rifampin (Rx)

Brand and Other Names:Rifadin, Rimactane
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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

capsule

  • 150mg
  • 300mg

injectable powder

  • 600mg
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Tuberculosis

10 mg/kg/day PO or 10 mg/kg PO twice weekly (directly observed therapy [DOT]); not to exceed 600 mg/day 

Dosing considerations

  • May be given in conjunction with isoniazid or with isoniazid and pyrazinamide
  • Rifampin dosage not to exceed 600 mg/day

Neisseria Meningitidis Carrier

600 mg q12hr for 2 days

Haemophilus Influenzae Type B Infection

Prophylaxis

600 mg/day PO/IV for 4 days

Dosage Forms & Strengths

capsule

  • 150mg
  • 300mg

injectable powder

  • 600mg
more...

Tuberculosis

10-20 mg/kg/day IV/PO or 10-20 mg/kg PO twice weekly (DOT); not to exceed 600 mg/day 

Neisseria Meningitidis Infection

Prophylaxis

≤1 month: 10 mg/kg/day PO divided q12hr for 2 days 

>1 month: 20 mg/kg/day PO divided q12hr for 2 days; not to exceed 600 mg/day

Haemophilus Influenzae Type B Infection (Off-label)

Prophylaxis

≤1 month: 10 mg/kg/day PO for 4 days 

>1 month: 20 mg/kg/day PO for 4 days; not to exceed 600 mg/day

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Interactions

Interaction Checker

and rifampin

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            Adverse Effects

            1-10%

            Elevated liver function test (LFT) results (up to 14%)

            Rash (1-5%)

            Epigastric distress (1-2%)

            Anorexia (1-2%)

            Nausea (1-2%)

            Vomiting (1-2%)

            Diarrhea (1-2%)

            Cramps (1-2%)

            Pseudomembranous colitis (1-2%)

            Pancreatitis (1-2%)

            Frequency Not Defined

            Muscular weakness

            Edema

            Flushing

            Ataxia

            Impaired concentration

            Fever

            Fatigue

            Headache

            Numbness

            Behavioral changes

            Dizziness

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            Warnings

            Contraindications

            Hypersensitivity to rifamycins

            Concomitant administration of live bacterial vaccines

            Contraindicated in patients receiving ritonavir-boosted saquinavir, because of increased risk of severe hepatocellular toxicity

            Contraindicated in patients receiving atazanavir, darunavir, fosamprenavir, saquinavir, or tipranavir, because rifampin may cause substantial decreases in plasma concentrations of these antiviral drugs, which may result in loss of antiviral efficacy or development of viral resistance

            Cautions

            May decrease the effectiveness of oral contraceptive pills (OCPs)

            Do not administer parenteral preparation IM or SC

            Patients on regimens of >600 mg once or twice weekly may experience adverse reactions, including flulike syndrome

            History of diabetes mellitus (rifampin may make diabetes management more difficult)

            Regimens of >600 mg once or twice weekly may cause leukemia, anemia, or thrombocytopenia

            Discontinue therapy if patient develops any signs of hepatocellular damage, including hyperbilirubinemia

            Prolonged use may result in bacterial or fungal superinfection

            Use with caution in patients with liver impairment and porphyria

            Not for use in meningococcal disease; may be suitable for short-term use in asymptomatic carriers

            Use with caution in patients with history of alcoholism and patients receiving additional medications that may cause hepatotoxicity

            Rifampin is not recommended for intermittent therapy; caution patient against intentional or accidental interruption of daily dosage regimen; rare renal hypersensitivity reactions have been reported when therapy was resumed in such cases

            Rifampin has enzyme-inducing properties that can enhance metabolism of endogenous substrates, including adrenal hormones, thyroid hormones, and vitamin D

            Systemic hypersensitivity reactions, including Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) syndrome, may occur; signs and symptoms may include fever, rash, urticaria, angioedema, hypotension, acute bronchospasm, conjunctivitis, thrombocytopenia, neutropenia, elevated liver transaminases or flu-like syndrome (weakness, fatigue, muscle pain, nausea, vomiting, headache, chills, aches, itching, sweats, dizziness, shortness of breath, chest pain, cough, syncope, palpitations;. reactions may be severe and fatal; monitor for signs and/or symptoms of hypersensitivity reactions; discontinue therapy and administer supportive measures if symptoms occur

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            Pregnancy & Lactation

            Pregnancy category: C

            Effects unknown; reported to cross placental barrier and appear in cord blood; increased congenital malformations, primarily spina bifida and cleft palate reported in offspring of rodents given oral doses of 150-250 mg/kg/day during pregnancy; case reports of postnatal hemorrhage in mother and infant when administered during last few weeks of pregnancy

            Lactation: Drug enters breast milk

            Pregnancy Categories

            A:Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B:May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C:Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D:Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X:Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA:Information not available.

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            Pharmacology

            Mechanism of Action

            Inhibits DNA-dependent RNA polymerase by binding to beta subunit, which in turn blocks RNA transcription; potent enzyme inducer

            Absorption

            PO well absorbed; food may delay or slightly reduce peak

            Peak plasma time: PO, 2-4 hr

            Distribution

            Highly lipophilic; crosses blood-brain barrier well, and relative diffusion from blood into CSF is adequate, with or without inflammation (exceeds usual MICs)

            Protein bound: 80%

            Metabolism

            Metabolized by liver; undergoes enterohepatic recirculation

            Elimination

            Half-life: 3-4 hr (prolonged in hepatic impairment); in end-stage renal disease, 1.8-11 hr

            Excretion: Feces (60-65%) and urine (~30%) as unchanged drug

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            Administration

            PO

            Take on empty stomach

            IV Compatibilities

            Solution: D5W (at 1.2 g/L within 4 hours)

            IV Incompatibilities

            Solution: NS (may be used within 24 hours)

            Additive: Minocycline

            Y-Site: Diltiazem

            IV Preparation

            Add 10 mL of SWI to 600 mg of rifampin in vial

            Before administration, solution may be added to 500 mL of D5W or 100 mL of D5W

            IV Administration

            Prepare and administer within 4 hours

            In 500 mL of D5W: Infuse within 3 hours

            In 100 mL of D5W: Infuse within 30 minutes

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            Formulary

            FormularyPatient Discounts

            Adding plans allows you to compare formulary status to other drugs in the same class.

            To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.

            Adding plans allows you to:

            • View the formulary and any restrictions for each plan.
            • Manage and view all your plans together – even plans in different states.
            • Compare formulary status to other drugs in the same class.
            • Access your plan list on any device – mobile or desktop.

            The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
            QL Quantity Limits
            Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
            ST Step Therapy
            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
            OR Other Restrictions
            Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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