BMA Concise Guide to Medicine & Drugs

Rifampicin

Brand names Rifadin, Rimactane

Used in the following combined preparations Rifater, Rifinah, Voractiv

QUICK REFERENCE

Drug group Antituberculous drug

Overdose danger rating Medium

Dependence rating Low

Prescription needed Yes

Available as generic Yes

GENERAL INFORMATION

Rifampicin is an antibacterial drug that is highly effective in the treatment of tuberculosis. Taken by mouth, the drug is well absorbed in the intestine and widely distributed throughout the body, including the brain. As a result, it is particularly useful in the treatment of tuberculous meningitis.

The drug is also used to treat leprosy and other serious infections, including brucellosis, Legionnaires’ disease, and infections of the bone (osteomyelitis). Additionally, it is given to anyone in close contact with meningococcal meningitis in order to prevent infection. Rifampicin is always prescribed with other antibiotics or antituberculous drugs because of rapid resistance in some bacteria.

A harmless red-orange coloration may be imparted to the urine, saliva, and tears, and soft contact lenses may become permanently stained.

INFORMATION FOR USERS

Your drug prescription is tailored for you. Do not alter dosage without checking with your doctor.

How taken/used Tablets, capsules, liquid, injection.

Frequency and timing of doses 1 x daily, 30 minutes before breakfast (leprosy, tuberculosis) or once a month (leprosy); 2 x daily (prevention of meningococcal meningitis); 2–4 x daily, 30 minutes before or 2 hours after meals (other serious infections).

Adult dosage range According to weight; usually 450–600mg daily (tuberculosis, leprosy) or 600mg once a month (leprosy); 600mg–1.2g daily (other serious infections); 1.2g daily for 2 days (meningococcal meningitis).

Onset of effect Over several days.

Duration of action Up to 24 hours.

Diet advice None.

Storage Keep in original container at room temperature out of the reach of children. Protect from light.

Missed dose Take as soon as you remember. If your next dose is due within 6 hours, take a single dose now, then return to normal dosing schedule.

Stopping the drug Take the full course. Even if you feel better, the original infection may still be present and symptoms may recur if treatment is stopped too soon. In rare cases stopping the drug suddenly after high-dose treatment can lead to a severe flu-like illness.

Exceeding the dose An occasional unintentional extra dose is unlikely to cause problems. Large overdoses may cause liver damage, nausea, vomiting, and lethargy. Notify your doctor immediately.

POSSIBLE ADVERSE EFFECTS

Serious adverse effects are rare with rifampicin. A red-orange discoloration of body fluids normally occurs but is harmless. Headache and breathing difficulties may occur after stopping high-dose treatment. Rarely, rifampicin may cause nausea, vomiting, and diarrhoea; if these are severe, discuss with your doctor. Muscle cramps or aches, rash, itching, and jaundice may occasionally occur; if so, you should notify your doctor, promptly in the case of jaundice. If you experience a flu-like illness or easy bruising or bleeding, you should stop taking the drug and contact your doctor immediately.

INTERACTIONS

General note Rifampicin may reduce the effectiveness of a wide variety of drugs, such as oral contraceptives (in which case alternative contraceptive methods may be necessary), phenytoin, corticosteroids, oral antidiabetics, disopyramide, and oral anticoagulants. Dosage adjustment of these drugs may be necessary at the start or end of treatment with rifampicin. Consult your doctor or pharmacist for advice.

SPECIAL PRECAUTIONS

Be sure to tell your doctor if:

· You have a long-term liver or kidney problem.

· You have porphyria.

· You wear contact lenses.

· You are taking other medicines.

Pregnancy Safety in pregnancy not established. Discuss with your doctor.

Breast-feeding The drug passes into the breast milk, but at normal doses adverse effects on the baby are unlikely. Discuss with your doctor.

Infants and children Reduced dose necessary.

Over 60 Increased risk of adverse effects. Reduced dose may therefore be necessary.

Driving and hazardous work No problems expected.

Alcohol Avoid excessive amounts. Heavy alcohol consumption may increase the risk of liver damage.

PROLONGED USE

Prolonged use of rifampicin may cause liver damage.

Monitoring Periodic blood tests may be performed to monitor liver function.