Rimactane Side Effects

Generic Name: rifampin

Note: This page contains side effects data for the generic drug rifampin. It is possible that some of the dosage forms included below may not apply to the brand name Rimactane.

It is possible that some side effects of Rimactane may not have been reported. These can be reported to the FDA here. Always consult a healthcare professional for medical advice.

For the Consumer

Applies to rifampin: oral capsule, oral syrup, oral tablet

As well as its needed effects, rifampin (the active ingredient contained in Rimactane) may cause unwanted side effects that require medical attention.

If any of the following side effects occur while taking rifampin, check with your doctor immediately:

Rare
  • Abdominal or stomach pain
  • agitation
  • back pain
  • bleeding gums
  • blood in the urine or stools
  • bruising
  • confusion
  • cough or hoarseness
  • coughing or vomiting blood
  • dark urine
  • darkening of the skin
  • decreased frequency or amount of urine
  • difficulty with swallowing
  • dizziness
  • fainting
  • fast heartbeat
  • fever with or without chills
  • general feeling of tiredness or weakness
  • headache
  • hives
  • hostility
  • increased blood pressure
  • increased thirst
  • irritability
  • lethargy
  • light-colored stools
  • loss of appetite
  • lower back or side pain
  • mental depression
  • nausea and vomiting
  • painful or difficult urination
  • persistent bleeding or oozing from puncture sites, mouth, or nose
  • puffiness or swelling of the eyelids or around the eyes, face, lips, or tongue
  • shortness of breath
  • skin itching, rash, or redness
  • sores, ulcers, or white spots on the lips or in the mouth
  • swelling of the face, ankles, fingers, hands, or lower legs
  • tightness in the chest
  • tiredness
  • troubled breathing
  • unusual bleeding or bruising
  • unusual tiredness or weakness
  • weight gain
  • wheezing
  • yellow eyes or skin
Incidence not known
  • Blistering, peeling, or loosening of the skin
  • bloating
  • bone pain
  • chest pain
  • chills
  • cold, clammy skin
  • diarrhea, watery and severe, which may also be bloody
  • difficulty with speaking
  • double vision
  • fast heartbeat
  • fast, weak pulse
  • inability to move the arms, legs, or facial muscles
  • inability to speak
  • joint or muscle pain
  • lightheadedness
  • pale skin
  • pinpoint red spots on the skin
  • red skin lesions, often with a purple center
  • red, irritated eyes
  • redness, soreness, or itching skin
  • slow speech
  • sores, welting, or blisters
  • sweating
  • swollen glands
  • unpleasant breath odor
  • unusual weight loss

If any of the following symptoms of overdose occur while taking rifampin, get emergency help immediately:

Symptoms of overdose
  • Blurred vision
  • convulsions (seizures)
  • dizziness, faintness, or lightheadedness when getting up suddenly from a lying or sitting position
  • fast, pounding, or irregular heartbeat or pulse
  • full feeling in the upper abdomen or stomach
  • itching
  • low blood pressure or slow pulse
  • nausea or vomiting
  • pain in the upper abdomen or stomach
  • reddish-orange to reddish-brown color of the urine, stool, saliva, sputum, sweat, and tears
  • swelling around the eyes or face
  • unconsciousness
  • unusual tiredness or weakness
  • yellow eyes or skin

Some rifampin side effects may not need any medical attention. As your body gets used to the medicine these side effects may disappear. Your health care professional may be able to help you prevent or reduce these side effects, but do check with them if any of the following side effects continue, or if you are concerned about them:

Rare
  • Feeling that others are watching you or controlling your behavior
  • feeling that others can hear your thoughts
  • feeling, seeing, or hearing things that are not there
  • muscular pain, tenderness, wasting, or weakness
  • severe mood or mental changes
  • unusual behavior
Incidence not known
  • Belching
  • bloated or full feeling
  • drowsiness
  • excess air or gas in the stomach or intestines
  • indigestion
  • not able to concentrate
  • pain or discomfort in the chest, upper stomach, or throat
  • weight loss

For Healthcare Professionals

Applies to rifampin: compounding powder, intravenous powder for injection, oral capsule

Gastrointestinal

Gastrointestinal side effects have included nausea and dyspepsia in 2% of patients. Heartburn, anorexia, vomiting, flatulence, cramps and diarrhea have also been observed. Rare cases of pill-induced esophagitis and pseudomembranous colitis have been associated with the use of rifampin (the active ingredient contained in Rimactane) [Ref]

Hepatic

Hyperbilirubinemia and hepatitis have been reported in up to 3% of patients. Approximately 50% of hepatotoxicity has been observed during the first month of therapy.

If rifampin (the active ingredient contained in Rimactane) is essential in the treatment of patients with liver disease, extreme caution and strict medical supervision should be exercised. Baseline liver function tests should be obtained and monitored every two weeks during therapy.[Ref]

Hepatic side effects have included cases of hepatitis and severe hepatotoxicity with fatal outcome. Fatal cases of hepatotoxicity have been observed in patients with existing liver dysfunction and in patients with normal liver function who are also taking other hepatotoxic drugs. Jaundice, hepatitis, transient abnormalities in liver function tests (e.g., elevations in serum bilirubin, BSP, alkaline phosphatase, serum transaminases), and hyperbilirubinemia have been reported. Baseline and periodic liver function testing are recommended for all patients on long-term rifampin therapy.[Ref]

Immunologic

The 'flu-like syndrome' generally occurs with intermittent dosing of rifampin (the active ingredient contained in Rimactane) in patients with poor adherence to daily rifampin therapy, and when daily rifampin is resumed after a drug free period.[Ref]

Immunologic side effects have included flu-like syndrome presenting as fever, malaise, nausea, vomiting, petechiae and myalgias. This syndrome is probably an immune-mediated reaction. Rarely, dyspnea and shock have been associated with once-daily rifampin therapy.[Ref]

Renal

Renal side effects have included elevations in BUN and serum uric acid. Hemoglobinuria, hematuria, interstitial nephritis, acute tubular necrosis, renal insufficiency, and acute renal failure have been reported. These events are generally associated with an immune-mediated reaction which occurs after interruption in rifampin (the active ingredient contained in Rimactane) therapy. Standard doses may produce orange-colored urine.[Ref]

There have been rare case reports of reversible acute renal failure due to glomerulonephritis and renal epithelial cell injury in patients receiving rifampin. Often in these patients other immune-mediated reactions occur, such as hemolysis and thrombocytopenia. Antibodies to rifampin have been identified in some affected patients. Generally these reactions occur after reintroduction of the drug following a lapse in therapy, although they have also been associated with continuous therapy.[Ref]

Hematologic

Petechiae associated with thrombocytopenia may occur in 1% of patients who are receiving rifampin (the active ingredient contained in Rimactane) Rifampin antibodies have been demonstrated in some of these patients. Thrombocytopenia is seen most frequently in patients receiving weekly therapy or after a lapse in therapy, but has also been reported during daily therapy. Decreased hemoglobin and transient leukopenia have been reported in patients who had chronic diseases and in whom other medications were given, which made it difficult to definitively determine if these adverse effects were due to rifampin.

A 76-year-old male with a diagnosis of Mycobacterium kansasii pulmonary disease experienced leukocytoclastic vasculitis, thrombocytopenia, and acute renal failure coincident with rifampin therapy. He was admitted to the hospital with a one-week history of fever, dry cough, dyspnea, oliguria, and bilateral edema in lower extremities. He was treated for the Mycobacterium kansasii pulmonary disease with a combined preparation of isoniazid 50 mg, rifampin 250 mg, rifampin 600 mg, and pyrazinamide 1500 mg (Rifater). On the patients admission, laboratory data showed acute renal failure (serum creatinine 9.6 mg/dL, urea 168 mg/dL) and thrombocytopenia (platelets 85 x 10 (3)/ microliter). Other results were WBC count 13,300/ microliter, hemoglobin 13.9 g/dL, and proteinuria, with urine protein 1.5 g/L. Pyrazinamide was discontinued and broad spectrum antimicrobials were introduced. Two weeks after pyrazinamide was discontinued, clinical and analytical parameters normalized. With the goal of treating Mycobacterium kansasii, a controlled trial of rifampin at increasing doses (80 mg the first day, 150 mg the second day, 200 mg the third day) was attempted a week later. The day following reintroduction, a palpable purpura appeared, serum creatinine increased (1.9 mg/dL), and the platelet count dropped. Rifampin was withdrawn on the fourth day; 4 days later, the serum creatinine level returned to within normal limits and skin purpura disappeared. Skin purpura biopsy demonstrated leukocytoclastic vasculitis. Two weeks later, the patient was discharged with normal renal function and platelet count.[Ref]

Hematologic side effects have included thrombocytopenia, leukopenia, hemolytic anemia, and decreased hemoglobin, in less than 1% of patients. Thrombocytopenia has occurred primarily with high dose intermittent therapy, and after resumption of interrupted therapy. Red cell aplasia, agranulocytosis, methemoglobinemia, and disseminated intravascular coagulation have been reported very rarely. Hemolysis has been described as part of an immune-mediated reaction which generally occurs after interruptions in therapy. At least one case of rifampin-related leukocytoclastic vasculitis, thrombocytopenia, and acute renal failure has been reported.[Ref]

Dermatologic

Dermatologic side effects have included cutaneous reactions that are mild and self-limiting and usually not associated with a hypersensitivity to rifampin (the active ingredient contained in Rimactane) These reactions generally manifest as itching and flushing with or without rash. Serious dermatologic reactions that resulted from hypersensitivity have been reported rarely.[Ref]

Nervous system

Nervous system side effects have included headache, paresthesias, and weakness. Other central nervous system side effects reported have included drowsiness, fatigue, ataxia, dizziness, decreased concentration, mental confusion, behavioral changes, muscular weakness, pain, and numbness.[Ref]

Metabolic

Drug level monitoring may be necessary in patients who remain acid-fast bacilli smear positive after 3 months of directly observed therapy. Dosage may be titrated upwards to keep the rifampin (the active ingredient contained in Rimactane) level in the therapeutic range.[Ref]

Metabolic side effects have included increases in hepatic metabolism of thyroxine (T4) and triiodothyronine (T3). A fall in plasma concentration time curve of rifampin and an increase in renal clearance due to a decrease in protein-bound drug has been reported in pulmonary tuberculosis patients who are often malnourished.[Ref]

Cardiovascular

Cardiovascular side effects have been reported rarely. These have included decreased blood pressure when rifampin (the active ingredient contained in Rimactane) dosages were administered intermittently.[Ref]

Hypersensitivity

Hypersensitivity side effects have included urticaria, rash, pruritus, pemphigoid reaction, erythema multiforme including Stevens-Johnson syndrome, toxic epidermal necrolysis, vasculitis, eosinophilia, sore mouth, sore tongue, and conjunctivitis. Rarely, anaphylaxis has been reported. At least one case of multiple hypersensitivity reactions including anaphylactic shock, liver injury, hemolytic anemia, acute renal failure, and disseminated intravascular coagulation have also been reported.[Ref]

A 35-year-old male who was diagnosed with pulmonary tuberculosis experienced multiple hypersensitivity reactions coincident with rifampin therapy. After being admitted to the hospital with multiple symptoms of tuberculosis, the patient was prescribed rifampin, isoniazid, pyrazinamide, and ethambutol. Two hours after taking the first pill of rifampin (600 mg), the patient developed anaphylactic shock, liver injury, hemolytic anemia, acute renal failure, and disseminated intravascular coagulation. Direct and indirect antiglobulin (Coombs) tests were positive. RFP-dependent IgG and IgM antibodies with complement fixing capability were observed in the serum. The patient was transferred to the intensive care unit and underwent hemodialysis. Clinical recovery and return of laboratory data to normal levels occurred over a 5-week period. The patient was subsequently given isoniazid, pyrazinamide, ethambutol, ciprofloxacin, and recovered from tuberculosis.[Ref]

Endocrine

Endocrine side effects have included menstrual disturbances and rare reports of adrenal insufficiency in patients with impaired adrenal function.[Ref]

Musculoskeletal

Musculoskeletal side effects have included myopathy and muscular weakness.[Ref]

Ocular

Ocular side effects have included visual disturbances. Ocular side effects are generally limited to patients who wear contact lenses. Rifampin (the active ingredient contained in Rimactane) can cause a red-brown or orange discoloration of tears which can stain contact lenses.[Ref]

Psychiatric

Psychiatric side effects have rarely included psychoses.[Ref]

Respiratory

Respiratory side effects have included shortness of breath and wheezing with the use of intermittent dosage regimens. A 'flu syndrome' may appear if rifampin (the active ingredient contained in Rimactane) is taken irregularly or if daily administration is resumed after a drug free interval.[Ref]

Other

Other side effects have rarely included edema of the face and extremities.[Ref]

Fatal acute overdoses have been reported with doses ranging from 14 to 60 grams of rifampin. Alcohol or a history of alcohol abuse was involved in some of the fatal and nonfatal cases. The minimum acute lethal or toxic dose is not well established.[Ref]

References

1. Chen TC, Lu PL, Lin WR, Lin CY, Wu JY, Chen YH "Rifampin-associated pseudomembranous colitis." Am J Med Sci 338 (2009): 156-8

2. Dutt AK, Moers D, Stead WW "Short-course chemotherapy for tuberculosis with mainly twice-weekly isoniazid and rifampin: community physicians' seven-year experience with mainly outpatients." Am J Med 77 (1984): 233-42

3. Wenning LA, Hanley WD, Brainard DM, et al. "Effect of rifampin, a potent inducer of drug metabolizing enzymes, on the pharmacokinetics of raltegravir." Antimicrob Agents Chemother 53 (2009): 2852-6

4. Miller DL, Sedlack JD, Holt RW "Perforation complicating rifampin-associated pseudomembranous enteritis." Arch Surg 124 (1989): 1082

5. Gabriel R "Rifampin jaundice." Br Med J 3 (1971): 182

6. O'Brien RJ, Long MW, Cross FS, et al "Hepatotoxicity from isoniazid and rifampin among children treated for tuberculosis." Pediatrics 72 (1983): 491-9

7. "Product Information. Rifadin (rifampin)." Hoechst Marion-Roussel Inc, Kansas City, MO.

8. Smith SJ, Lee AJ, Maddix DS, Chow AW "Pill-induced esophagitis caused by oral rifampin." Ann Pharmacother 33 (1999): 27-31

9. Boriello SP, Jones RH, Phillips I "Rifampicin-associated pseudomembranous colitis." Br Med J 281 (1980): 1180-1

10. Allen RJ, Almond SN, Caiolsa SM, et al "Rifampin." Drug Intell Clin Pharm 5 (1971): 364-5

11. Castro KG, Jereb JA, Koppaka VR, Cohn DL "Fatal liver injury associated with rifampin-pyrazinamide treatment of latent tuberculosis infection." Chest 123 (2003): 967

12. Leung CC, Law WS, Chang KC, et al. "Initial Experience on Rifampin and Pyrazinamide vs Isoniazid in the Treatment of Latent Tuberculosis Infection Among Patients With Silicosis in Hong Kong." Chest 124 (2003): 2112-8

13. Davis CE Jr, Carpenter JL, Ognibene AJ, McAllister CK "Rifampicin-induced acute renal failure." South Med J 79 (1986): 1012-5

14. Dutt AK, Moers D, Stead WW "Undesirable side effects of isoniazid and rifampin in largely twice-weekly short-course chemotherapy for tuberculosis." Am Rev Respir Dis 128 (1983): 419-24

15. Tahan SR, Diamond JR, Blank JM, Horan RF "Acute hemolysis and renal failure with rifampicin-dependent antibodies after discontinuous administration." Transfusion 25 (1985): 124-7

16. Levine M, Collin K, Kassen BO "Acute hemolysis and renal failure following discontinuous use of rifampin." DICP 25 (1991): 743-4

17. Mauri JM, Bartolome J, Camps J, et al "Antirifampicin antibodies in acute rifampicin-associated renal failure." Nephron 31 (1982): 177-9

18. Nolan RL, Cleary JD, Chapman SW "Fever associated with daily rifampin therapy." Clin Pharm 9 (1990): 57-8

19. Brook G, Pain A "Major adverse reactions to a short course of daily rifampicin." Scand J Infect Dis 19 (1987): 271-2

20. van Assendelft AH "Renal failure and haemolysis caused by rifampicin." Tubercle 67 (1986): 234-5

21. Martinez E, Collazos J, Mayo J "Shock and cerebral infarct after rifampin re-exposure in a patient infected with human immunodeficiency virus." Clin Infect Dis 27 (1998): 1329-30

22. Muthukumar T, Jayakumar M, Fernando EM, Muthusethupathi MA "Acute renal failure due to rifampicin: a study of 25 patients." Am J Kidney Dis 40 (2002): 690-6

23. Berbatis CG, Eckert GM, Woods V "Nephropathy associated with rifampicin." Aust J Hosp Pharm 6 (1976): 171-3

24. Power DA, Russell G, Smith FW, et al "Acute renal failure due to continuous rifampicin." Clin Nephrol 20 (1983): 155-9

25. Murray AN, Cassidy MJ, Templecamp C "Rapidly progressive glomerulonephritis associated with rifampicin therapy for pulmonary tuberculosis." Nephron 46 (1987): 373-6

26. Neugarten J, Gallo GR, Baldwin DS "Rifampin-induced nephrotic syndrome and acute interstitial nephritis." Am J Nephrol 3 (1983): 38-42

27. Campese V, Marzullo F, Schena F, Coratelli P "Acute renal failure during intermittent rifampicin therapy." Nephron 10 (1973): 256

28. Yoshioka K, Satake N, Kasamatsu Y, Nakamura Y, Shikata N "Rapidly Progressive Glomerulonephritis due to Rifampicin Therapy." Nephron 90 (2002): 116-118

29. Munoz ME, Ruiz P, Borobia AM, Pagan B, Pano-Pardo JR, Cerezo JG "Rifampin-Related Acute Renal Failure, Thrombocytopenia, and Leukocytoclastic Vasculitis (May)." Ann Pharmacother (2008):

30. Lee M, Berger HW "Eosinophilia caused by rifampin." Chest 77 (1980): 579

31. White NW "Venous thrombosis and rifampicin." Lancet 2 (1989): 434-5

32. Ferguson GC "Rifampicin and thrombocytopenia." Br Med J 3 (1971): 638

33. Hadfield JW "Rifampicin-induced thrombocytopenia." Postgrad Med J 56 (1980): 59-60

34. Luzio JL, Matos FJ, De Sa AB "Methemoglobinemia after rifampin therapy." Ann Pharmacother 30 (1996): 1339-40

35. Kindelan JM, Serrano I, Jurado R, Villanueva JL, Garcialazaro M, Garciaherola A, Cisneros JT "Rifampin-induced severe thrombocytopenia in a patient with pulmonary tuberculosis." Ann Pharmacother 28 (1994): 1304-5

36. Lee CH, Lee CJ "Thrombocytopenia: a rare but potentially serious side effect of initial daily and interrupted use of rifampicin." Chest 96 (1989): 202-3

37. Mariette X, Mitjavila MT, Moulinie JP, et al "Rifampicin-induced pure red cell aplasia." Am J Med 87 (1989): 459-60

38. Hall AP, Thorpe JW, Seaton D "New hazard of meningococcal chemoprophylaxis." J Antimicrob Chemother 31 (1993): 451

39. Goldin HM, Schweitzer WJ, Bronson DM "Rifampin and exfoliative dermatitis." Ann Intern Med 107 (1987): 789

40. Iredale JP, Sankaran R, Wathen CG "Cutaneous vasculitis associated with rifampin therapy." Chest 96 (1989): 215-6

41. Walkerrenard P "Pruritus associated with intravenous rifampin." Ann Pharmacother 29 (1995): 267-8

42. Mimouni A, Hodak E, Mimouni M "Fixed drug eruption following rifampin treatment." DICP 24 (1990): 947-8

43. Chan CH, Chong YW, Sun AJ, Hoheisel GB "Cutaneous vasculitis associated with tuberculosis and its treatment." Tubercle 71 (1990): 297-300

44. Okano M, Kitano Y, Igarashi T "Toxic epidermal necrolysis due to rifampicin." J Am Acad Dermatol 17 (1987): 303-4

45. Surks MI, Sievert R "Drugs and thyroid function." N Engl J Med 333 (1995): 1688-94

46. Mehta JB, Shantaveerapa H, Byrd RP Jr, Morton SE, Fountain F, Roy TM "Utility of Rifampin Blood Levels in the Treatment and Follow-up of Active Pulmonary Tuberculosis in Patients who Were Slow to Respond to Routine Directly Observed Therapy." Chest 120 (2001): 1520-4

47. Burman WJ, Gallicano K, Peloquin C "Comparative pharmacokinetics and pharmacodynamics of the rifamycin antibacterials." Clin Pharmacokinet 40 (2001): 327-41

48. Luzzati R, Giacomazzi D, Franchi F, Barcobello M, Vento S "Life-threatening, multiple hypersensitivity reactions induced by rifampicin in one patient with pulmonary tuberculosis." South Med J 100 (2007): 854-6

49. Walker-Renard P "Pruritus associated with intravenous rifampin." Ann Pharmacother 29 (1995): 267-8

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