Meds and you

30 September 2013

Rifampicin

Rifampicin is an antibiotic used as first-line treatment of tuberculosis.

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Rifampicin is the active ingredient of Rimactane (Nappi Code: 815969-007, 760692-009, 7607140-002 & 7607222-005).

Rifampicin is also one of multiple active ingredients found in Rifafour (Nappi Code: , 701608001/2/3/4/5), Rifinah (Nappi Code: 760641-015, 702502-001), Rimactazid (Nappi Code: 702376-001, 702373-002), Rimactazid Paed (Nappi Code: 863971-008/16, 704472-001), Rimcure Paed (Nappi Code: 863998- 003/011/038), and Rimstar 4-FDC (Nappi Code: 702384-004/5/6).

General information
Rifampicin is an antibiotic used as first-line treatment of tuberculosis.

It is often used in combination with other antibiotics to provide a broader spectrum of action, and to reduce the risk of certain bacteria developing a resistance against this drug.

In South Africa rifampicin is registered for the treatment of tuberculosis, mycobacterium infections other than tuberculosis, leprosy, Legionnaires' disease, brucellosis and bacterial infections caused by resistant strains of staphylococcus.

Rifampicin is also used as preventative treatment against tuberculosis (in combination with isoniazid) and meningococcal meningitis in those exposed to high-risk environments.

For rifampicin to be effective it has to be taken regularly, even if you do not notice an immediate effect.

Rifampicin may colour your urine/stool/saliva or tears orange/red. Although this is not harmful at all, those wearing contact lenses should be aware that it may stain lenses permanently.

Rifampicin should best be taken 1 hour before, or 2 hours after a meal. If taken with a meal gastro-intestinal irritation will be less, but absorption may then be impaired.

Treatment with rifampicin should not be stopped abruptly, even if you feel better. To prevent the infection from returning as a result of premature stoppage, you should decrease your dose only as directed by your doctor, only when instructed to do so.

How does rifampicin work?
Rifampicin inactivates a bacterial enzyme that is responsible for the production of proteins essential for bacteria to reproduce.

Fast facts Drug schedule: schedule 4
Available as: rifampicin is available as tablets, capsules or injection.
What does it do? Rifampicin has an anti-biotic action.
Overdose risk: medium
Dependence risk: low
Is rifampicin available as a generic? yes
Is rifampicin available on prescription only? yes

User information Onset of effect: the full effect of this drug may only be seen after a few days of treatment.
Duration of action: 12-24 hours
Dietary advice: rifampicin should best be taken 1 hour before, or 2 hours after a meal. If taken with a meal gastro-intestinal irritation will be less, but absorption of the drug may then be impaired.
Stopping this medicine: treatment with rifampicin should not be stopped abruptly, even if you feel better. To prevent the infection from returning as a result of premature stoppage, you should decrease your dose only as directed by your doctor, only when instructed to do so.
Prolonged use: prolonged use may lead to liver damage. Periodic blood and liver function tests are advised.

Special precautions
Consult your doctor before using this drug if:

  • you are an alcoholic

  • you have a liver or kidney disease

  • you have porphyria

  • you are taking other medication

Pregnancy: avoid. Potential risk to the foetus has been reported. Consult your doctor before use, or if you are planning to fall pregnant
Breastfeeding: avoid. It is unknown how this medication may affect your baby. Consult your doctor before use.
Porphyria: avoid. This medication may cause serious adverse effects. Consult your doctor before use.
Infants and children: this medication is safe for use in children at the recommended dose.
The elderly: caution is advised in the elderly as the risk of adverse effects are increased.
Driving and hazardous work: caution is advised as use of this medication may lead to dizziness, light-headedness and/or sedation. Avoid such activities until you know how this medication affects you.
Alcohol: avoid concomitant use of alcohol with this medication.

Possible side effects

Side Effect
Frequency
Consult your doctor

Common
Rare
Only if severe
In all cases
diarrhoea

X
X

nausea/vomiting

X
X

loss of appetite

X
X

abdominal discomfort

X
X

yellow tinge to skin or eyes

X

X
flu-like symptoms

X

X
fever

X

X
drowsiness

X
X

headache

X
X

mental confusion

X

X
muscular weakness or cramps

X

X

Interactions

alcohol increased risk of liver damage
antacids may reduce absorption of rifampicin - take at least 2 hours apart
warfarin may reduce the effect of warfarin
antifungal drugs e.g. fluconazole reduced effect of antifungal drug
atovaquone reduced effect of atovaquone
benzodiazepines reduced effect of benzodiazepines
diltiazem, verapamil, nifedipine reduced effect of these agents
cyclosporin reduced effect of cyclosporin
cimetidine educed effect of cimetidine
chloramphenicol reduced effect of chloramphenicol
corticosteroids reduced effect of corticosteroids
dapsone reduced effect of dapsone
fluvastatin reduced effect of fluvastatin
haloperidol reduced effect of haloperidol
indinavir reduced effect of indinavir
oral contraceptive risk of contraceptive failure
phenytoin reduced effect of phenytoin
carbamazepine reduced effect of carbamazepine
thyroxin higher thyroxin dose may be needed
tricyclic antidepressants possible reduced effect of antidepressant

Many other drugs may interact with rifampicin. It is important to consult your doctor or pharmacist before combining any drug with rifampicin.

Disease interactions
Consult your doctor before using this drug if you have liver or kidney disease or if you have porphyria or if you have diabetes. <>p>Overdose action
A small overdose is no cause for concern. In case of intentional large overdose seek emergency medical attention.

Recommended dosage
Adults, oral: 10 mg/kg/day up to a maximum of 600 mg/day

This material is not intended to substitute medical advice, but is for informational purposes only. Please consult a physician for specific treatment and recommendations.
 
 

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