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rifampin

Pronunciation

Generic Name: rifampin (rif AM pin)
Brand Name: Rifadin, Rimactane, Rifadin IV

What is rifampin?

Rifampin is an antibiotic that fights bacteria and prevents it from spreading in your body.

Rifampin is used to treat or prevent tuberculosis (TB).

Rifampin may also be used to reduce certain bacteria in your nose and throat that could cause meningitis or other infections. Rifampin prevents you from spreading these bacteria to other people, but this medicine will not treat an active meningitis infection.

Rifampin may also be used for purposes not listed in this medication guide.

What is the most important information I should know about rifampin?

Some medicines can interact with rifampin and should not be used at the same time. Your doctor may need to change your treatment plan if you take medicine to treat HIV or AIDS.

Slideshow: View Frightful (But Dead Serious) Drug Side Effects

What should I discuss with my healthcare provider before using rifampin?

You should not use rifampin if you are allergic to it, or if you are taking saquinavir with ritonavir.

Some medicines can interact with rifampin and should not be used at the same time. Rifampin can make certain HIV or AIDS medicines less effective, or make your HIV infection resistant to antiviral medicine. Your doctor may need to change your treatment plan if you take:

  • atazanavir;

  • darunavir;

  • fosamprenavir;

  • saquinavir; or

  • tipranavir.

To make sure rifampin is safe for you, tell your doctor if you have:

  • diabetes;

  • liver disease;

  • porphyria (a genetic enzyme disorder that causes symptoms affecting the skin or nervous system).

FDA pregnancy category C. It is not known whether rifampin will harm an unborn baby. However, taking rifampin during the last few weeks of pregnancy may cause bleeding in the mother or the newborn baby. Tell your doctor if you are pregnant or plan to become pregnant while using this medicine.

Rifampin can make birth control pills less effective. Ask your doctor about using non hormonal birth control (condom, diaphragm with spermicide) to prevent pregnancy while taking rifampin.

Rifampin can pass into breast milk and may harm a nursing baby. You should not breast-feed while using this medicine.

How should I use rifampin?

Rifampin is usually taken daily. Follow all directions on your prescription label. Do not take this medicine in larger or smaller amounts or for longer than recommended.

Take this medicine with a full glass of water.

Rifampin works best if you take it 1 hour before or 2 hours after a meal.

Rifampin may cause your body fluids (sweat, urine, saliva, and tears) to turn a reddish-brown color. This side effect is usually not harmful. However, this effect can permanently discolor soft contact lenses if you wear them while taking rifampin.

Dark colored urine can be a sign of liver problems. Call your doctor if you have reddish-brown urine together with upper stomach pain, loss of appetite, and jaundice (yellowing of your skin or eyes).

Use this medicine for the full prescribed length of time. Your symptoms may improve before the infection is completely cleared. Skipping doses may increase your risk of further infection that is resistant to antibiotics. Rifampin will not treat a viral infection such as the flu or a common cold.

While using rifampin, you may need frequent blood tests.

If you need surgery, tell the surgeon ahead of time that you are using rifampin. You may need to stop using the medicine for a short time.

You should not stop using rifampin without your doctor's advice. Stopping the medicine suddenly and later starting again may cause kidney problems. Rifampin is usually given until lab tests show that the infection has cleared.

This medicine can cause unusual results with certain medical tests. Tell any doctor who treats you that you are using rifampin.

Store at room temperature away from moisture and heat. Keep the bottle tightly closed when not in use.

What happens if I miss a dose?

Take the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not take extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.

Overdose can cause worsening symptoms such as nausea, vomiting, stomach pain, itching, headache, and lack of energy, leading to loss of consciousness.

What should I avoid while taking rifampin?

Avoid drinking alcohol.

Do not wear contact lenses while you are taking rifampin. This medicine may discolor your tears, which could permanently stain soft contact lenses.

Rifampin side effects

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficult breathing; swelling of your face, lips, tongue, or throat.

Call your doctor at once if you have:

  • flu symptoms (fever, chills, body aches, headache, dizziness);

  • easy bruising or bleeding (nosebleeds, bleeding gums);

  • diarrhea that is watery or bloody;

  • little or no urinating;

  • liver problems--upper stomach pain, tired feeling, loss of appetite, dark urine, jaundice (yellowing of the skin or eyes); or

  • severe skin reaction--fever, sore throat, swelling in your face or tongue, burning in your eyes, skin pain, followed by a red or purple skin rash that spreads (especially in the face or upper body) and causes blistering and peeling.

Common side effects may include:

  • heartburn, gas, upset stomach, loss of appetite;

  • nausea, vomiting, diarrhea, stomach cramps;

  • headache, dizziness, drowsiness, weakness, tired feeling;

  • muscle weakness, pain in your arms or legs;

  • vision problems;

  • flushing (warmth, redness, or tingly feeling); or

  • confusion, changes in behavior, trouble concentrating.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

See also: Side effects (in more detail)

Rifampin dosing information

Usual Adult Dose for Tuberculosis -- Active:

The manufacturer recommends: 10 mg/kg (not to exceed 600 mg) orally or IV once a day

The American Thoracic Society (ATS), Centers for Disease Control and Prevention (CDC), and Infectious Diseases Society of America (IDSA) recommend:
Daily regimen: 10 mg/kg (up to 600 mg/day) orally or IV once a day
Intermittent regimen: 10 mg/kg (up to 600 mg/dose) orally or IV 2 or 3 times a week

A three-drug regimen consisting of isoniazid, rifampin, and pyrazinamide is recommended in the initial phase of short-course therapy which is usually continued for 2 months. Treatment should then be continued with isoniazid and rifampin for at least 4 months. Treatment duration should be extended if the patient's sputum or culture remains positive, if resistant organisms are present, or if the patient is HIV positive.

The Advisory Council for the Elimination of Tuberculosis, the ATS, and the CDC recommend adding streptomycin or ethambutol as a fourth drug in a regimen including isoniazid, pyrazinamide, and rifampin for initial treatment of tuberculosis unless the probability of isoniazid or rifampin resistance is very low. The need for a fourth drug should be reevaluated when susceptibility test results are known. If current community rates of isoniazid resistance are less than 4%, initial treatment with less than 4 drugs may be considered.

Usual Adult Dose for Tuberculosis -- Latent:

Patients with a positive tuberculin test without evidence of disease: 10 mg/kg (not to exceed 600 mg) orally or IV once a day for 4 months

While isoniazid monotherapy is usually sufficient for treatment with a positive tuberculin skin test and no signs of disease, rifampin may be used if isoniazid resistance is suspected or if isoniazid is not tolerated.

Usual Adult Dose for Meningococcal Meningitis Prophylaxis:

Treatment of asymptomatic carriers of Neisseria meningitidis to eliminate meningococci from the nasopharynx: 600 mg orally or IV twice a day for 2 days

Usual Adult Dose for Haemophilus influenzae Prophylaxis:

600 mg orally or IV once a day for 4 consecutive days

Usual Adult Dose for Endocarditis:

300 mg orally or IV every 8 hours for 6 weeks

Used concomitantly with nafcillin or vancomycin for the treatment of endocarditis in the presence of prosthetic material. Gentamicin is often added for the first 2 weeks of therapy.

Usual Adult Dose for Legionella Pneumonia:

600 mg orally or IV once a day for 14 days

May be added to erythromycin therapy

Usual Adult Dose for Nasal Carriage of Staphylococcus aureus:

600 mg orally or IV twice a day for 5 days for the treatment of chronic carriage of Staphylococcus aureus

Rifampin monotherapy or rifampin plus penicillin has been shown to eradicate staphylococci and Streptococcus pyogenes nasal colonization in nearly all cases.

Usual Adult Dose for Meningitis:

Caused by Streptococcus pneumoniae: 600 mg orally or IV once a day for 10 to 14 days, in patients with severe penicillin allergy needing empiric or specific coverage

Sometimes used as adjunctive therapy for penicillin-resistant (MIC greater than or equal to 2.0 mcg/mL) meningitis. Regimen consists of vancomycin IV and rifampin. In addition, rifampin is sometimes used as adjunctive therapy to vancomycin in patients with infected CSF shunts.

Usual Adult Dose for Leprosy -- Tuberculoid:

Paucibacillary (tuberculid or indeterminate): 600 mg orally once a month, plus dapsone 100 mg daily, for a total of 6 months of therapy

Usual Adult Dose for Leprosy -- Borderline:

Multibacillary (lepromatous or borderline): 600 mg orally once a month along with clofazimine, plus daily dapsone and clofazimine, for a total of 12 months of therapy

Usual Pediatric Dose for Meningococcal Meningitis Prophylaxis:

Treatment of asymptomatic carriers of Neisseria meningitidis to eliminate meningococci from the nasopharynx:
Less than 1 month: 5 mg/kg orally or IV every 12 hours for 2 days
1 month or older: 10 mg/kg (not to exceed 600 mg/dose) orally or IV every 12 hours for 2 days

Usual Pediatric Dose for Tuberculosis -- Active:

For pediatric patients, the manufacturer recommends: 10 to 20 mg/kg/day (not to exceed 600 mg/day) orally or IV

For patients less than 15 years, the ATS, CDC, IDSA, and American Academy of Pediatrics (AAP) recommend:
Daily regimen: 10 to 20 mg/kg/day (up to 600 mg/day) orally or IV
Intermittent regimen: 10 to 20 mg/kg (up to 600 mg/dose) orally or IV twice a week

For patients 15 years or older, the ATS, CDC, and IDSA recommend:
Daily regimen: 10 mg/kg (up to 600 mg/day) orally or IV once a day
Intermittent regimen: 10 mg/kg (up to 600 mg/dose) orally or IV 2 or 3 times a week

A three-drug regimen consisting of isoniazid, rifampin, and pyrazinamide is recommended in the initial phase of short-course therapy which is usually continued for 2 months. Treatment should then be continued with isoniazid and rifampin for at least 4 months. Treatment duration should be extended if the patient's sputum or culture remains positive, if resistant organisms are present, or if the patient is HIV positive.

The Advisory Council for the Elimination of Tuberculosis, the ATS, and the CDC recommend adding streptomycin or ethambutol as a fourth drug in a regimen including isoniazid, pyrazinamide, and rifampin for initial treatment of tuberculosis unless the probability of isoniazid or rifampin resistance is very low. The need for a fourth drug should be reevaluated when susceptibility test results are known. If current community rates of isoniazid resistance are less than 4%, initial treatment with less than 4 drugs may be considered.

Study (n=175)
Directly Observed Therapy (DOT) - Two weeks daily therapy:
Greater than 1 month:
Weeks 1 and 2: Daily dosing of rifampin 10 to 20 mg/kg/day, isoniazid 10 to 15 mg/kg/day, and pyrazinamide 20 to 40 mg/kg/day
Weeks 3 to 8: Twice weekly rifampin 10 to 20 mg/kg/dose, isoniazid 20 to 40 mg/kg/dose, and pyrazinamide 50 to 70 mg/kg/dose
Weeks 9 to 24: Twice weekly rifampin 10 to 20 mg/kg/dose and isoniazid 20 to 40 mg/kg/dose

Usual Pediatric Dose for Tuberculosis -- Latent:

Infants, children, and adolescents:
The ATS, CDC, and AAP recommend: 10 to 20 mg/kg/day (up to 600 mg/day) orally or IV for 4 to 6 months

What other drugs will affect rifampin?

Many drugs can interact with rifampin. Not all possible interactions are listed here. Tell your doctor about all your medications and any you start or stop using during treatment with rifampin, especially:

  • sulfasalazine;

  • theophylline;

  • birth control pills or hormone replacement therapy;

  • levothyroxine or other thyroid medicine;

  • certain antibiotics, such as chloramphenicol, clarithromycin, doxycycline, ciprofloxacin;

  • antifungal medicines--fluconazole, itraconazole, ketoconazole, voriconazole;

  • drugs that lower cholesterol, such as clofibrate;

  • drugs that treat or prevent blood clots--apixaban, dabigatran, rivaroxaban, ticagrelor, warfarin (Coumadin);

  • drugs to treat depression or mental illness, such as amitriptyline, haloperidol, lurasidone, nortriptyline;

  • drugs to treat HIV or AIDS, such as zidovudine;

  • heart or blood pressure medicine, such as digoxin, diltiazem, disopyramide, enalapril, metoprolol, mexiletine, nifedipine, nimodipine, quinidine, ranolazine, tocainide, verapamil;

  • medicine to prevent organ transplant rejection--cyclosporine, sirolimus, tacrolimus;

  • medicines to treat or prevent malaria, such as artemether-lumefantrine, atovaquone, praziquantel, quinine;

  • narcotic medicine, such as morphine, methadone;

  • oral diabetes medication, such as glimepiride, glipizide, tolbutamide;

  • a sedative, such as diazepam or midazolam;

  • seizure medicine, such as phenytoin, phenobarbital, lamotrigine; or

  • steroid medicine (prednisone, and others).

This list is not complete and many other drugs can interact with rifampin. This includes prescription and over-the-counter medicines, vitamins, and herbal products. Give a list of all your medicines to any healthcare provider who treats you.

Where can I get more information?

  • Your pharmacist can provide more information about rifampin.
  • Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.
  • Disclaimer: Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.

Copyright 1996-2012 Cerner Multum, Inc. Version: 3.01. Revision Date: 2014-03-16, 11:59:54 PM.

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