Pharm
Rifampin
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Rifampin
Background
Semisynthetic derivative of rifamycin
Rifamycin produced by Streptomyces mediterranei
Drug resistance emerges rapidly
Must be used with other antituberculous drugs
Indications
Multi-drug
Tuberculosis
Treatment regimen
Contraindications
Multiple
Drug Interaction
s (especially lowering the serum levels of
HIV Medication
s)
Use only with caution with
HIV Medication
s
Dosing
Adult: 600 mg/day PO or IV
Pediatric: 10-20 mg/kg/day (Max 600/day)
Adverse Effects
Nephritis or
Acute Renal Failure
Pruritus
with or without Rash
Thrombocytopenia
and
Hemolytic Anemia
Influenza
-like Syndrome
Associated with infrequent dosing
Body fluids become orange tinged
Urine
Sweat
Tears (may discolor
Contact Lens
es)
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
Drug Interactions
Increases other drug elimination, decreased levels and decreased efficacy (Strong
CYP450
enzyme inducer)
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 Contraceptive
s (as well as
Contraceptive Patch
,
Estrogen Ring
)
Consider alternative contraceptives (e.g.
Depo Provera
, IUD)
Antiretroviral
s
Ketoconazole
Chloramphenicol
Methadone
Protease Inhibitor
s (reduced drug level and efficacy)
Nonnucleoside reverse transcriptase inhibitors (reduced drug level and efficacy)
Monitoring
Complete Blood Count
Baseline
Liver Function Test
s
Follow labs if abnormal or
Active Tuberculosis
develops
References
(2000) MMWR Recomm Rep 49(RR-6): 1-51 [PubMed]
Hartman-Adams (2014) Am Fam Physician 89(11): 889-96 [PubMed]
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