Rifapentine (Oral)

As an antibiotic, rifapentine works by stopping bacterial growth and infection, but will not work on viral infections.

Overview

Rifapentine is an antibiotic medicine that treats both active and latent tuberculosis and is used for both adults and children. However, usage of rifapentine in younger children requires more studies on its use and efficiency.

To maximise the effect and benefits of rifapentine, it is often prescribed together with other medication like isoniazid. However, as with any other drug, rifapentine may have unwanted interactions with other drugs, and therefore it is important that the doctor is aware of any other drugs or supplements that the patient is taking. Mixing alcohol with rifapentine is especially discouraged as it may stop rifapentine from working, and may lead to an increased risk for liver damage.

Antibiotics should be taken according to prescription, and patients should not stop halfway through a course of treatment. Otherwise, bacteria may become resistant to the medication and possibly cause new or more severe infections in the future. The same reason applies for not consuming antibiotics unnecessarily. Antibiotics can only treat bacterial infections and not viral infections such as the flu.

Patients should note that using rifapentine may lead to a higher chance for liver problems, especially if they have had a medical history of it or drink alcohol. It may also increase the risk of an intestinal infection that may lead to severe diarrhea.

However, rifapentine is usually prescribed if the doctor feels that the benefits of the medication outweighs the risks and effects. By following their prescriptions closely, patients should see their conditions improve, with decreased chances of experiencing any of the medicine’s side effects.

Conditions Treated

  • Active tuberculosis
  • Latent tuberculosis

Type of Medicine

  • Antibiotic

Side Effects

While using rifapentine, there is a chance that the patient may encounter side effects, although not all patients will do so. Some of these side effects may be milder, and do not require medical attention unless they worsen or persist, but others may be more serious and require immediate medical treatment.

The following list contains milder side effects that should go away on their own. However, the patient should check with their doctor if they are concerned and have any questions, or if symptoms continue for a period of time or even deteriorate.

  • Acne
  • Constipation
  • Loss of appetite

Some more common side effects with rifapentine are listed as follows:

  • Nausea
  • Vomiting
  • Headaches
  • Upset stomach

More serious side effects include:

  • Swelling or pain in the joints
  • Swelling of feet or lower legs
  • Dark and/or bloody urine
  • Black, tarry stools or bloody stools
  • Unusual bleeding and/or bruising
  • Unusual tiredness or weakness
  • Signs of new infection (such as fever, or a sore throat that persists)
  • Small red spots on skin

The above is not a complete list of side effects that may occur. If the patient encounters any of the above side effects, whether they belong to the list of common or serious side effects, or if they notice any new symptoms in their body, they should notify their doctor right away to discuss their condition.

Rifapentine may lead to an increased chance of serious liver problems, and the risk may be exacerbated if the patient drinks alcohol regularly. The patient should keep an eye out for:

  • Persistent nausea and/or vomiting
  • Loss of appetite
  • Unusual tiredness or weakness
  • Yellowing eyes or skin
  • Tenderness or pain in the stomach or abdominal area
  • Pale or clay-colored stools
  • Dark urine

The use of rifapentine may lead to a new infection of the intestine by a type of resistant bacteria, and may cause Clostridium-difficile associated diarrhea. If the patient starts to have diarrhea, they should refrain from using anti-diarrhea and narcotic pain medication as it may worsen their condition. The diarrhea may happen while the patient is on rifapentine, or it may occur up to a few weeks after they have already stopped treatment. They should tell their doctor if they notice the following symptoms:

  • Pain or cramps in the stomach or abdominal area
  • Blood or mucus in the stools
  • Persistent diarrhea

Rifapentine may also cause saliva, tears, sweat and urine to turn reddish in color. Dentures and contact lenses may be permanently stained by this effect. Patients are advised to refrain from wearing contact lenses from this period, although hard contact lenses are more resistant to the staining. However, it is harmless, and the patient does not have to worry about it unless the effect persists for longer than the duration of the treatment.

Allergy to rifapentine is rare, but the patient should take note of the following symptoms of an allergic reaction and seek emergency medical treatment:

  • Rashes or itching
  • Hives
  • Swelling of the skin, face, throat or tongue
  • Chills
  • Fever
  • Lightheadedness or dizziness
  • Fainting
  • Fast but irregular heartbeat or pulse

Dosage

Before starting this medication, patients should read all available information on the drug from their doctor or a qualified healthcare professional such as their nurse or pharmacist. If they have any doubts or questions, they should resolve them before treatment.

The dosage of rifapentine will vary based on the patient and their needs. The following lists an average dose, but the patient should take care to adhere to the dosage and dosing schedule that has been prescribed to them.

For active tuberculosis:

  • For adults and children above 12 years of age: 600 milligrams (mg) twice a week, with at least 72 hours in between each dose. Thereafter, 600mg should be taken once a week with other medicines such as isoniazid.
  • For children younger than 12 years of age: The doctor will determine the use and dosage of the medicine.

For latent tuberculosis:

  • For adults and children above 12 years of age: Dosage is determined by the doctor based on the patient’s weight. An average dose can be up to 900mg taken once a week for 12 weeks, paired with medicines such as isoniazid.
  • For children aged 2 to 11 years old: Dosage is determined by the doctor based on the patient’s weight. An average dose ranges from 300mg to 900mg, which is taken once a week for 12 weeks, paired with medicines such as isoniazid.
  • For children aged 2 years and below: The doctor will determine the use and dosage of the medicine.

Patients should take the medicine strictly according to the doctor’s instructions. They should not take more of, or less of the medicine than has been prescribed, nor should they take it more or less often than their scheduled doses. Misusing the medication may lead to a higher chance of side effects. To help patients remember when to take their medication, it is recommended that they take it at the same time of the day for each dose, and to mark their calendars for their next scheduled doses.

Rifapentine should be taken whole with food. It should not be broken into smaller pieces, chewed or crushed. In the event that the patient is unable to swallow the tablet whole, they may crush the tablet to add to a small amount of semi-solid food. If so, the medicine should be taken immediately and not left for future use. Taking rifapentine with food increases absorption of the food, and will also help decrease certain side effects such as nausea or vomiting.

As rifapentine is an antibiotic, the patient should continue the full course of treatment even if they feel better after a few days. This is to prevent the bacteria forming a resistance to the medication and possibly causing a worse infection in the future.

If the patient has missed a dose, it is advised that they resume the dose as soon as possible. However if it is too close to the next scheduled dose, they should skip the missed one, and continue as usual. They should not double the dosage. If in doubt, or if more than one dose has been missed, the patient will need to contact their doctor for further advice.

Interactions

Drugs may interact with one another, or with various health supplements and herbal products, which may change the way that the medicine works, or even lead to a higher risk of unwanted side effects.

Prior to starting rifapentine, the patient should note down all medication, supplements (such as multivitamins) and herbal products that they are currently consuming or have taken recently, so that they can share it with their doctor. They should also let their doctor know of any allergies they have, whether it is to medication, food, dyes, or to any animal or plant product.

The following is an incomplete list of drugs and supplements that have been shown to interact with rifapentine. Patients should check with their doctor for a full list of drug interactions.

  • Acetaminophen
  • Atorvastatin
  • Carvedilol
  • Cetirizine
  • Clopidogrel
  • Diphenhydramine
  • Docusate
  • Doxepin
  • Ergocalciferol
  • Isosorbide mononitrate
  • Lisinopril
  • LVP solution with potassium
  • Medroxyprogesterone
  • Nitroglycerin
  • Omeprazole
  • Sertraline
  • Sucralfate
  • Topiramate
  • Vitamin C (ascorbic acid)

In certain cases, the doctor may choose to combine medicines even if they produce an interaction if they judge it to be necessary. Both patient and doctor should discuss the effects and if the patient desires to continue with the medications.

While on medication, the patient should refrain from certain foods, drinks, medicines and supplements. Alcohol and tobacco, in particular, have high chances of reacting with medicines. The use of alcohol with rifapentine may decrease the effectiveness of it and even lead to a higher chance of liver disease or other side effects.

Live bacterial vaccines such as the typhoid vaccine may not work if the patient is consuming rifapentine. They should avoid any bacterial vaccines while on this medication.

Some medical conditions may also interact with rifapentine negatively, so patients should tell their doctor their medical history, especially if they have had or are at risk of:

  • Liver disease
  • Elevated liver enzymes
  • Porphyria
  • Colitis
  • HIV

If the patient’s condition does not improve or even worsens while on rifapentine, they should let their doctor know as soon as possible.

Warnings

As rifapentine contains inactive ingredients, the patient should let their doctor know of any allergies they have to prevent any reactions or unwanted problems.

If the patient is undergoing surgery, they should also let their healthcare providers know of any allergies, or any medications and supplements they are currently taking. The same goes for any medical tests that the patient may be required to take, as rifapentine may affect the results of those tests.

It is important for the doctor to check in with the patient at regular intervals to ensure that the medication is working as intended. If the patient’s condition does not improve, or deteriorates, within two to three weeks, they should tell their doctor at once.

Regular drinking of alcohol will prevent rifapentine from working as it should, and may lead to serious liver problems. Patients taking this medication should refrain from alcohol. Their doctor or healthcare giver should be made aware of any issues with alcohol beforehand.

Rifapentine can lower the amount of white blood cells and platelets, which can lead to a higher chance of infection, and may also interfere with blood clotting as well as healing. Therefore the patient should be careful to avoid injury, and may wish to stop or delay any dental work until their course of treatment is over. They should also take care when brushing their teeth or when using dental floss and toothpicks, as dental bleeding can be common with more forceful brushing or flossing. If they have any questions, they can resolve it with their doctor, or their dentist for oral hygiene-related issues.

The use of rifapentine may lead to severe diarrhea. If the patient has this symptom, they should not attempt to treat it with diarrhea medication as it may worsen it. They should contact their doctor, as it may be a sign of an infection in the bowels.

Birth control pills may be affected by rifapentine. Patients who are using birth control pills may want to consider other forms of contraceptives, such as condoms.

There is little information on how rifapentine affects pregnancy. If the patient is planning on getting pregnant, or is already pregnant, they should discuss the matter with their doctor before starting medication. Breastfeeding patients may want to consider feeding alternatives or monitor their infant closely for any side effects, as rifapentine has been shown to alter the composition and production of breast milk.

The use of rifapentine to treat active tuberculosis in children younger than 12 years of age, as well as latent tuberculosis in children younger than 2 years of age, does not yet have sufficient studies and information.

Any use of medication, whether prescription or over-the-counter, supplements or herbal products should be either avoided or carefully monitored by a doctor.

Storage

Rifapentine should be stored in a closed container, in a cool and dry place away from direct sunlight, at room temperature. It should not be stored in the bathroom as it may be too humid. The medicine should also not be exposed to freezing temperatures.

It should be stored out of the reach of children and animals.

Any expired or unneeded medication should be disposed of properly. If the patient is unsure about proper disposal methods for medication, they should consult their doctor or local waste management for best practices.

Summary

Rifapentine is usually prescribed with other medication(s) to treat both active and latent tuberculosis. While it can be used by both adults and children, there are insufficient studies and information on its use with younger children, and the child’s parent or caretaker should discuss its use with the doctor.

Patients should take special care to finish the course of medication they have been prescribed even if they feel better after a few days, as failure to finish a course of antibiotics can mean that bacteria become resistant to the the medicine. This may lead to a new or even more serious infection.

They should also take note of any side effects they encounter, whether or not they are listed in this guide. The use of rifapentine may lead to a higher risk of diarrhea caused by an intestinal infection, or to a higher risk of bleeding and other infections as rifapentine can lower the number of platelets and white blood cells. If the patient is scheduled for surgery or dental work, they may wish to discuss the details with their doctors or dentists and postpone them until they have finished treatment.

If the patient has any history of liver disease or drinks regularly, they may also experience a higher risk of liver problems. Drinking alcohol is highly discouraged while the patient is taking rifapentine as it may affect the efficiency of the drug.

There is currently insufficient information on how rifapentine affects pregnant or nursing patients. Rifapentine may affect the production and composition of breast milk. It may also decrease the effectiveness of birth control pills. Patients who are pregnant or planning to get pregnant, or are breastfeeding, should consult with their doctors regarding their options.

By following their doctor’s instructions and prescription closely, patients with tuberculosis are expected to see their conditions improve with the use of rifapentine.

 

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Last Reviewed:
January 31, 2018
Last Updated:
January 27, 2018
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