Rifampin (Oral)

Rifampin is an antibiotic medicine that is used in combination with other medicines to treat tuberculosis in various parts of the body. Alongside this, it is also used to stop the spread of meningitis bacteria that is found in the nose or throat of patients.

Overview

Otherwise known by its brand names Rifadin and Rimactane, rifampin is an antibiotic medication that is taken orally to treat tuberculosis in multiple parts of the body. Tuberculosis is a severe condition that predominantly infects the lungs but can also spread to other organs. Symptoms can include coughing up blood, chest pain and pain when breathing, weight loss, fever and fatigue. It is a highly treatable condition once diagnosed, and is also highly contagious, is easily spread by untreated people through the air when they cough or sneeze.

To treat tuberculosis, rifampin is taken alongside other medications, as part of an effective treatment regime. It will only treat bacterial infections, however, and it is ineffective at treating viral infections such as a cold or flu. In other cases, rifampin is used to treat some patients who have the bacteria infection, Neisseria meningitidis, in their throat or nose. This bacteria can be incredibly harmful and has the potential to cause meningitis. Patients who have this virus will not have developed any symptoms of meningitis, and rifampin is used to prevent the infection from spreading and infecting other people.

This medication works by destroying infection-causing bacteria. It is classified in a group of medicines known as antimycobacterial and must only ever be prescribed and managed by a doctor. It is taken orally and is available in capsule, tablet or syrup forms. It should always be taken with water on an empty stomach and its dosage is dependent on a patient's condition.

For patients taking rifampin in the treatment of tuberculosis, it is likely that your doctor will instruct you to take the medication for several months. As will all antibiotics, it is essential that you continue to take the medication, even if you feel better, and are diligent with your dosing schedule. This will avoid the possibility of bacteria becoming resistant to the antibiotics and causing your condition to redevelop or worsen.

Conditions treated

  • Tuberculosis
  • Neisseria meningitidis
  • Mycobacterial infections

Type of medicine

  • Antimycobacterial antibiotic.

Side effects

Rifampin has the potential to cause various side effects, with many of reactions being easy to manage with the guidance of your doctor. Because of this, it is important to keep track of any adverse effects that may be a result of your medication and alert your doctor if you become concerned. Side effects that may occur and don't usually require medical attention, or are likely to go away once your body becomes adjusted to the medication include, belching, bloating and feeling full, drowsiness, indigestion, the inability to concentrate, pain or discomfort in the chest, upper stomach or the throat and weight loss due to a lack of appetite. You may also experience some other reactions that are less likely to need medical attention but are rarer. These include the feeling that people are watching you, controlling your behaviour or hearing your thoughts, hallucinations, muscle pain, tenderness or weakness, mood or mental changes and unusual behaviour. If you notice any of these symptoms and they concern you, make sure to discuss them with your doctor when possible.

If you or your child experiences any pain or tenderness in the upper stomach, dark urine, pale stools, a loss of appetite, nausea, unusual tiredness, weakness or yellow eyes or skin, it is important that you see a doctor right away. These could all be indicators of a serious liver problem that has occurred due to this medication.

Blood in the urine, stools, vomit or blood when coughing as well as unusual bleeding, persistent bleeding from puncture sites or wounds and persistent bleeding from the nose or mouth or gums are all signs of rare and serious side effects that should be alerted to your doctor. Patients may also experience back or lower side pain, bruising, darkening of the skin, painful, difficult or a decreased amount of urination, increased blood pressure and an increased thirst. As well as this, the experience of agitation, confusion, fever, lethargy, mental depression, irritability, dizziness and hostility should all be communicated to the doctor and are signs of rare and potentially serious side effects.

As with all medications, there is also a rare but serious possibility of an allergic reaction. If you notice any swelling and redness of the face and eyes, difficulty in breathing and a tight, painful chest, hives, a fast heartbeat and difficulty in swallowing, seek emergency medical treatment when possible.

In very rare cases, patients may experience blistering, peeling or loosening of the skin, bone pain, chest pain, cold, clammy skin, severe diarrhea which may also be bloody, difficulty with speaking, double vision, a fast, weak pulse, unpleasant breath odor and pinpoint red spots on the skin. These are signs of serious side effects that are highly uncommon and should be alerted to a healthcare professional when possible. Patients may also experience swollen glands, sores, welts or blisters, red, irritated skin and eyes and the inability to move the legs, arms or facial muscles.

This is not a comprehensive list of all the possible side effects that rifampin may cause patients. Before beginning your treatment with this medication, make sure to read all the documentation that will be provided with it. Additionally, if you become bothered by any side effects or find that they are persistent, please make sure to discuss them with your doctor.

Dosage

A patients dosage will be dependant on a number of factors including their condition, their current state of health and any previous medical conditions or illnesses.

The standard dose of rifampin for adult patients receiving treatment of tuberculosis is 10 mg/kg once per day. This should not be more than 600 mg per day, however. For pediatric patients receiving this medication for the treatment of tuberculosis, it is advised that this dose is 10-20 mg/ kg and it should not be more than 600 mg per day. It should be taken one to two hours after a meal with a glass of water. When used to treat tuberculosis, rifampin is usually taken in combination with other medicines as part of a treatment regime that will be continued for up to four months. For patients who are positive to tests, who have resistant organisms or who are HIV positive, this treatment may be continued for longer.

In the treatment of adult patients who have bacteria that can cause meningitis, the standard dose of rifampin is 600 mg, to be taken twice a day for two days. In children of one month or older, this dose should be 10 mg/kg, every two hours for two days. This dose should never exceed 600 mg. In pediatric patients under one-month-old, this dose should be 5 mg/kg every 12 hours for two days.

Interactions

Before beginning your treatment with rifampin, it is vital that you alert your doctor to any other medications that you may be taking. This is because there are many other medicines that can cause potentially harmful reactions when taken in combination rifampin. When alerting your doctor of any current medications that you may be taking, it is also important that you include herbal remedies, medicines or supplements, as these can all have negative interactions with rifampin. Vitamin B12 is a particular supplement that has been shown to interact with this medicine.

Rifampin has been recorded to cause certain antiviral drugs to become much less efficient. These medicines include atazanavir, darunavir, fosamprenavir, saquinavir, and tipranavir and must be discussed with your doctor. It is likely that your doctor will arrange alternative medication as these should never be combined with rifampin.

Rifampin is also known to speed up the metabolism of certain medications including many forms of anticonvulsants, antiarrhythmics, oral anticoagulants, antifungals, barbiturates, beta-blockers, calcium channel blockers, corticosteroids, fluoroquinolones and tricyclic antidepressants. Additionally to these, it is important to inform your doctor of medicines such as digitoxin, chloramphenicol, dapsone, fluoroquinolones, haloperidol, levothyroxine, progestins, quinine, tacrolimus, and zidovudine.

The effects of rifampin and anticoagulant medicines of the coumarin type are negative, with rifampin causing an increase in the requirements of anticoagulant amounts needed to treat patients.

Alongside this, it is essential that patients discuss any contraceptives that they may be taking. This medication can cause hormonal and certain types of contraceptives to become ineffective. Because of this, it is likely that your doctor will recommend an alternative before your treatment begins.

For patients who are taking antacids, medical evidence has shown that the absorption of rifampin can be reduced. Due to this, it is important that each dose of rifampin is taken at least one hour in advance before the consumption of antacids.

Other notable medications that should be discussed with your doctor include probenecid and cotrimoxazole, halothane, isoniazid, sulfapyridine, sulfasalazine and mesalamine.

Warnings

Before beginning your treatment with Rifampin, it is incredibly important that you alert your doctor to any prior allergies and sensitivities to medications that you may have taken in the past. Because there is the potential to experience serious and harmful side effects, it is important to be as clear with your doctor as possible.

Be diligent with any side effects you do experience, as there is the possibility for them to worsen or become severe. It is best to discuss any concerns or physical problems with your healthcare professional as soon as possible, to help control and manage adverse reactions. You must also be mindful of any new additions to your lifestyle or diet, as some vitamins and herbal supplements can be detrimental to your treatment.

There is a potential for this medication to cause or exacerbate a liver problem. This risk is increased in those who frequently drink alcohol. Because of this, it is important that you reduce the number of alcoholic beverages that you consume whilst you are taking this medicine. If you are worried about this or would like more help in managing your alcohol consumption, talk to your doctor.

Your doctor will also want to check on you or your child with regular appointments when taking this medication. This can ensure that they are able to determine the progress of it, and help maintain or reduce any side effects that you may be having. It is important that you keep up with your appointments and are transparent with your doctor about any reactions that you may be experiencing. It is also important to keep in mind that fact that many of these appointments may require blood tests.

If you or your child are due to have any other medical tests that may be unrelated to the condition that you have been prescribed rifampin for, make sure to tell the doctor in charge that you or your child are taking this medicine. This medicine has been known to alter the results of certain tests.

For patients who are taking rifampin as part of a treatment plan for tuberculosis, it is likely that your doctor will direct you to take it for several months. To avoid the adaptation of bacteria to the medicine and the return or deterioration of your condition, it is vital that you continue taking your medication, even if you feel better. It is also important that you do not miss any doses of rifampin as this can cause the development of serious and uncomfortable side effects once you begin taking the medication again.

When taking this medicine, it is important to remember that it can cause urine, stools, saliva, phlegm, sweat, and tears to become a reddish-orange or reddish-brown color. This can be worrisome but it is to be expected with this medicine and will return to normal once your treatment has stopped and it has left your body. Be aware that this discolouration is also likely to affect soft contact lenses, and can cause them to become permanently discoloured. For the reason, it is best that patients do not wear soft contact lenses whilst taking rifampin.

Finally, patients should be aware that birth control pills may not work adequately whilst they are taking this medicine. Your doctor will likely offer pregnancy tests at checkup appointments if necessary, as well as offer guidance in alternative contraceptive methods for the duration of your treatment with rifampin. For patients of childbearing age, it is important that they are understanding and knowledgeable of the effects of rifampin and birth control, and the alternative contraceptives that are available.

Storage

As with all medication, it is essential that you keep rifampin out of the reach of children and vulnerable adults. Rifampin should always be kept sealed in a secure container in a cool, dry place such as a medicine cabinet or cupboard. It should be stored at an ideal temperature of 25°C, with certain medical and controlled environments enabling a temperature of 15-30°C.

Always make sure that you dispose of rifampin once it has expired, or if it appears to be damaged. If you happen to suspect that your tablets have been tampered with, dispose of them immediately and consult your doctor.

Summary

Following effective treatment with rifampin, most patients who have been diagnosed with tuberculosis or who have meningitis-causing bacteria will experience a full recovery, as well as the destruction of harmful bacteria that may be found in the nose or throat and can be spread to others.

Tuberculosis is a serious condition that can cause distressing symptoms including chest pain, coughing up blood and difficulty in breathing. It is highly contagious, being spread through droplets in the air following coughing or sneezing, but it can also be treated effectively and successfully following a diagnosis.

Because of this medicine's oral administration, it can be planned and managed effectively and by patients of any ability. However, it can also be daunting for some patients, with many people being intimidated by the need for regular dosing schedules and the need to not miss a dose. However, these concerns can be discussed and managed with your doctor, who may advise on certain methods to cope with this issue, from taking medicines at set meal times and using daily dosing containers to setting alarms or reminders on clocks and phones. It is essential that patients do take their entire course of rifampin, even if they feel better, as it can be incredibly harmful to stop treatment before planned. This is because the bacteria that has caused your infection can adapt to the antibiotics, rendering them ineffective. This will mean your condition worsening or returning, in a way that may be much more difficult to treat and more dangerous when spread to others.

Rifampin does have the potential to cause some bothersome side effects, with the most common ones being issues such as bloating, drowsiness, indigestion, the inability to concentrate, pain or discomfort in the chest, weight loss and a lack of appetite. These can all cause minor impact a person's daily routine, and even though they are likely to go away once your body has adjusted to the medicine, they should be discussed with your doctor if they cause any concern. There is also a chance of some effects that may cause mental harm and conditions such as hallucinations, depression and hearing voices, which can be extremely distressing. These are much rarer side effects and should be discussed with a doctor when experienced as well as alerted to a family member or coinhabitant.

For those who have pre-existing conditions or diseases, and who may be taking other medications, vitamins or supplements, it is vital that you discuss them with your doctor and are completely honest. Rifampin can have some serious reactions to other medications as well as exacerbate certain illnesses, and its treatment will need to be tracked carefully for anyone in this position. It is particularly important that your doctor provides extra tests and appointments for those with pre-existing liver conditions, as they can all have serious implications. When taking this medication, be prepared to have regular visits and checkups as well as making changes to your lifestyle and diet, in particular, alcohol consumption. This will ensure that you can experience that best treatment possible.

It is also important to discuss any birth control that you may be taking, as this medication can render certain forms of it ineffective. You must be mindful of these when taking rifampin and it is advised that alternate forms of contraceptives are taken in combination with this medication. Make sure to alert a partner of this medical interaction, as it is essential that you are both able to provide effective contraceptive treatment.

To achieve the best results from this medication, it requires plenty of dedication and responsibility. You must be thorough with your treatment plan and mindful of the effects that certain diets, lifestyles or alternative medications may have on your treatment.

 

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Last Reviewed:
January 30, 2018
Last Updated:
January 27, 2018