Rifampin

💊 What is Rifampin used for?

• •Treatment of all forms of tuberculosis, including initial treatment and retreatment, when the drug cannot be taken by mouth
• •Treatment of asymptomatic carriers of Neisseria meningitidis, to eliminate meningococci from the nasopharynx

How it works

The label describes rifampin as a semisynthetic antibiotic. It also says the medicine is a strong inducer of drug-metabolizing enzymes and transporters, which can change how the body handles other medicines. The label does not explain its antibacterial mechanism in more detail in the text provided.

How it is usually taken

• •Rifampin is given by intravenous (IV) infusion. The label says the IV dose is the same as the oral dose and that it is given once daily. The label describes how the powder is mixed with sterile water and then added to an infusion fluid, which is given over a set time (either about 3 hours or 30 minutes). Follow the instructions from your prescriber or pharmacist. The label says the medicine should be taken exactly as directed and that doses should not be skipped.

Comes as

• •Rifampin for Injection, USP, 600 mg sterile glass vials of red lyophilized powder (to be dissolved before use)

⚠️ Rifampin side effects

🛑 Who should not take Rifampin, and who should be careful

The label says not to take it if

• 🚨You have had an allergic reaction (hypersensitivity) to rifampin or any of its components, or to any rifamycin (contraindication).
• 🚨You are taking ritonavir-boosted saquinavir, because of an increased risk of severe liver toxicity.
• 🚨You are taking atazanavir, darunavir, fosamprenavir, saquinavir, tipranavir, cabotegravir, fostemsavir, or lenacapavir, because rifampin can substantially lower their levels.
• 🚨You are taking praziquantel, because effective blood levels of praziquantel may not be reached.
• 🚨You are taking lurasidone, because rifampin can decrease its exposure.

Tell your doctor before taking it if

• •Tell your care team about any other medicines you take, including herbal products, because the label says rifampin can change how many drugs work.
• •Tell your care team if you have liver disease, because the label says people with impaired liver function should receive rifampin only when necessary and under strict medical supervision.
• •Tell your care team if you use hormonal birth control, because the label says its reliability may be affected.
• •Tell your care team if you wear soft contact lenses, because the label says they may be permanently stained.
• •Tell your care team if you have a history of porphyria, because the label mentions reports of porphyria getting worse with rifampin.
• •Tell your care team if you drink alcohol, because the label advises abstaining from alcohol while taking rifampin.
• •Your care team may order liver and blood clotting tests, because the label says these should be monitored during treatment.

🔀 Rifampin with other medicines, food and alcohol

The label says to discuss these with your doctor or pharmacist

• •Ritonavir-boosted saquinavir: contraindicated because of severe liver toxicity risk.
• •Antiretroviral medicines such as atazanavir, darunavir, fosamprenavir, saquinavir, tipranavir, cabotegravir, fostemsavir, and lenacapavir: contraindicated because they may lose effectiveness.
• •Praziquantel: contraindicated. The label says rifampin should be stopped 4 weeks before praziquantel is given, and it can be restarted one day after praziquantel treatment is finished.
• •Lurasidone: contraindicated.
• •Isoniazid and halothane: other liver-toxic medicines that can increase the risk of liver toxicity. The label says patients on both rifampin and isoniazid should be monitored closely, and rifampin and halothane should be avoided together.
• •Cefazolin: high doses given with rifampin may prolong prothrombin time and cause serious clotting problems. The label says to avoid this combination in patients at increased risk for bleeding.
• •Anticoagulants and other drugs: rifampin may increase or decrease the effects of many drugs, so the label says other medicines may need dose adjustments.
• •Hormonal contraceptives: their reliability may be affected, and the label says alternative contraceptive measures should be considered.
• •Alcohol, hepatotoxic medicines, and herbal products: the label advises avoiding them while taking rifampin.

Alcohol and food

The label advises patients to abstain from alcohol while taking rifampin. The label text provided does not give specific food instructions for the IV form.

🤰 Rifampin in pregnancy and breastfeeding

Pregnancy

The label does not say.

Breastfeeding

The label says that because rifampin showed potential for tumorigenicity in animal studies, a decision should be made whether to stop nursing or stop the drug, taking into account how important the drug is to the mother.

🗓️ Storage, missed doses and taking too much

Storage

Store at 25°C (77°F); excursions are permitted between 15°C and 30°C (59°F to 86°F). Avoid excessive heat (above 40°C or 104°F). Protect from light.

If a dose is missed

The label text provided does not give specific instructions for a missed dose. The label does stress that people should not miss any doses, and that skipping doses may make treatment less effective and increase the chance of bacterial resistance.

If too much is taken

The label says nausea, vomiting, abdominal pain, itching, headache, and increasing lethargy will probably occur soon after an overdose. Unconsciousness may occur when there is severe liver disease. Liver enlargement, raised liver enzymes or bilirubin, and rapid jaundice may develop, and body fluids and skin may turn brownish-red or orange. The label text provided does not describe specific treatment steps.

🗒️ Questions to ask about Rifampin

• Why am I receiving rifampin by IV instead of by mouth?
• How long will my treatment last, and will I need blood or liver tests during treatment?
• Which of my current medicines, including herbal products, could interact with rifampin?
• Will I need another medicine added to my treatment, such as isoniazid or pyrazinamide?
• What should I do if I notice yellow skin or eyes, dark urine, or unusual bleeding?
• Could rifampin affect my birth control, and what other options should I consider?
• Will rifampin stain my teeth, contact lenses, or body fluids, and what should I expect?

❓ Rifampin: frequently asked questions