7. Influenza-like Syndrome
    1. Associated with infrequent dosing
  8. Immune Reconstitution Inflammatory Syndrome (HIV patients)
  9. False Positive on drug screening for Opiates
  10. Body fluids become orange tinged
    1. Urine
    2. Sweat
    3. Tears (may discolor Contact Lenses)

VII. Adverse Effects: Hepatotoxicity - Risk Factors

  1. Slow acetylators
  2. Hepatitis C
  3. Hepatitis B
  4. Concurrent Hepatotoxin exposure
  5. Age over 50 years
  6. Pregnancy and postpartum (within 3 months)
  7. Malnutrition

VIII. Drug Interactions

  1. Background
    1. Strong CYP450 enzyme inducer
    2. Increases other drug elimination, decreased levels and decreased efficacy
  2. Warfarin (Coumadin)
    1. Obtain INR weekly until stable and then for at least one month after stopping Rifampin
    2. Warfarin dose may need to increase up to 5x while on Rifampin
    3. (2014) Presc lett 21(8): 47
  3. Phenytoin (Dilantin)
  4. Oral Contraceptives (as well as Contraceptive Patch, Estrogen Ring)
    1. Consider alternative contraceptives (e.g. Depo Provera, IUD)
  5. Ketoconazole
  6. Chloramphenicol
  7. Methadone
  8. Antiretroviral therapy (HIV)
    1. Protease Inhibitors (reduced drug level and efficacy)
    2. Nonnucleoside reverse transcriptase inhibitors (reduced drug level and efficacy)

IX. Monitoring

  1. Complete Blood Count
  2. Baseline Liver Function Tests
  3. Follow labs if abnormal or Active Tuberculosis develops

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Related Studies

Cost: Medications

rifampin (on 5/17/2017 at Medicaid.Gov Survey of pharmacy drug pricing)
RIFAMPIN 150 MG CAPSULE Generic $1.10 each
RIFAMPIN 300 MG CAPSULE Generic $0.76 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