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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. Rifampin prevents bacteria from spreading in your body.

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

Rifampin may also be used to eliminate a bacteria from your nose and throat that may cause meningitis or other infections, even if you do not have an infection. Rifampin prevents you from spreading this bacteria to other people, but the medication will not treat an infection caused by the bacteria.

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

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

Before taking rifampin, tell your doctor if you are allergic to any drugs, or if you have liver disease or porphyria ( (a genetic enzyme disorder that causes symptoms affecting the skin or nervous system).

Take this medication for the full prescribed length of time. Your symptoms may improve before the infection is completely cleared. Rifampin will not treat a viral infection such as the common cold or flu.

Take the rifampin capsule on an empty stomach 1 hour before or 2 hours after a meal.

Rifampin can make birth control pills less effective. Ask your doctor about using a non-hormone method of birth control (such as a condom, diaphragm, spermicide) to prevent pregnancy while taking rifampin.

There are many other medicines that can interact with rifampin. Tell your doctor about all the prescription and over-the-counter medications you use. This includes vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start using a new medication without telling your doctor. Keep a list with you of all the medicines you use and show this list to any doctor or other healthcare provider who treats you.

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

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

You should not use this medication if you are allergic to rifampin.

Before taking rifampin, tell your doctor if you are allergic to any drugs, or if you have:

  • liver disease; or

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

If you have any of these conditions, you may need a dose adjustment or special tests to safely take rifampin.

FDA pregnancy category C. This medication may be harmful to an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant during treatment.

Rifampin can make birth control pills less effective. Ask your doctor about using a non-hormone method of birth control (such as a condom, diaphragm, spermicide) to prevent pregnancy while taking rifampin.

Rifampin passes into breast milk and may harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby.

How should I use rifampin?

Take this medication exactly as prescribed by your doctor. Do not take it in larger amounts or for longer than recommended. Follow the directions on your prescription label.

Take the rifampin capsule on an empty stomach 1 hour before or 2 hours after meals. Swallow the capsule with a full glass (8 ounces) of water.

Take this medication for the full prescribed length of time. Your symptoms may improve before the infection is completely cleared. Rifampin will not treat a viral infection such as the common cold or flu.

Store this medication at room temperature away from moisture and heat.

What happens if I miss a dose?

Take the missed dose as soon as you remember. However, if it is almost time for your next regularly scheduled dose, skip the missed dose and take the next one as directed. Do not take extra medicine to make up a missed dose.

What happens if I overdose?

Seek emergency medical attention if you think have used too much of this medicine.

Overdose symptoms may include nausea, vomiting, itching, headache, weakness, fast or uneven heart rate, or feeling like you might pass out.

What should I avoid while taking rifampin?

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; difficulty breathing; swelling of your face, lips, tongue, or throat.

Call your doctor at once if you have a serious side effect such as:

  • fever, chills, body aches, flu symptoms;

  • joint pain or swelling;

  • easy bruising or bleeding, weakness;

  • urinating less than usual or not at all; or

  • nausea, stomach pain, loss of appetite, itching, dark urine, clay-colored stools, jaundice (yellowing of the skin or eyes).

Less serious side effects may include:

  • tired feeling; or

  • red or orange colored urine, stools, tears, sweat, or saliva.

This is not a complete list of side effects and others may occur. Tell your doctor about any unusual or bothersome side effect. 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. Below is just a partial list. Tell your doctor if you are using:

  • acetaminophen (Tylenol);

  • a blood thinner such as warfarin (Coumadin);

  • a barbiturate such as phenobarbital (Solfoton);

  • diazepam (Valium) or similar medicines such as alprazolam (Xanax), chlordiazepoxide (Librium), midazolam (Versed), temazepam (Restoril), triazolam (Halcion), and others;

  • a beta-blocker such as atenolol (Tenormin), bisoprolol (Zebeta, Ziac), labetalol (Normodyne, Trandate), metoprolol (Lopressor, Toprol), propranolol (Inderal, InnoPran), timolol (Blocadren), and others;

  • clofibrate (Atromid-S);

  • steroids such as prednisone, fluticasone (Advair), mometasone (Asmanex, Nasonex), dexamethasone (Decadron, Hexadrol) and others;

  • birth control pills or estrogen hormone replacement;

  • heart medicines such as digoxin (Lanoxin), disopyramide (Norpace), quinidine (Quinaglute, Quinidex), mexiletine (Mexitil), tocainide (Tonocard), verapamil (Calan, Verelan, Isoptin), or enalapril (Vasotec);

  • HIV medicines such as delavirdine (Rescriptor), saquinavir (Invirase, Fortovase), ritonavir (Norvir), nelfinavir (Viracept), and others;

  • ketoconazole (Nizoral), itraconazole (Sporanox), or fluconazole (Diflucan);

  • methadone (Dolophine);

  • phenytoin (Dilantin), ethotoin (Peganone), and mephenytoin (Mesantoin);

  • sulfa drugs (Bactrim, Gantanol, Septra, and others);

  • diabetes medication you take by mouth;

  • cyclosporine (Sandimmune, Neoral); or

  • theophylline (Elixophyllin, TheoCap, Theochron, Uniphyl).

This list is not complete and there are many other medicines that can interact with rifampin. Tell your doctor about all the prescription and over-the-counter medications you use. This includes vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start using a new medication without telling your doctor. Keep a list with you of all the medicines you use and show this list to any doctor or other 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: 2.09. Revision Date: 2010-12-15, 5:01:39 PM.

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