RIFAMPICIN
DOSAGE
Adults (<50kg): 450mg once a day (oral or intravenous); or for DOT supervised regimen: 600mg three times a week (oral).
Adults (50kg+): 600mg once a day (oral or intravenous); or for DOT supervised regimen: 900mg three times a week (oral).
Children: 15mg/kg (max. 450mg if <50kg; 600mg if 50kg+) once a day (oral or intravenous); or for DOT supervised regimen: 15mg/kg (max. 900mg) three times a week (oral). (Doses should be rounded up to facilitate administration of suitable volumes of liquid or an appropriate strength of capsule).
Rifampicin should be taken 30-60 minutes before food, or 2 hours after food.
PREPARATIONS
Oral: 150mg, 300mg capsules.
100mg/5mL syrup.
Rifinah® 300/150 tablets (rifampicin 300mg, isoniazid 150mg).
Rifinah® 150/100 tablets (rifampicin 150mg, isoniazid 100mg).
Rifater tablets (rifampicin 120mg, isoniazid 50mg, pyrazinamide 300mg).
Voractiv® tablets (rifampicin 150mg, isoniazid 75mg, pyrazinamide 400mg, ethambutol 275mg).
Paediatric oral fixed dose combinations (dissolvable in water):
*Ethambutol should be added in the intensive phase for children with extensive disease or living in settings where the prevalence of HIV or of isoniazid resistance is high.
Parenteral: 600mg powder for reconstitution.
DRUG LEVEL MONITORING
Indications for monitoring:
Timing of sample:
ADVERSE EFFECTS
COMMON:
Reddish discolouration of urine, sweat, sputum, tears.
Gastrointestinal: Anorexia, nausea, vomiting, heartburn.
Hepatic: Transient increases in LFTs.
Flu-like syndrome.
SERIOUS:
Haematological: Agranulocytosis (rare), Haemolytic anaemia (rare, usually intermittent therapy), Thrombocytopaenia (rare, usually high-dose / intermittent therapy).
Hepatic: Hepatotoxicity (rare).
Renal: Nephrotoxicity (rare).
ADVERSE EFFECTS: MONITORING
Routine tests as per generic MDR-TB treatment monitoring guidelines.
INTERACTONS
Analgesics: Accelerated metabolism of opiates, resulting in reduced effect (e.g. alfentanyl, codeine, fentanyl, methadone, morphine and possibly oxycodone).
Antacids: Reduced absorption of rifampicin.
Anti-arrhythmics: Accelerated metabolism of disopyramide.
Antibacterials: Reduced plasma concentrations of chloramphenicol, clarithromycin, dapsone, doxycycline, linezolid, trimethoprim.
Anticoagulants: Reduced plasma concentration of apixaban, dabigatran and rivaroxaban; accelerated metabolism of coumarins (e.g. warfarin).
Anti-diabetics: Accelerated metabolism of tolbutamide and sulfonylureas (reduced effect); reduced effect of linagliptan, netaglinide and repaglinide.
Antiepileptics: Reduced plasma concentration of lamotrigine and phenytoin; phenobarbital possibly reduces plasma concentration of rifampicin.
Antifungals: Accelerated metabolism of ketoconazole, fluconazole, itraconazole, posaconazole, terbinafine and voriconazole (reduced plasma concentrations; avoid concomitant use of rifampicin with itraconazole or voriconazole). Rifampicin initially increases then decreases caspofungin levels (consider increasing caspofungin dose).
Antimalarials: Reduced plasma concentration of mefloquine (avoid use) and quinine.
Antipsychotics: Accelerated metabolism of haloperidol and possibly aripiprazole and clozapine.
Antivirals: Reduced plasma concentration of atazanavir, darunavir, fosamprenavir, lopinavir, nelfinavir, nevirapine, rilpivirine, saquinavir and telaprevir (avoid concomitant use), and possibly abacavir, boceprevir, ritonavir, and tipranavir. Rifampicin also reduces plasma concentration of efavirenz (increase dose of efavirenz), maraviroc and raltegravir (consider increasing doses). Accelerated metabolism of indinavir (avoid concomitant use).
Atovaquone: Reduced plasma concentrations of atovaquone; increased plasma concentration of rifampicin (avoid concomitant use).
Bosentan: Reduced plasma concentration of bosentan (avoid concomitant use).
Calcium-channel blockers: Accelerated metabolism of diltiazem, nifedipine, nimodipine and verapamil (significant reduction in plasma concentrations), and possibly isradipine and nicardipine.
CFTR modulators: reduced plasma concentration of ivacaftor, tezacaftor, elexacaftor.
Ciclosporin: Accelerated metabolism of ciclosporin (reduced plasma concentration.
Contraceptives: Accelerated metabolism of oestrogens and progestogens (reduced contraceptive effect). Avoid use of combined hormonal contraception (oral, patch or vaginal ring), progestogen-only contraception (pill and implant). Suitable alternatives include barrier methods, copper-bearing intrauterine system, or progestogen-only injectable (depot medroxyprogesterone acetate, norethisterone enantate, or levonorgestrel-releasing intrauterine system, which can be continued at the usual dose and dosing/replacement interval of 12 weeks, 8 weeks and 5 years, respectively).
Corticosteroids: Accelerated metabolism of corticosteroids (reduced effect).
Diuretics: Reduced plasma concentration of eplerenone (avoid concomitant use).
Hormone Replacement Therapy (HRT): Rifampicin would be expected to reduce the efficacy of HRT.
Mycophenolate: Reduced plasma concentration of active metabolite of mycophenolate.
P-aminosalicylic acid: Reduced absorption of rifamycins. Give 8-12 hours apart.
Ranolazine: Reduced plasma concentration of ranolazine (avoid concomitant use).
Sirolimus: Reduced in plasma concentration of sirolimus.
Tacrolimus: Reduced in plasma concentration of tacrolimus.
Tadalafil: Reduced plasma concentration of tadalafil (avoid concomitant use).
Theophylline: Accelerated metabolism of theophylline (reduced plasma concentration).
Ticagrelor: Reduced plasma concentration of ticagrelor.
This information is not inclusive of all drug interactions. Please discuss with a pharmacist.
CONTRA-INDICATIONS & CAUTIONS
Contraindications:
Hypersensitivity: To rifampicin or other rifamycins.
Liver Disease: Avoid if jaundiced.
Drug Interactions: Avoid concomitant use with saquinavir or ritonavir.
Cautions:
Liver Disease: Use cautiously and monitor LFTs; hyperbilirubinaemia may occur early in treatment in some patients due to competition between rifampicin and bilirubin for hepatic excretion.
LABORATORY INFORMATION
Please find up to date information at www.assayfinder.com regarding individual providers of drug level monitoring tests. Click on the provider to discover contact details. Turnaround time varies depending on the test and whether it is run locally or sent to an external lab. By contacting laboratories in advance, turnaround time can significantly be reduced.
Sample Type: Serum.
Volume Required: Please note that rifampicin binds to glass and plastics and therefore there may be a significant loss of drug if a small volume of serum is dispatched in a relatively large container. Please try and fill the container to 2/3 -3/4 its capacity).
Sample Container: Plain glass or plastic (non SST).
Container Type: Any.
Availability: Office Hours.
Turnaround Time: Telephoned same day if received 9am-3pm Mon-Fri if advanced warning given. Written confirmation report will be sent by 1st Class post.
The sample must be heat-treated before dispatch if HIV positive.
Please telephone at least one day in advance of the sample.
Adults (<50kg): 450mg once a day (oral or intravenous); or for DOT supervised regimen: 600mg three times a week (oral).
Adults (50kg+): 600mg once a day (oral or intravenous); or for DOT supervised regimen: 900mg three times a week (oral).
Children: 15mg/kg (max. 450mg if <50kg; 600mg if 50kg+) once a day (oral or intravenous); or for DOT supervised regimen: 15mg/kg (max. 900mg) three times a week (oral). (Doses should be rounded up to facilitate administration of suitable volumes of liquid or an appropriate strength of capsule).
Rifampicin should be taken 30-60 minutes before food, or 2 hours after food.
PREPARATIONS
Oral: 150mg, 300mg capsules.
100mg/5mL syrup.
Rifinah® 300/150 tablets (rifampicin 300mg, isoniazid 150mg).
Rifinah® 150/100 tablets (rifampicin 150mg, isoniazid 100mg).
Rifater tablets (rifampicin 120mg, isoniazid 50mg, pyrazinamide 300mg).
Voractiv® tablets (rifampicin 150mg, isoniazid 75mg, pyrazinamide 400mg, ethambutol 275mg).
Paediatric oral fixed dose combinations (dissolvable in water):
*Ethambutol should be added in the intensive phase for children with extensive disease or living in settings where the prevalence of HIV or of isoniazid resistance is high.
Parenteral: 600mg powder for reconstitution.
DRUG LEVEL MONITORING
Indications for monitoring:
- Known or suspected malabsorption.
- Poor treatment response.
Timing of sample:
- 2 hours post dose.
- Repeat at 6 hours if suspect delayed.
- Drug levels need not be routinely measured.
ADVERSE EFFECTS
COMMON:
Reddish discolouration of urine, sweat, sputum, tears.
Gastrointestinal: Anorexia, nausea, vomiting, heartburn.
Hepatic: Transient increases in LFTs.
Flu-like syndrome.
SERIOUS:
Haematological: Agranulocytosis (rare), Haemolytic anaemia (rare, usually intermittent therapy), Thrombocytopaenia (rare, usually high-dose / intermittent therapy).
Hepatic: Hepatotoxicity (rare).
Renal: Nephrotoxicity (rare).
ADVERSE EFFECTS: MONITORING
Routine tests as per generic MDR-TB treatment monitoring guidelines.
INTERACTONS
Analgesics: Accelerated metabolism of opiates, resulting in reduced effect (e.g. alfentanyl, codeine, fentanyl, methadone, morphine and possibly oxycodone).
Antacids: Reduced absorption of rifampicin.
Anti-arrhythmics: Accelerated metabolism of disopyramide.
Antibacterials: Reduced plasma concentrations of chloramphenicol, clarithromycin, dapsone, doxycycline, linezolid, trimethoprim.
Anticoagulants: Reduced plasma concentration of apixaban, dabigatran and rivaroxaban; accelerated metabolism of coumarins (e.g. warfarin).
Anti-diabetics: Accelerated metabolism of tolbutamide and sulfonylureas (reduced effect); reduced effect of linagliptan, netaglinide and repaglinide.
Antiepileptics: Reduced plasma concentration of lamotrigine and phenytoin; phenobarbital possibly reduces plasma concentration of rifampicin.
Antifungals: Accelerated metabolism of ketoconazole, fluconazole, itraconazole, posaconazole, terbinafine and voriconazole (reduced plasma concentrations; avoid concomitant use of rifampicin with itraconazole or voriconazole). Rifampicin initially increases then decreases caspofungin levels (consider increasing caspofungin dose).
Antimalarials: Reduced plasma concentration of mefloquine (avoid use) and quinine.
Antipsychotics: Accelerated metabolism of haloperidol and possibly aripiprazole and clozapine.
Antivirals: Reduced plasma concentration of atazanavir, darunavir, fosamprenavir, lopinavir, nelfinavir, nevirapine, rilpivirine, saquinavir and telaprevir (avoid concomitant use), and possibly abacavir, boceprevir, ritonavir, and tipranavir. Rifampicin also reduces plasma concentration of efavirenz (increase dose of efavirenz), maraviroc and raltegravir (consider increasing doses). Accelerated metabolism of indinavir (avoid concomitant use).
Atovaquone: Reduced plasma concentrations of atovaquone; increased plasma concentration of rifampicin (avoid concomitant use).
Bosentan: Reduced plasma concentration of bosentan (avoid concomitant use).
Calcium-channel blockers: Accelerated metabolism of diltiazem, nifedipine, nimodipine and verapamil (significant reduction in plasma concentrations), and possibly isradipine and nicardipine.
CFTR modulators: reduced plasma concentration of ivacaftor, tezacaftor, elexacaftor.
Ciclosporin: Accelerated metabolism of ciclosporin (reduced plasma concentration.
Contraceptives: Accelerated metabolism of oestrogens and progestogens (reduced contraceptive effect). Avoid use of combined hormonal contraception (oral, patch or vaginal ring), progestogen-only contraception (pill and implant). Suitable alternatives include barrier methods, copper-bearing intrauterine system, or progestogen-only injectable (depot medroxyprogesterone acetate, norethisterone enantate, or levonorgestrel-releasing intrauterine system, which can be continued at the usual dose and dosing/replacement interval of 12 weeks, 8 weeks and 5 years, respectively).
Corticosteroids: Accelerated metabolism of corticosteroids (reduced effect).
Diuretics: Reduced plasma concentration of eplerenone (avoid concomitant use).
Hormone Replacement Therapy (HRT): Rifampicin would be expected to reduce the efficacy of HRT.
Mycophenolate: Reduced plasma concentration of active metabolite of mycophenolate.
P-aminosalicylic acid: Reduced absorption of rifamycins. Give 8-12 hours apart.
Ranolazine: Reduced plasma concentration of ranolazine (avoid concomitant use).
Sirolimus: Reduced in plasma concentration of sirolimus.
Tacrolimus: Reduced in plasma concentration of tacrolimus.
Tadalafil: Reduced plasma concentration of tadalafil (avoid concomitant use).
Theophylline: Accelerated metabolism of theophylline (reduced plasma concentration).
Ticagrelor: Reduced plasma concentration of ticagrelor.
This information is not inclusive of all drug interactions. Please discuss with a pharmacist.
CONTRA-INDICATIONS & CAUTIONS
Contraindications:
Hypersensitivity: To rifampicin or other rifamycins.
Liver Disease: Avoid if jaundiced.
Drug Interactions: Avoid concomitant use with saquinavir or ritonavir.
Cautions:
Liver Disease: Use cautiously and monitor LFTs; hyperbilirubinaemia may occur early in treatment in some patients due to competition between rifampicin and bilirubin for hepatic excretion.
LABORATORY INFORMATION
Please find up to date information at www.assayfinder.com regarding individual providers of drug level monitoring tests. Click on the provider to discover contact details. Turnaround time varies depending on the test and whether it is run locally or sent to an external lab. By contacting laboratories in advance, turnaround time can significantly be reduced.
Sample Type: Serum.
Volume Required: Please note that rifampicin binds to glass and plastics and therefore there may be a significant loss of drug if a small volume of serum is dispatched in a relatively large container. Please try and fill the container to 2/3 -3/4 its capacity).
Sample Container: Plain glass or plastic (non SST).
Container Type: Any.
Availability: Office Hours.
Turnaround Time: Telephoned same day if received 9am-3pm Mon-Fri if advanced warning given. Written confirmation report will be sent by 1st Class post.
The sample must be heat-treated before dispatch if HIV positive.
Please telephone at least one day in advance of the sample.