Intravenous Brucellosis, Legionnaire's disease, Severe staphylococcal infections
Adult: In combination with other antibacterial drugs: 600-1,200 mg daily in 2-4 divided doses. Doses are given via slow IV infusion over 30 minutes to 3 hours.
Intravenous Tuberculosis
Adult: In combination with other antituberculosis agents: 10 mg/kg once daily via slow IV infusion over 30 minutes to 3 hours. Max: 600 mg daily. Dosage and infusion rate recommendations may vary among individual products and between countries (refer to specific product guidelines). Child: In combination with other antituberculosis agents: 10-20 mg/kg once daily via slow IV infusion over 30 minutes to 3 hours. Max: 600 mg daily. Dosage and infusion rate recommendations may vary among individual products and between countries (refer to specific product guidelines).
Oral Leprosy
Adult: In combination with dapsone for paucibacillary leprosy, or with dapsone and clofazimine for multibacillary leprosy: 600 mg once monthly. Doses are given at least 1 hour before or 2 hours after meals. Treatment duration: 6 months (paucibacillary leprosy); 12 months (multibacillary leprosy). Dosing regimens may vary among individual products or between countries (refer to specific product guidelines). Child: In combination with dapsone for paucibacillary leprosy, or with dapsone and clofazimine for multibacillary leprosy: ≥10 years 450 mg once monthly. Treatment duration: 6 months (paucibacillary leprosy); 12 months (multibacillary leprosy). Dosing regimens may vary among individual products or between countries (refer to specific product guidelines).
Oral Haemophilus influenzae, prophylaxis
Adult: As chemoprophylaxis for household members exposed to H. influenzae type B disease: 20 mg/kg once daily for 4 days. Max: 600 mg daily. Doses are given at least 1 hour before or 2 hours after meals. Child: As chemoprophylaxis for exposed patients: 20 mg/kg once daily for 4 days. Max: 600 mg daily. Dosage recommendations may vary among individual products or between countries (refer to specific product guidelines).
Oral Prophylaxis of meningococcal meningitis
Adult: For asymptomatic carriers of Neisseria meningitidis to eliminate meningococci from the nasopharynx or in close contacts: 600 mg bid for 2 days. Doses are given at least 1 hour before or 2 hours after meals. Child: ≥1 month 10 mg/kg 12 hourly for 2 days. Max: 600 mg/dose. Dosage recommendations and age range of use may vary among individual products or between countries (refer to specific product guidelines).
Oral Tuberculosis
Adult: In combination with other antituberculosis agents: 8-12 mg/kg once daily. Usual dose: Patients weighing <50 kg: 450 mg daily; ≥50 kg: 600 mg daily. Doses are given at least 1 hour before or 2 hours after meals. Dosage recommendations and treatment regimens may vary among individual products and between countries (refer to specific product guidelines). Child: In combination with other antituberculosis agents: 10-20 mg/kg once daily. Max: 600 mg daily. Dosage recommendations and treatment regimens may vary among individual products and between countries (refer to specific product guidelines).
Oral Brucellosis, Legionnaire's disease, Severe staphylococcal infections
Adult: In combination with other antibacterial drugs: 600-1,200 mg daily in 2-4 divided doses. Doses are given at least 1 hour before or 2 hours after meals.
What are the brands available for Rifampicin in Malaysia?
Rifasynt
Rimactane
Hepatic Impairment
Oral/Intravenous:
Max: 8 mg/kg daily.
Administration
Rifampicin Should be taken on an empty stomach.
Reconstitution
Powder for solution for IV infusion: Reconstitute a 600 mg vial with 10 mL sterile water for inj to prepare a 60 mg/mL solution. Withdraw a volume equivalent to the dose, then further dilute with an appropriate volume of compatible solution (e.g. dextrose 5% in water, NaCl 0.9% solution) to a final concentration not exceeding 6 mg/mL.
Incompatibility
IV infusion: May result in precipitation when given with diltiazem via Y-site administration.
Contraindications
Hypersensitivity to rifampicin or other rifamycins. Jaundice. Concurrent use with saquinavir, saquinavir/ritonavir combination, atazanavir, darunavir, fosamprenavir, tipranavir, praziquantel, and lurasidone.
Special Precautions
Patient with diabetes mellitus, porphyria, risk factors for hepatotoxicity (e.g. alcoholism, malnutrition, receiving other hepatotoxic agents). Not indicated for the treatment of meningococcal infection. Avoid extravasation (IV). Renal and hepatic impairment. Neonates, children, and elderly. Pregnancy and lactation.
Adverse Reactions
Significant: Hypersensitivity reactions (e.g. anaphylaxis, angioedema, urticaria, flu-like symptoms); increased liver enzymes; exacerbation of porphyria; red-orange, yellow or brown discolouration of the teeth, faeces, urine, sweat, saliva, sputum, tears and other body fluids; decreased Hb, disseminated intravascular coagulation, eosinophilia, haemolysis, haemolytic anaemia, leucopenia, thrombocytopenia, vitamin K-dependent coagulopathy and bleeding; paradoxical drug reaction. Rarely, Clostridioides difficile-associated diarrhoea and pseudomembranous colitis. Gastrointestinal disorders: Nausea, vomiting, diarrhoea. General disorders and administration site conditions: Chills, pyrexia, oedema. Metabolism and nutrition disorders: Decreased appetite. Musculoskeletal and connective tissue disorders: Myopathy, muscle weakness. Nervous system disorders: Dizziness, headache, drowsiness. Reproductive system and breast disorders: Menstrual disorder. Skin and subcutaneous tissue disorders: Rash, pruritus, flushing. Potentially Fatal: Hepatotoxicity of cholestatic, hepatocellular or mixed patterns, including hyperbilirubinaemia, jaundice, hepatitis, severe drug-induced liver injury or fulminant hepatic failure; thrombotic microangiopathy (TMA), manifested as thrombotic thrombocytopenic purpura (TTP) or haemolytic uraemic syndrome (HUS); severe cutaneous adverse reactions, including drug reaction with eosinophilia and systemic symptoms (DRESS), Stevens-Johnson syndrome, toxic epidermal necrolysis, and acute generalised exanthematous pustulosis; interstitial lung disease (ILD), including pneumonitis, eosinophilic pneumonitis, pulmonary infiltrates, acute respiratory distress syndrome, bronchiolitis obliterans organising pneumonia, and pulmonary fibrosis.
This drug may cause red-orange discolouration of teeth, faeces, urine, sweat, saliva, sputum, and tears; this is harmless, do not be alarmed. It may also cause permanent staining of soft contact lenses; remove soft contact lenses during therapy.
Monitoring Parameters
Perform culture and susceptibility tests; consult local institutional recommendations before treatment initiation due to antibiotic resistance risks. Obtain LFTs at baseline and regularly during treatment, especially for patients with pre-existing hepatic impairment; serum creatinine and CBC before treatment initiation and periodically (in those with baseline abnormalities). Monitor mental status, sputum culture and chest X-ray 2-3 months after the start of therapy. Assess for severe/bloody diarrhoea and for signs and symptoms of liver injury, hypersensitivity reactions (including anaphylaxis), skin reactions, ILD, or pneumonitis.
Overdosage
Symptoms: Nausea, vomiting, abdominal pain, pruritus, headache, lethargy, transient increase in liver enzymes and/or bilirubin, brownish-red or orange discolouration of the skin, urine, sweat, saliva, tears and faeces; facial or periorbital oedema (particularly in children). Hypotension, sinus tachycardia, ventricular arrhythmias, seizures, and cardiac arrest may occur in severe cases.
Management: Symptomatic and supportive treatment. Perform gastric lavage. May administer activated charcoal to help absorb any remaining drug in the gastrointestinal tract. May give an antiemetic to control severe nausea and vomiting. May consider initiating active diuresis (with measured intake and output) and haemodialysis.
Drug Interactions
May increase the risk of hepatotoxicity with halothane, isoniazid and paracetamol. May increase the metabolism and decrease the serum concentrations of antiarrhythmics (e.g. mexiletine, quinidine), antiepileptics (e.g. phenytoin, phenobarbital), antiestrogens (e.g. tamoxifen, toremifene), antipsychotics (e.g. haloperidol), antiretrovirals (e.g. efavirenz, indinavir), hepatitis C antivirals (e.g. daclatasvir, sofosbuvir), β-blockers (e.g. propranolol, bisoprolol), anxiolytics (e.g. diazepam), calcium channel blockers (e.g. diltiazem, verapamil, nifedipine), antibiotics (e.g. clarithromycin, fluoroquinolones, dapsone, doxycycline), corticosteroids, cardiac glycosides (e.g. digoxin), immunosuppressants (e.g. ciclosporin, tacrolimus), thyroid hormones (e.g. levothyroxine), narcotic analgesics (e.g. methadone, morphine), TCAs (e.g. amitriptyline, nortriptyline), sulfonylureas, simvastatin, antifungals (e.g. fluconazole, ketoconazole) and theophylline. May decrease the active metabolite exposure of enalapril. May increase the active metabolite exposure of clopidogrel which may increase the risk of bleeding. May reduce the systemic exposure and efficacy of hormonal contraceptives (e.g. estrogen, progestins) and mifepristone. Concomitant use of rifampicin with atovaquone results in increased serum concentrations of rifampicin and reduced serum levels of atovaquone. Reduced absorption with antacids. Potentially Fatal: Increased risk of hepatotoxicity with saquinavir or saquinavir/ritonavir combination. May significantly decrease the serum concentrations of lurasidone, praziquantel, atazanavir, darunavir, fosamprenavir, and tipranavir which may lead to loss of efficacy. May result in severe coagulation disorders with other antibiotics causing vitamin K-dependent coagulopathy (e.g. cefazolin or other cephalosporins with N-methylthiotetrazole side chain).
Food Interaction
Delayed or reduced absorption with food.
Lab Interference
May cause a false-positive result with urine detection of opioids. May interfere with standard microbiological assays for serum folate and vitamin B12. May impair the biliary excretion of contrast media used for gallbladder visualisation.
Action
Description: Mechanism of Action: Rifampicin, a rifamycin antimycobacterial agent, binds to the β subunit of DNA-dependent RNA polymerase and blocks the bacterial RNA synthesis, resulting in the inhibition of bacterial RNA transcription. Synonym(s): Rifampin. Duration: ≤24 hours. Pharmacokinetics: Absorption: Readily and well absorbed from the gastrointestinal tract. Delayed or reduced absorption with food. Time to peak plasma concentration: Approx 2 hours. Distribution: Widely distributed in the body tissues and fluids; increased diffusion in the CSF when meninges are inflamed. Crosses the blood-brain barrier. Crosses the placenta and enters breast milk. Plasma protein binding: 80%. Metabolism: Rapidly metabolised in the liver to 25-O-deacetylrifampicin (active metabolite). Undergoes enterohepatic recirculation. Excretion: Via faeces (60-65% as unchanged drug); urine (≤30% as unchanged drug). Elimination half-life: Approx 2-3 hours.
Chemical Structure
Rifampicin Source: National Center for Biotechnology Information. PubChem Compound Summary for CID 135398735, Rifampin. https://pubchem.ncbi.nlm.nih.gov/compound/Rifampin. Accessed Nov. 26, 2024.
Storage
Oral: Susp/Syr: Store below 25°C. Cap: Store between 15-30°C. Avoid excessive heat. Protect from light.
Intravenous: Intact vial: Store below 25°C. Avoid excessive heat. Protect from light. Reconstituted vial: Stable at room temperature for up to 30 hours. Diluted solution for infusion (using dextrose 5% in water): May store at room temperature for up to 8 hours. Diluted solution for infusion (using NaCl 0.9% solution): May be kept at room temperature for up to 6 hours.
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