Rifadin 150mg Capsules
It is used to treat TB (tuberculosis). It is used to stop the spread of meningitis in people who carry the bacteria but are not sick with the disease.It may be given to you for other reasons. Talk with the doctor.
Drug Class
Antitubercular agent; Antibiotic
Pharmacologic Class
Rifamycin antibiotic
Pregnancy Category
Category C
FDA Approved
Aug 1971
DEA Schedule
Not Controlled
Overview
What is this medicine?
Rifampin is an antibiotic used to treat serious bacterial infections, especially tuberculosis (TB). It works by stopping the growth of bacteria. It's also used to prevent certain types of meningitis in people who have been exposed to it.
How to Use This Medicine
Taking Your Medication Correctly
To get the most benefit from your medication, follow your doctor's instructions carefully. Read all the information provided with your prescription and follow the instructions closely.
Take your medication on an empty stomach, either at least 1 hour before or at least 2 hours after a meal.
Swallow your medication with a full glass of water.
* Continue taking your medication as directed by your doctor or healthcare provider, even if you start feeling well.
If you are taking an antacid, be sure to take your medication at least 1 hour before taking the antacid.
Special Instructions for Liquid Formulation
If you have difficulty swallowing pills, your doctor or pharmacist can help you prepare a liquid (suspension) form of your medication. If a liquid formulation is prepared, shake it well before use. To ensure accurate dosing, measure the liquid carefully using the measuring device provided with your medication. If no device is included, ask your pharmacist for a suitable measuring device.
Storing and Disposing of Your Medication
Store your medication at room temperature in a dry place, away from the bathroom. Protect it from heat and light. If you have a liquid formulation, you can store it at room temperature or in the refrigerator. Discard any unused portion of the liquid formulation after 4 weeks.
What to Do If You Miss a Dose
If you miss a dose, take it as soon as you remember. However, if it's close to the time for your next scheduled dose, skip the missed dose and resume your regular dosing schedule. Do not take two doses at the same time or take extra doses.
To get the most benefit from your medication, follow your doctor's instructions carefully. Read all the information provided with your prescription and follow the instructions closely.
Take your medication on an empty stomach, either at least 1 hour before or at least 2 hours after a meal.
Swallow your medication with a full glass of water.
* Continue taking your medication as directed by your doctor or healthcare provider, even if you start feeling well.
If you are taking an antacid, be sure to take your medication at least 1 hour before taking the antacid.
Special Instructions for Liquid Formulation
If you have difficulty swallowing pills, your doctor or pharmacist can help you prepare a liquid (suspension) form of your medication. If a liquid formulation is prepared, shake it well before use. To ensure accurate dosing, measure the liquid carefully using the measuring device provided with your medication. If no device is included, ask your pharmacist for a suitable measuring device.
Storing and Disposing of Your Medication
Store your medication at room temperature in a dry place, away from the bathroom. Protect it from heat and light. If you have a liquid formulation, you can store it at room temperature or in the refrigerator. Discard any unused portion of the liquid formulation after 4 weeks.
What to Do If You Miss a Dose
If you miss a dose, take it as soon as you remember. However, if it's close to the time for your next scheduled dose, skip the missed dose and resume your regular dosing schedule. Do not take two doses at the same time or take extra doses.
Lifestyle & Tips
- Take Rifampin on an empty stomach (1 hour before or 2 hours after a meal) for best absorption.
- Take all of your medication as prescribed, even if you start to feel better. Stopping early can lead to drug-resistant infections.
- Rifampin can cause your urine, sweat, tears, saliva, and other body fluids to turn a reddish-orange color. This is harmless but can permanently stain soft contact lenses and clothing.
- If you wear soft contact lenses, consider switching to glasses during treatment.
- Rifampin can make birth control pills less effective. Use an alternative non-hormonal method of birth control (e.g., condoms, IUD) while taking Rifampin and for at least one month after stopping.
- Avoid alcohol while taking Rifampin, as it can increase the risk of liver problems.
- Inform your doctor about all other medications, supplements, and herbal products you are taking, as Rifampin interacts with many drugs.
Available Forms & Alternatives
Available Strengths:
Generic Alternatives:
Dosing & Administration
Adult Dosing
Standard Dose:
Tuberculosis: 10 mg/kg (max 600 mg) orally or IV once daily or 2-3 times weekly, depending on regimen. Prophylaxis for Meningococcal/Haemophilus influenzae: 600 mg orally every 12 hours for 2 days (meningococcal) or 4 days (Haemophilus).
Dose Range:
10 - 600 mg
Condition-Specific Dosing:
Tuberculosis (daily):
10 mg/kg (max 600 mg) PO/IV once daily
Tuberculosis (intermittent):
10 mg/kg (max 600 mg) PO/IV 2-3 times weekly
Meningococcal Prophylaxis:
600 mg PO every 12 hours for 2 days
Haemophilus influenzae Prophylaxis:
600 mg PO every 12 hours for 4 days
Pediatric Dosing
Neonatal:
Not established for routine use; consult specialist. For TB, 10-20 mg/kg/day.
Infant:
Tuberculosis: 10-20 mg/kg/day (max 600 mg/day) orally or IV. Prophylaxis for Meningococcal/Haemophilus influenzae: 10 mg/kg (max 600 mg) orally every 12 hours for 2 days (meningococcal) or 4 days (Haemophilus).
Child:
Tuberculosis: 10-20 mg/kg/day (max 600 mg/day) orally or IV. Prophylaxis for Meningococcal/Haemophilus influenzae: 10 mg/kg (max 600 mg) orally every 12 hours for 2 days (meningococcal) or 4 days (Haemophilus).
Adolescent:
Tuberculosis: 10-20 mg/kg/day (max 600 mg/day) orally or IV. Prophylaxis for Meningococcal/Haemophilus influenzae: 10 mg/kg (max 600 mg) orally every 12 hours for 2 days (meningococcal) or 4 days (Haemophilus).
Dose Adjustments
Renal Impairment:
Mild:
No adjustment typically needed.
Moderate:
No adjustment typically needed.
Severe:
No adjustment typically needed, as primarily eliminated via bile/feces. Use with caution in severe renal impairment.
Dialysis:
No dosage adjustment needed for hemodialysis or peritoneal dialysis. Administer dose after dialysis.
Hepatic Impairment:
Mild:
Use with caution; monitor liver function closely.
Moderate:
Dosage reduction may be necessary; monitor liver function closely. Consider alternative agents if possible.
Severe:
Contraindicated or use with extreme caution and significant dose reduction; monitor liver function closely. Risk of severe hepatotoxicity.
Pharmacology
Mechanism of Action
Rifampin inhibits bacterial DNA-dependent RNA polymerase activity by binding to its beta subunit, thereby preventing transcription of RNA and subsequent protein synthesis. This action is bactericidal against susceptible organisms, particularly Mycobacterium tuberculosis.
Pharmacokinetics
Absorption:
Bioavailability:
90-95%
Tmax:
2-4 hours
FoodEffect:
Food may decrease absorption; administer 1 hour before or 2 hours after meals.
Distribution:
Vd:
0.9-1.2 L/kg
ProteinBinding:
75-90%
CnssPenetration:
Yes (especially with inflamed meninges)
Elimination:
HalfLife:
1.5-5 hours (autoinduction occurs, leading to shorter half-life with repeated dosing)
Clearance:
Not available (highly variable due to autoinduction)
ExcretionRoute:
Primarily biliary/fecal (60-65%), with some renal (30%)
Unchanged:
30% (renal)
Pharmacodynamics
OnsetOfAction:
Rapid
PeakEffect:
2-4 hours (plasma concentration)
DurationOfAction:
24 hours (bactericidal effect)
Safety & Warnings
Side Effects
Urgent Side Effects: Seek Medical Help Right Away
Although rare, some people may experience severe and potentially life-threatening side effects while taking this medication. If you notice any of the following symptoms, contact your doctor immediately or seek emergency medical attention:
Signs of an allergic reaction: rash, hives, itching, red, swollen, blistered, or peeling skin (with or without fever), wheezing, tightness in the chest or throat, difficulty breathing, swallowing, or talking, unusual hoarseness, or swelling of the mouth, face, lips, tongue, or throat.
Signs of liver problems: dark urine, fatigue, decreased appetite, upset stomach or stomach pain, light-colored stools, vomiting, or yellow skin or eyes.
Signs of kidney problems: inability to urinate, changes in urine output, blood in the urine, or significant weight gain.
Dizziness or fainting.
Flu-like symptoms.
Fever, chills, or sore throat; unexplained bruising or bleeding; or feeling extremely tired or weak.
Joint pain or swelling.
Muscle pain or weakness.
Chest pain.
Excessive sweating.
Abnormal heartbeat.
Swelling in the arms or legs.
Purple spots or redness of the skin.
Balance problems.
Confusion, difficulty focusing, or changes in behavior.
Menstrual changes.
Changes in vision, eye pain, or severe eye irritation.
Changes in tooth color (which may be long-lasting).
If you experience any new or worsening symptoms, such as cough, fever, fatigue, weakness, shortness of breath, headache, pain, night sweats, swollen glands, decreased appetite, weight loss, or skin sores, contact your doctor right away.
Important Warnings
Diarrhea is a common side effect of antibiotics. However, a severe form called C. diff-associated diarrhea (CDAD) can occur, which may lead to life-threatening bowel problems. If you experience stomach pain, cramps, or loose, watery, or bloody stools, contact your doctor immediately. Do not treat diarrhea without consulting your doctor.
Severe skin reactions, including Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), and other serious reactions, can occur with this medication. These reactions can be life-threatening and may affect internal organs. Seek medical help immediately if you experience red, swollen, blistered, or peeling skin; red or irritated eyes; sores in your mouth, throat, nose, eyes, genitals, or skin; fever; chills; body aches; shortness of breath; or swollen glands.
Rare but potentially life-threatening blood problems, such as thrombotic thrombocytopenic purpura/hemolytic uremic syndrome (TTP/HUS), can occur with this medication. Contact your doctor immediately if you experience extreme fatigue or weakness, bruising or bleeding, dark urine or yellow skin or eyes, pale skin, changes in urine output, vision changes, weakness or numbness on one side of the body, difficulty speaking or thinking, or balance problems.
Other Side Effects
Most people do not experience significant side effects, but some may occur. If you experience any of the following side effects, contact your doctor if they bother you or do not go away:
Drowsiness.
Gas.
Diarrhea, upset stomach, or vomiting.
Heartburn.
Stomach cramps.
* Changes in body fluid color to orange or red.
This is not an exhaustive list of possible side effects. If you have questions or concerns about side effects, contact your doctor. You can also report side effects to the FDA at 1-800-332-1088 or online at https://www.fda.gov/medwatch.
Although rare, some people may experience severe and potentially life-threatening side effects while taking this medication. If you notice any of the following symptoms, contact your doctor immediately or seek emergency medical attention:
Signs of an allergic reaction: rash, hives, itching, red, swollen, blistered, or peeling skin (with or without fever), wheezing, tightness in the chest or throat, difficulty breathing, swallowing, or talking, unusual hoarseness, or swelling of the mouth, face, lips, tongue, or throat.
Signs of liver problems: dark urine, fatigue, decreased appetite, upset stomach or stomach pain, light-colored stools, vomiting, or yellow skin or eyes.
Signs of kidney problems: inability to urinate, changes in urine output, blood in the urine, or significant weight gain.
Dizziness or fainting.
Flu-like symptoms.
Fever, chills, or sore throat; unexplained bruising or bleeding; or feeling extremely tired or weak.
Joint pain or swelling.
Muscle pain or weakness.
Chest pain.
Excessive sweating.
Abnormal heartbeat.
Swelling in the arms or legs.
Purple spots or redness of the skin.
Balance problems.
Confusion, difficulty focusing, or changes in behavior.
Menstrual changes.
Changes in vision, eye pain, or severe eye irritation.
Changes in tooth color (which may be long-lasting).
If you experience any new or worsening symptoms, such as cough, fever, fatigue, weakness, shortness of breath, headache, pain, night sweats, swollen glands, decreased appetite, weight loss, or skin sores, contact your doctor right away.
Important Warnings
Diarrhea is a common side effect of antibiotics. However, a severe form called C. diff-associated diarrhea (CDAD) can occur, which may lead to life-threatening bowel problems. If you experience stomach pain, cramps, or loose, watery, or bloody stools, contact your doctor immediately. Do not treat diarrhea without consulting your doctor.
Severe skin reactions, including Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), and other serious reactions, can occur with this medication. These reactions can be life-threatening and may affect internal organs. Seek medical help immediately if you experience red, swollen, blistered, or peeling skin; red or irritated eyes; sores in your mouth, throat, nose, eyes, genitals, or skin; fever; chills; body aches; shortness of breath; or swollen glands.
Rare but potentially life-threatening blood problems, such as thrombotic thrombocytopenic purpura/hemolytic uremic syndrome (TTP/HUS), can occur with this medication. Contact your doctor immediately if you experience extreme fatigue or weakness, bruising or bleeding, dark urine or yellow skin or eyes, pale skin, changes in urine output, vision changes, weakness or numbness on one side of the body, difficulty speaking or thinking, or balance problems.
Other Side Effects
Most people do not experience significant side effects, but some may occur. If you experience any of the following side effects, contact your doctor if they bother you or do not go away:
Drowsiness.
Gas.
Diarrhea, upset stomach, or vomiting.
Heartburn.
Stomach cramps.
* Changes in body fluid color to orange or red.
This is not an exhaustive list of possible side effects. If you have questions or concerns about side effects, contact your doctor. You can also report side effects to the FDA at 1-800-332-1088 or online at https://www.fda.gov/medwatch.
Seek Immediate Medical Attention If You Experience:
- Yellowing of the skin or eyes (jaundice)
- Dark urine or pale stools
- Persistent nausea, vomiting, or loss of appetite
- Unusual tiredness or weakness
- Fever, chills, or body aches (flu-like symptoms)
- Severe skin rash or itching
- Easy bruising or bleeding
- Joint pain or swelling
Before Using This Medicine
Before Taking This Medication: Important Information to Share with Your Doctor
It is essential to inform your doctor about the following:
Any allergies you have, including allergies to this medication, its components, or other substances, such as foods or drugs. Be sure to describe the symptoms you experienced.
If you have previously taken this medication and it caused liver problems.
Any medications you are currently taking, including prescription and over-the-counter (OTC) drugs, natural products, and vitamins, as some may interact with this medication. Specifically, certain drugs used to treat HIV, infections, depression, and other conditions should not be taken with this medication. Your doctor or pharmacist can provide guidance on potential interactions.
Please note that this is not an exhaustive list of all possible drug interactions or health concerns related to this medication. To ensure your safety, it is crucial to:
Inform your doctor and pharmacist about all your medications (prescription and OTC), natural products, vitamins, and health problems.
Verify that it is safe to take this medication with your existing medications and health conditions.
Do not start, stop, or change the dose of any medication without first consulting your doctor.
It is essential to inform your doctor about the following:
Any allergies you have, including allergies to this medication, its components, or other substances, such as foods or drugs. Be sure to describe the symptoms you experienced.
If you have previously taken this medication and it caused liver problems.
Any medications you are currently taking, including prescription and over-the-counter (OTC) drugs, natural products, and vitamins, as some may interact with this medication. Specifically, certain drugs used to treat HIV, infections, depression, and other conditions should not be taken with this medication. Your doctor or pharmacist can provide guidance on potential interactions.
Please note that this is not an exhaustive list of all possible drug interactions or health concerns related to this medication. To ensure your safety, it is crucial to:
Inform your doctor and pharmacist about all your medications (prescription and OTC), natural products, vitamins, and health problems.
Verify that it is safe to take this medication with your existing medications and health conditions.
Do not start, stop, or change the dose of any medication without first consulting your doctor.
Precautions & Cautions
It is essential to inform all your healthcare providers, including doctors, nurses, pharmacists, and dentists, that you are taking this medication. Your doctor will likely recommend regular blood tests and other laboratory evaluations to monitor your condition. Be aware that this drug may interfere with certain lab tests, so it is crucial to notify all your healthcare providers and laboratory personnel that you are taking this medication.
To minimize potential risks, avoid consuming alcohol while taking this drug. If you have diabetes, it is vital to closely monitor your blood sugar levels, as this medication may affect them. Be aware of the signs of high blood sugar, such as confusion, drowsiness, increased thirst or hunger, frequent urination, flushing, rapid breathing, or fruity-smelling breath, and report them to your doctor promptly.
Additionally, this drug may cause discoloration of contact lenses. Do not use this medication for longer than prescribed, as this may increase the risk of a second infection.
Rifampin has been associated with liver problems, which can be severe and potentially life-threatening, especially in individuals with pre-existing liver disease or those taking other medications that may increase the risk of liver damage. If you have concerns, discuss them with your doctor.
This medication has also been linked to certain lung problems, which can be fatal. If you have questions or concerns, consult your doctor.
If you are 65 years or older, use this medication with caution, as you may be more susceptible to side effects.
It is essential to note that birth control pills and other hormone-based contraceptives may be less effective while taking this medication. To prevent pregnancy, use an additional form of birth control, such as a condom.
If you are pregnant, plan to become pregnant, or are breastfeeding, inform your doctor, as they will need to discuss the potential benefits and risks of this medication to you and your baby.
To minimize potential risks, avoid consuming alcohol while taking this drug. If you have diabetes, it is vital to closely monitor your blood sugar levels, as this medication may affect them. Be aware of the signs of high blood sugar, such as confusion, drowsiness, increased thirst or hunger, frequent urination, flushing, rapid breathing, or fruity-smelling breath, and report them to your doctor promptly.
Additionally, this drug may cause discoloration of contact lenses. Do not use this medication for longer than prescribed, as this may increase the risk of a second infection.
Rifampin has been associated with liver problems, which can be severe and potentially life-threatening, especially in individuals with pre-existing liver disease or those taking other medications that may increase the risk of liver damage. If you have concerns, discuss them with your doctor.
This medication has also been linked to certain lung problems, which can be fatal. If you have questions or concerns, consult your doctor.
If you are 65 years or older, use this medication with caution, as you may be more susceptible to side effects.
It is essential to note that birth control pills and other hormone-based contraceptives may be less effective while taking this medication. To prevent pregnancy, use an additional form of birth control, such as a condom.
If you are pregnant, plan to become pregnant, or are breastfeeding, inform your doctor, as they will need to discuss the potential benefits and risks of this medication to you and your baby.
Overdose Information
Overdose Symptoms:
- Nausea, vomiting, abdominal pain
- Lethargy, drowsiness
- Headache
- Increased liver enzymes (transaminases)
- Orange-red discoloration of skin, urine, sweat, tears, and feces (more intense than therapeutic effect)
- Hepatomegaly (enlarged liver)
- Jaundice
- In severe cases: loss of consciousness, convulsions, cardiac arrhythmias
What to Do:
Seek immediate medical attention or call a poison control center (e.g., 1-800-222-1222). Treatment is supportive and symptomatic. Gastric lavage may be considered if performed early. Activated charcoal may be administered. Monitor liver function, renal function, and vital signs. Forced diuresis may aid excretion.
Drug Interactions
Contraindicated Interactions
- Protease inhibitors (e.g., atazanavir, darunavir, fosamprenavir, saquinavir, tipranavir) - due to significant decrease in antiretroviral concentrations
- Non-nucleoside reverse transcriptase inhibitors (e.g., rilpivirine, doravirine) - due to significant decrease in antiretroviral concentrations
- Direct-acting antiviral agents for HCV (e.g., ledipasvir/sofosbuvir, glecaprevir/pibrentasvir) - due to significant decrease in antiviral concentrations
- Oral contraceptives (estrogen/progestin) - due to decreased contraceptive efficacy
- P-glycoprotein substrates with narrow therapeutic index (e.g., dabigatran, rivaroxaban)
Major Interactions
- Warfarin (decreased anticoagulant effect)
- Corticosteroids (decreased corticosteroid effect)
- Cyclosporine, tacrolimus, sirolimus (decreased immunosuppressant effect)
- Digoxin (decreased digoxin levels)
- Phenytoin (decreased phenytoin levels)
- Sulfonylureas (decreased hypoglycemic effect)
- Theophylline (decreased theophylline levels)
- Calcium channel blockers (e.g., verapamil, diltiazem, nifedipine) - decreased antihypertensive effect
- Beta-blockers (e.g., metoprolol, propranolol) - decreased beta-blocker effect
- Opioid analgesics (e.g., methadone, oxycodone) - decreased opioid effect, risk of withdrawal
- Antifungals (e.g., azoles like fluconazole, itraconazole, voriconazole) - decreased antifungal levels
- Clarithromycin (decreased clarithromycin levels, increased rifampin levels)
- Chloramphenicol (decreased chloramphenicol levels)
- Quinine (decreased quinine levels)
- Oral anticoagulants (DOACs) - decreased anticoagulant effect
- Thyroid hormones (decreased thyroid hormone levels)
Moderate Interactions
- Acetaminophen (increased risk of hepatotoxicity with chronic use)
- Benzodiazepines (e.g., midazolam, triazolam) - decreased benzodiazepine effect
- Buspirone (decreased buspirone levels)
- Clozapine (decreased clozapine levels)
- Dapsone (decreased dapsone levels)
- Fentanyl (decreased fentanyl levels)
- Haloperidol (decreased haloperidol levels)
- Imatinib (decreased imatinib levels)
- Isoniazid (increased risk of hepatotoxicity)
- Ketoconazole (decreased ketoconazole levels)
- Losartan (decreased losartan levels)
- Metronidazole (decreased metronidazole levels)
- Nortriptyline (decreased nortriptyline levels)
- Propafenone (decreased propafenone levels)
- Quinidine (decreased quinidine levels)
- Sildenafil, tadalafil, vardenafil (decreased PDE5 inhibitor levels)
- Tramadol (decreased tramadol levels)
- Zolpidem (decreased zolpidem levels)
Minor Interactions
- Food (decreased absorption, but not clinically significant for most uses if taken consistently)
- Antacids (may reduce absorption, separate administration)
Monitoring
Baseline Monitoring
Liver function tests (ALT, AST, bilirubin)
Rationale: Rifampin can cause hepatotoxicity, especially when combined with other antitubercular drugs.
Timing: Before initiation of therapy.
Complete Blood Count (CBC) with differential
Rationale: To establish baseline and monitor for hematologic abnormalities (e.g., thrombocytopenia, leukopenia).
Timing: Before initiation of therapy.
Renal function tests (BUN, creatinine)
Rationale: To assess baseline renal function, though renal excretion is minor.
Timing: Before initiation of therapy.
Ophthalmic examination
Rationale: If co-administered with ethambutol, to establish baseline visual acuity and color vision.
Timing: Before initiation of therapy.
Routine Monitoring
Liver function tests (ALT, AST, bilirubin)
Frequency: Monthly or more frequently if clinically indicated (e.g., symptoms of hepatotoxicity, pre-existing liver disease, or co-administration with other hepatotoxic drugs).
Target: Within normal limits or stable from baseline.
Action Threshold: Discontinue if ALT/AST >3-5x ULN with symptoms, or >5x ULN without symptoms. Re-evaluate regimen.
Complete Blood Count (CBC)
Frequency: Monthly or as clinically indicated.
Target: Within normal limits.
Action Threshold: Significant drop in platelet count or other cell lines may warrant discontinuation.
Clinical symptoms of hepatotoxicity
Frequency: Ongoing patient education and inquiry at each visit.
Target: Absence of symptoms.
Action Threshold: Yellow skin/eyes, dark urine, nausea, vomiting, unusual fatigue, abdominal pain - prompt evaluation and LFTs.
Adherence to therapy
Frequency: At each visit.
Target: Consistent medication intake.
Action Threshold: Poor adherence requires counseling and strategies to improve.
Symptom Monitoring
- Flu-like syndrome (fever, chills, headache, muscle/joint pain)
- Rash, itching, hives
- Nausea, vomiting, abdominal pain, loss of appetite
- Dark urine, yellowing of skin or eyes (jaundice)
- Unusual fatigue or weakness
- Easy bruising or bleeding
- Reddish-orange discoloration of urine, sweat, tears, saliva, and contact lenses
Special Patient Groups
Pregnancy
Category C. Rifampin crosses the placenta. While animal studies show teratogenicity at high doses, human data for TB treatment suggest no increased risk of major birth defects. However, it can cause postnatal hemorrhage in mother and infant due to vitamin K deficiency. Benefits of treating active TB in pregnant women generally outweigh the risks. Vitamin K supplementation for mother in last month of pregnancy and for newborn at birth is recommended.
Trimester-Specific Risks:
First Trimester:
Potential for teratogenicity observed in animal studies at high doses; human data are reassuring but limited.
Second Trimester:
Generally considered safe for use if indicated for active TB.
Third Trimester:
Risk of postnatal hemorrhage in mother and infant due to vitamin K deficiency. Vitamin K supplementation recommended.
Lactation
Rifampin is excreted into breast milk in small amounts. The amount ingested by the infant is generally considered too low to be harmful or to provide therapeutic benefit. The American Academy of Pediatrics considers rifampin compatible with breastfeeding. Monitor infant for gastrointestinal upset (diarrhea, vomiting) or jaundice.
Infant Risk:
Low risk (L3). Small amounts in milk, generally considered safe. Monitor for GI upset or jaundice.
Pediatric Use
Rifampin is widely used and effective in pediatric patients for tuberculosis and prophylaxis. Dosing is weight-based. Close monitoring for adverse effects, especially hepatotoxicity, is important. Oral suspension is available for easier administration.
Geriatric Use
No specific dosage adjustment is generally required based on age alone. However, geriatric patients may have age-related decreases in hepatic or renal function, or multiple comorbidities and polypharmacy, which may increase the risk of adverse effects (especially hepatotoxicity) and drug interactions. Monitor liver function and other parameters closely.
Clinical Information
Clinical Pearls
- Rifampin is a potent inducer of numerous CYP450 enzymes (especially CYP3A4) and P-glycoprotein, leading to significant drug-drug interactions. Always review concomitant medications.
- Counsel patients about the harmless but striking reddish-orange discoloration of body fluids (urine, sweat, tears, saliva), which can permanently stain contact lenses and clothing.
- Administer on an empty stomach for optimal absorption.
- Strict adherence is crucial for successful treatment of tuberculosis and to prevent the development of drug resistance.
- Monitor liver function tests regularly, especially when co-administered with other hepatotoxic agents like isoniazid and pyrazinamide.
- Intermittent dosing regimens (e.g., twice or thrice weekly) are associated with a higher incidence of flu-like syndrome and other hypersensitivity reactions compared to daily dosing.
Alternative Therapies
- Isoniazid (for TB)
- Pyrazinamide (for TB)
- Ethambutol (for TB)
- Streptomycin (for TB)
- Other antitubercular agents (e.g., bedaquiline, delamanid, linezolid, fluoroquinolones for drug-resistant TB)
- Ciprofloxacin or Ceftriaxone (for meningococcal prophylaxis, if rifampin contraindicated)
Cost & Coverage
Average Cost:
$30 - $150 per 30 capsules (150mg or 300mg)
Generic Available:
Yes
Insurance Coverage:
Tier 1 or Tier 2 (Generic), Tier 3 (Brand)
General Drug Facts
If your symptoms or health issues persist or worsen, it's essential to contact your doctor for further guidance. To ensure your safety, never share your medication with others or take someone else's medication. Some medications may come with an additional patient information leaflet, so be sure to check with your pharmacist for more information. If you have any questions or concerns about your medication, don't hesitate to reach out to your doctor, nurse, pharmacist, or other healthcare provider. In the event of a suspected overdose, immediately call your local poison control center or seek medical attention. When seeking help, be prepared to provide details about the medication taken, the amount, and the time it happened.