Rifampicin oral
- Drugs List
- Therapeutic Indications
- Dosage
- Contraindications
- Precautions and Warnings
- Pregnancy and Lactation
- Side Effects
- Monograph
Presentation
Oral formulations containing rifampicin.
Drugs List
Therapeutic Indications
Uses
Elimination of Haemophilus influenzae from asymptomatic carriers
Legionnaires disease
Leprosy
Meningococcal meningitis - prophylaxis of
Prophylaxis of Haemophilus influenzae
Treatment of brucellosis
Treatment of staphylococcal infections
Tuberculosis
Tuberculosis
Treatment of all forms of tuberculosis including fresh, advanced, chronic and drug-resistant cases.
Rifampicin must be used in combination with other anti-tuberculous drugs.
It is effective against most atypical strains of Mycobacteria.
Leprosy
Management of multibacillary and paucibacillary leprosy to effect conversion to a non-infectious state.
Rifampicin must be used in combination with at least one other anti-leprosy drug.
Other infections
Treatment of brucellosis, Legionnaires' disease and serious staphylococcal infections in combination with another antibiotic indicated for the infection.
For prophylaxis of meningococcal meningitis. Elimination of N. meningitidis from the nasopharynx of asymptomatic carriers.
Treatment of asymptomatic carriers of Haemophilus influenzae and as chemoprophylaxis of exposed children 4 years old or younger.
Not all available brands are licensed for all indications.
Unlicensed Uses
Pruritus due to cholestasis
Tuberculosis in close contacts / tuberculin positive patients: prevention
Treatment of pruritus due to cholestasis in children
Prevention of tuberculosis in susceptible close contacts or those who have become tuberculin positive
Dosage
In the treatment of tuberculosis, rifampicin should be given with other anti-tuberculosis drugs to prevent the emergence of resistant strains.
Adults
Tuberculosis
Unsupervised treatment:
The following regimen should be used for those who are likely to take antituberculous drugs reliably without supervision by a healthcare worker.
Patients who are unlikely to comply with daily administration of antituberculous drugs should be treated with the regimen described under Supervised Treatment.
8mg/kg to 12mg/kg body weight once daily.
Patients weighing less than 50kg: 450mg once daily.
Patients weighing 50kg or more: 600mg once daily.
Supervised treatment:
Drug administration needs to be fully supervised by a healthcare worker (directly observed therapy, DOT) in children or families who cannot comply reliably with the treatment regimen.
600mg to 900mg three times a WEEK.
Leprosy
Rifampicin should be given with at least one other anti-leprosy drug to prevent the emergence of resistant strains.
600mg should be given once a MONTH.
As an alternative, a single daily dose of 10mg/kg may be given.
Patients weighing less than 50kg: 450mg once daily.
Patients weighing 50kg or more: 600mg once daily.
Brucellosis, Legionaires' disease or serious staphylococcal infections:
The recommended daily dose is 600mg to 1200mg in 2 to 4 divided doses given with another appropriate antibiotic to prevent the emergence of resistant strains.
Prophylaxis of meningococcal meningitis:
600mg twice daily for 2 days.
Prophylaxis of Haemophilus influenzae:
20mg/kg (maximum 600mg) once daily for 4 days.
Prevention of tuberculosis in susceptible close contacts or those who have become tuberculin positive in combination with isoniazid (unlicensed):
The following dose is suggested for 3 months in patients under 35 years.
Patients weighing less than 50kg: 450mg once daily.
Patients weighing 50kg or more: 600mg once daily.
Prevention of tuberculosis in susceptible close contacts or those who have become tuberculin positive who are isoniazid resistant (unlicensed):
The following dose is suggested for 6 months in patients under 35 years.
Patients weighing less than 50kg: 450mg once daily.
Patients weighing 50kg or more: 600mg once daily.
Children
Tuberculosis
For definition of Supervised and Unsupervised (See Dosage; Adult).
Unsupervised treatment
Children aged 1 month to 18 years:
Dose is suggested for a period of 6 months.
Bodyweight less than 50kg: 15mg/kg once daily (maximum 450mg).
Bodyweight 50kg or more: 15mg/kg once daily (maximum 600mg).
Supervised treatment
Children aged 1 month to 18 years: 15mg/kg (maximum 900mg) three times a week for six months.
Prophylaxis of meningococcal meningitis
Children aged 12 to 18 years: 600mg twice daily for 2 days.
Children aged 1 to 12 years: 10mg/kg (maximum 600mg) twice daily for 2 days.
Children aged 3 months to 1 year: 5mg/kg twice daily for 2 days.
Children aged 1 to 3 months (unlicensed):5mg/kg twice daily for 2 days.
Prophylaxis of Haemophilus influenzae
Children aged 12 to 18 years:600mg once daily for 4 days.
Children aged 3 months to 12 years: 20mg/kg (maximum 600mg) once daily for 4 days.
Children 1 to 3 months: 10mg/kg once daily for 4 days.
Brucellosis, Legionaires' disease or serious staphylococcal infections (unlicensed)
Children aged 1 to 18 years: 10mg/kg (maximum 600mg) twice daily.
Children aged 1 month to 1 year: 5mg/kg to 10mg/kg twice daily
Pruritus due to cholestasis (unlicensed):
Children aged 1 month to 18 years: 5mg/kg to 10mg/kg (maximum 600mg) once daily.
Prevention of tuberculosis in susceptible close contacts or those who have become tuberculin positive in combination with isoniazid (unlicensed):
Dose is suggested for a period of 3 months.
Children aged 12 to 18 years:
Bodyweight less than 50kg: 450mg once daily
Bodyweight 50kg or more: 600mg once daily
Children aged 1 month to 12 years:
Bodyweight less than 50kg: 15mg/kg once daily (maximum 450mg)
Bodyweight 50kg or more: 15mg/kg once daily (maximum 600mg)
Prevention of tuberculosis in susceptible close contacts or those who have become tuberculin positive who are isoniazid-resistant (unlicensed):
Dose is suggested for a period of 6 months.
Children aged 12 to 18 years:
Bodyweight less than 50kg: 450mg once daily
Bodyweight 50kg or more: 600mg once daily
Children aged 1 month to 12 years:
Bodyweight less than 50kg: 15mg/kg once daily (maximum 450mg)
Bodyweight 50kg or more: 15mg/kg once daily (maximum 600mg)
Neonates
Brucellosis, Legionaires' disease or serious staphylococcal infections (unlicensed):
5mg/kg to 10mg/kg twice daily.
Congenital tuberculosis (unlicensed):
15mg/kg once daily for 6 months.
Prophylaxis of meningococcal meningitis (unlicensed):
5mg/kg twice a day for 2 days.
Patients with Renal Impairment
Glomerular filtration rate above 10ml/minute - dose as normal.
Glomerular filtration rate below 10ml/minute - up to a 50% dose reduction required.
Patients with Hepatic Impairment
Do not exceed a daily dose of 8mg/kg.
Use only when strictly necessary and then with caution and under close medical supervision.
Additional Dosage Information
Tuberculosis is treated in two phases, an initial phase using at least four drugs (including rifampicin) and a continuation phase using two drugs (including rifampicin) in fully sensitive cases.
Treatment requires specialist knowledge, particularly where the disease involves resistant organisms or non-respiratory organisms.
Contraindications
Jaundice
Precautions and Warnings
Elderly
Chronic alcoholism
Diabetes mellitus
Galactosaemia
Glucose-galactose malabsorption syndrome
Hepatic impairment
Hereditary fructose intolerance
Immunodeficiency syndromes
Lactose intolerance
Porphyria
Pregnancy
Renal impairment - glomerular filtration rate below 10ml/minute
Consider vitamin K supplementation risk of vitamin K dependent coagulopathy
Reduce dose in patients with a glomerular filtration rate below 10ml/min
Reduce dose in patients with hepatic impairment
Intermittent therapy increases the risk of hypersensitivity reactions
Treatment to be initiated and supervised by a specialist
Some brands contain metabisulfite, may cause bronchospasm/allergies
Some formulations contain lactose
Some formulations contain sucrose
Monitor hepatic function before treatment and regularly during treatment
Monitor renal function prior to initiating treatment
Monitor antidiabetic drug treatment
Monitor hepatic function frequently in patients with hepatic impairment
Perform blood counts in patients with alcohol dependence
Perform blood counts in patients with hepatic impairment
Perform blood counts on prolonged use of this treatment
Advise patient that red discolouration of body fluids may occur
Advise patients to report signs of hepatic damage (malaise, jaundice etc.)
Discontinue if thrombocytopenia occurs
May cause hyperbilirubinaemia
May cause vitamin K dependent coagulopathy and severe bleeding
May affect results of some laboratory tests
Discontinue if haemolytic anaemia occurs
Discontinue if renal failure develops
Discontinue if significant/persistent hepatic function abnormalities occur
Advise patient to avoid alcohol during treatment
Female: Barrier or non-hormonal contraception advised during treatment
Female: Oral contraception may not be adequate during treatment
Pregnancy: Administer vitamin K in the last few weeks of pregnancy
Advise patients on the importance of taking treatment regularly
Discolours soft contact lenses
If there is no pre-existing liver disease and pre-treatment liver tests are normal, repeat tests are required only if there is fever, vomiting, jaundice or deterioration in the patient's general condition.
If rifampicin is withdrawn due to changes in hepatic function and is reintroduced after liver function has returned to normal, liver function should be monitored daily.
Because of the possibility of immunological reaction including anaphylaxis occurring with intermittent therapy (less than 2 to 3 times per week) patients should be closely monitored. Patients should be cautioned against interrupting treatment.
Pregnancy and Lactation
Pregnancy
Rifampicin may be used as part of a multidrug regimen for the treatment of active tuberculosis in pregnancy.
There are no well-controlled studies of the use of rifampicin during human pregnancy. Several reviews on the available treatment of tuberculosis during pregnancy have concluded that rifampicin was not a proven teratogen. Rifampicin crosses the placenta to the foetus.
Rifampicin influences vitamin K synthesis and is associated with an increased risk of haemorrhagic complications in the mother and in the newborn. Prophylactic vitamin K is recommended for the mother and neonate when rifampicin is used near term.
The use of all medication in pregnancy should be avoided whenever possible; particularly in the first trimester. Non-drug treatments should also be considered. When essential, a medication with the best safety record over time should be chosen, employing the lowest effective dose for the shortest possible time. Polypharmacy should be avoided. Teratogens taken in the pre-embryonic period, often quoted as lasting until 14 to 17 days post-conception, are believed to have an all-or-nothing effect. Where drugs have a short half-life, and when the date of conception is certain, this may allow women to be reassured where drug exposure has occurred within this time frame. Further advice may be available from the UK National Teratology Information Service (NTIS) and through ToxBase, available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).
Lactation
Rifampicin may be used during breastfeeding.
Rifampicin is excreted in breast milk in small amounts. It is thought to represent a very low risk to the nursing infant.
Neonates, infants born prematurely, those with low birth weight, those with an unstable gastrointestinal function or who have serious illnesses may require special consideration. For any infant, if a drug is prescribed to the nursing mother, it should be at the lowest practical dose and for the shortest time. When drug administration is unavoidable and breastfeeding is to continue, minimisation of exposure of the infant to the drug may sometimes be achieved by timing the maternal doses to just after a feeding episode. Infants exposed to drugs via breast milk should be monitored for unusual signs or symptoms. Interactions between the drug received by the infant from the mother's milk and medication prescribed for the infant should also be considered, for example, when the drug given to the infant may prevent metabolism of the drug received via breast milk.
Specialist advice is available from the UK Drugs in Lactation Advisory Service at https://www.midlandsmedicines.nhs.uk/content.asp?section=6&subsection=17&pageIdx=1
Counselling
The daily dose of Rifampicin should preferably be taken at least 30 minutes before a meal or 2 hours after a meal to ensure rapid and complete absorption.
Side Effects
Abdominal discomfort
Abdominal distension
Abdominal pain
Acute renal failure
Acute tubular necrosis
Adrenal cortex insufficiency
Agranulocytosis
Amenorrhoea
Anaphylaxis
Anorexia
Asthma-like syndrome
Ataxia
Cerebral haemorrhage
Chills
Collapse and shock
Confusion
Conjunctivitis
Diarrhoea
Dizziness
Drowsiness
Dyspnoea
Elevation of liver enzymes
Eosinophilia
Erythema multiforme
Exfoliative dermatitis
Flushing
Fulminant hepatitis
Gastritis
Haemolytic anaemia
Headache
Hepatic failure
Hepatitis
Hypersensitivity reactions
Hypotension
Influenza-like symptoms
Interstitial nephritis
Intravascular coagulation (disseminated)
Itching
Jaundice
Leucopenia
Light-headedness
Lyell's syndrome
Menstrual disturbances
Muscle weakness
Myopathy
Nausea
Oedema
Pemphigoid reaction
Possible staining of soft contact lenses
Pseudomembranous colitis
Psychosis
Purpura
Pyrexia
Rash
Reddening of eyes
Reddish discolouration of body fluids
Renal impairment
Shock
Shortness of breath
Stevens-Johnson syndrome
Superficial tooth discolouration
Thrombocytopenia
Thrombocytopenic purpura
Tiredness
Toxic epidermal necrolysis
Urticaria
Vasculitis
Visual disturbances
Vomiting
Wheezing
Overdosage
It is strongly recommended that the UK National Poisons Information Service be consulted on cases of suspected or actual overdose where there is doubt over the degree of risk or about appropriate management.
The following number will direct the caller to the relevant local centre (0844) 892 0111
Information may be obtained if you have access to ToxBase the primary clinical toxicology database of the National Poisons Information Service. This is available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).
Further Information
Last Full Review Date: September 2014
Reference Sources
Drugs During Pregnancy and Lactation: Treatment Options and Risk Assessment, 2nd edition (2007) ed. Schaefer, C., Peters, P. and Miller, R. Elsevier, London.
Drugs in Pregnancy and Lactation: A Reference Guide to Fetal and Neonatal Risk, 9th edition (2011) ed. Briggs, G., Freeman, R. and Yaffe, S. Lippincott Williams & Wilkins, Philadelphia.
Martindale: The Complete Drug Reference, 37th edition (2011) ed. Sweetman, S. Pharmaceutical Press, London.
Medications and Mothers' Milk, 14th Edition (2010) Hale, T. Hale Publishing, Amarillo, Texas.
The Renal Drug Handbook. 3rd edition. (2009) ed. Ashley, C and Currie, Radcliffe Publishing Ltd, Abingdon.
Summary of Product Characteristics: Rifadin 150mg Capsules. Sanofi-Aventis. Revised January 2019.
Summary of Product Characteristics: Rifadin 300mg Capsules. Sanofi-Aventis. Revised January 2019.
Summary of Product Characteristics: Rifadin Syrup 100mg/5ml. Sanofi-Aventis. Revised February 2019.
Summary of Product Characteristics: Rimactane 300mg Capsules. Sandoz GmbH. Revised August 2014.
NICE Evidence Services Available at: www.nice.org.uk Last accessed: 14 September 2017
The Drug Database for Acute Porphyria (NAPOS)
Available at: https://www.drugs-porphyria.com/languages/UnitedKingdom/index2.php?l=gbr
Rifampicin. Last revised: October 1, 2004
Last accessed: 11 September, 2014
US National Library of Medicine. Toxicology Data Network. Drugs and Lactation Database (LactMed).
Available at: https://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT
Rifampin. Last revised: September 7, 2013
Last accessed: 11 September 2014
Medscape UK | Univadis prescription drug monographs & interactions are based on FDB Multilex Content
FDB Disclaimer : FDB Multilex is intended for the use of healthcare professionals and is provided on the basis that the healthcare professionals will retain FULL and SOLE responsibility for deciding what treatment to prescribe or dispense for any particular patient or circumstance.