rifamycin (Rx)

Brand and Other Names:Aemcolo, rifamycin SV MMX
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Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

tablet, delayed-release

  • 194mg

Traveler’s Diarrhea

Minimally absorbed antibiotic indicated for traveler’s diarrhea caused by noninvasive strains of Escherichia coli, not complicated by fever or blood in the stool

388 mg (2 tablets) PO BID x 3 days

Dosage Modifications

Renal or hepatic impairment: Not studied; no dosage adjustment required owing to minimal systemic absorption

Dosing Considerations

Limitations of use: Not indicated or shown effective in patients with diarrhea complicated by fever or bloody stool or due to pathogens other than noninvasive strains of E coli

To reduce the development of drug-resistant bacteria and maintain effectiveness of antibiotics, rifamycin should be used only to treat or prevent infections that are proven or strongly suspected to be caused by bacteria

<18 years: Safety and efficacy not established

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Adverse Effects

1-10%

Constipation (3.5%)

Headache (3.3%)

Dyspepsia (<2%)

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Warnings

Contraindications

Known hypersensitivity to rifamycin or any of the other rifamycin-class antimicrobial agents

Cautions

Not effective for diarrhea complicated by fever and/or bloody stool; discontinue use if diarrhea gets worse or persists >48 hr; consider alternative antibacterial therapy

Consider Clostridium difficile-associated diarrhea (CDAD) in all patients who present with diarrhea following antibacterial drug use; CDAD can occur over 2 months after antibiotic discontinued

Prescribing rifamycin without proven or strongly suspected bacterial infection or a prophylactic indication is unlikely to provide benefit to the patient and increases the risk of the development of drug-resistant bacteria

Owing to minimal systemic rifamycin concentrations observed, clinically relevant drug interactions are not expected

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Pregnancy

Pregnancy

There are no available data regarding use in pregnant women

Systemic absorption in humans is negligible following PO administration; not expected that maternal use results in fetal exposure

Lactation

There are no available data regarding presence in human milk

Systemic absorption in humans is negligible following PO administration; exposure to breastfed infants through breastmilk is expected to be negligible

The development and health benefits of breastfeeding should be considered along with the mother’s clinical need for the drug and any potential adverse effects on the breastfed child or from the underlying maternal condition

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

Oral nonabsorbable antibiotic that can be used for the treatment of bacterial infections of the colon

Belongs to the ansamycin antibacterial drug class and acts by inhibiting the beta-subunit of bacterial DNA-dependent RNA polymerase, blocking 1 of the DNA transcription steps; this results in bacterial synthesis inhibition and consequently bacterial growth

Absorption

Bioavailability: <0.1%

Distribution

Protein bound: ~80%

Metabolism

CYP-based metabolism not observed in vitro

Elimination

Excretion: 86% feces

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Administration

Oral Administration

Take each dose with full glass of liquid (6-8 oz)

Do not take concomitantly with alcohol

May take with or without food

Swallow delayed-release tablet whole; do not crush, break, or chew

Storage

Store at 20-25°C (68-77°F); excursions permitted to 15-30°C (59-86°F)

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Images

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Formulary

FormularyPatient Discounts

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

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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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Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.