AntitubercularUS FDA Database Verified

rifampin (Rx)

Generic: Rifampin

Brand: Rifadin, Rofact

(rif'am-pin)

Pregnancy Category: C

Pharmacological Action

Inhibits DNA-dependent polymerase, decreases tubercle bacilli replication

Therapeutic outcome: Bactericidal against the following organisms: mycobacteria, Staphylococcus aureus, Haemophilus influenzae, Neisseria meningitidis, Legionella pneumophila

Uses

Pulmonary TB, meningococcal carriers (prevention)

Contraindications

Hypersensitivity to this product or rifamycins, active Neisseria meningitidis infection

Precautions: Pregnancy C, breastfeeding, children ,5 yr, hepatic disease, blood dyscrasias

Dosage & Routes

Tuberculosis

Adult: PO/IV max 600 mg/day as single dose 1 hr before or 2 hr after meals, or 10 mg/kg/day 2-3 3/wk Child .5 yr: PO/IV 10-20 mg/kg/day as single dose 1 hr before or 2 hr after meals, max 600 mg/day, with other antitubercular products 6-mo regimen: 2-mo treatment of isoniazid, rifampin, pyrazinamide, and possibly streptomycin or ethambutol; then rifampin and isoniazid 3 4 mo 9-mo regimen: Rifampin and isoniazid supplemented with pyrazinamide or streptomycin or ethambutol Meningococcal carriers

Adult: PO/IV 600 mg bid 3 2 days, max 600 mg/dose Child .5 yr: PO/IV 10-20 mg/kg bid 3 2 days, max 600 mg/dose Infant 3 mo-1 yr: PO 5 mg/kg bid for 2 days

Available forms: Caps 150, 300 mg; powder for inj 600 mg/vial

Implementation - Do not give IM or SUBCUT

PO route: - On empty stomach, 1 hr before or 2 hr after meals with a full glass of water; give with other products for TB - Antiemetic if vomiting occurs - Capsules may be opened and mixed with applesauce or gelatin Intermittent IV INF route: - After diluting each 600 mg/10 ml of sterile water for inj (60 mg/ml), swirl, withdraw dose, and dilute in 100 ml or 500 ml of D5 W given as an inf over 3 hr, or if diluted in 100 ml, give over ½ hr; do not admix with other sol or medications

Y-site compatibilities: Amiodarone, bumetanide, midazolam, pantoprazole, vancomycin

Adverse Effects

CNS: Headache, fatigue, anxiety, drowsiness, confusion

EENT: Visual disturbances

GI: Nausea, vomiting, anorexia, diarrhea, pseudomembranous colitis, heartburn, sore mouth and tongue, pancreatitis, elevated liver function tests

GU: Hematuria, acute renal failure, hemoglobinuria

HEMA: Hemolytic anemia, eosinophilia, thrombocytopenia, leukopenia

INTEG: Rash, pruritus, urticaria

MISC: Flulike syndrome, menstrual disturbances, edema, SOB, Stevens-Johnson syndrome, toxic epidermal necrolysis, angioedema, anaphylaxis

MS: Ataxia, weakness

Pharmacokinetics

Absorption: Well absorbed (PO), completely absorbed (IV)

Distribution: Widely distributed, crosses placenta

Metabolism: Liver—extensively

Excretion: Feces

Half-life: 3 hr

Pharmacodynamics

PO: Onset Rapid, Peak 2-3 hr, Duration Unknown

IV: Onset Rapid, Peak Inf end, Duration Unknown

Interactions

Individual drugs Acetaminophen, alcohol, chloramphenicol, clofibrate, cycloSPORINE, dapsone, digoxin, diltiazem, doxycycline, haloperidol, NIFEdipine, phenytoin, theophylline, verapamil, zidovudine: decreased effect of specific product

Isoniazid: increased hepatotoxicity

Drug classifications Anticoagulants, antidiabetics, barbiturates, benzodiazepines, b-blockers, contraceptives (oral), glucocorticoids, hormones, imidazole antifungals: decreased effect of each product Protease inhibitors: do not use together

Drug/lab test

Increased: LFTs

Decreased: Hgb

Interference: folate level, vit B12

Nursing Considerations

Assessment - Monitor liver function tests qmo: ALT, AST, bilirubin, decreased appetite, jaundice, dark urine, fatigue - Monitor renal status: before, qmo: BUN, creatinine, output, specific gravity, urinalysis - Pseudomembranous colitis: assess for diarrhea, abdominal pain, fever, fatigue, anorexia; possible anemia, elevated WBC and low serum albumin; stop product and usually give either vancomycin or IV metroNIDAZOLE - Monitor mental status often: affect, mood, behavioral changes; psychosis may occur -

Infection: assess sputum culture, lung sounds - C&S should be performed before beginning treatment, during, and after therapy is completed - Serious skin reactions: assess for fever, sore throat, fatigue, ulcers, lesions in mouth, lips, rash; can be fatal

Patient/family education - Instruct patient that compliance with dosage schedule, duration is necessary - Instruct patient that scheduled appointments must be kept or relapse may occur - Instruct patient to notify prescriber if hepatitis, neutropenia, or thrombocytopenia occurs: sore throat, fever, bleeding, bruising, yellow sclera, anorexia, nausea, vomiting, fatigue, weakness, diarrhea with pus, mucus, blood - Advise patient that urine, feces, saliva, sputum, sweat, tears may be colored red-orange; soft contact lenses may become permanently stained - Caution patients using oral contraceptives to use a nonhormonal method of birth control because rifabutin may decrease the efficiency of oral contraceptives, to notify prescriber if pregnancy is planned or suspected - Advise patient to avoid alcohol; hepatotoxicity may occur

Evaluation

Positive therapeutic outcome: Decreased symptoms of TB

Reference

Mosby's Drug Guide; Davis Drug Guide

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