RIFAMPICIN = R oral

Last updated: June 2021

Therapeutic action

• Antibacterial, first line antituberculosis antibacterial (sterilising and bactericidal activity), antileprotic antibacterial (bactericidal activity)

Indications

• Tuberculosis, in combination with other antituberculosis antibacterials
• Paucibacillary and multibacillary leprosy, in combination with dapsone and clofazimine
• Brucellosis, in combination with another antibacterial
• Latent tuberculosis, as monotherapy or in combination with isoniazid 

Forms and strengths

• 150 mg tablet and 300 mg capsule

Dosage

Tuberculosis, latent tuberculosis, as monotherapy or in combination with isoniazid

• Child under 30 kg: 15 mg/kg once daily, on an empty stomach
• Child 30 kg and over and adult: 10 mg/kg once daily, on an empty stomach

Do not exceed 600 mg daily.

Paucibacillary and multibacillary leprosy

• Child under 10 years: 10 mg/kg once monthly, on an empty stomach
• Child from 10 to 14 years: 450 mg once monthly, on an empty stomach
• Child 15 years and over and adult: 600 mg once monthly, on an empty stomach

Brucellosis

• Child: 15 to 20 mg/kg once daily, on an empty stomach (max. 600 mg daily)
• Adult: 600 to 900 mg once daily, on an empty stomach

In patients with hepatic impairment: do not exceed 8 mg/kg/day when treatment is administered daily.

Duration

• Tuberculosis: according to protocol
• Latent tuberculosis as monotherapy: 4 months
• Latent tuberculosis in combination with isoniazid: 3 months
• Paucibacillary leprosy: 6 months
• Multibacillary leprosy: 12 months
• Brucellosis: 6 weeks

Contra-indications, adverse effects, precautions

• Do not administer to patients with jaundice, hypersensitivity to rifamycins or history of severe haematological disorders (thrombocytopenia, purpura) during a previous treatment with rifamycins.
• Avoid or administer with caution to patients with hepatic disorders.
• May cause:
  • harmless orange-red discoloration of body secretions (urine, tears, saliva, sputum, sweat, etc.);
  • gastrointestinal disturbances (can be taken with a small amount of food to increase gastrointestinal tolerance); headache, drowsiness, hepatotoxicity;
  • influenza-like symptoms;
  • thrombocytopenia, hypersensitivity reactions.
• If signs of hepatotoxicity (e.g. jaundice) develop, rifampicin should be discontinued until symptoms resolve.
• Rifampicin reduces the effect of many drugs (antimicrobials, some antiretrovirals, some hormones, antidiabetics, corticosteroids, phenytoin, direct-acting antivirals for chronic hepatitis C, warfarin, etc.):
  • in patients taking nevirapine, lopinavir/ritonavir, atazanavir/ritonavir, use rifabutin in place of rifampicin;
  • in women using contraception, use injectable medroxyprogesterone or an intrauterine device;
  • in the event of concomitant fluconazole administration, administer each drug 12 hours apart (rifampicin in the morning, fluconazole in the evening);
  • for the other drugs, adjust dosage if necessary.
• Pregnancy: no contra-indication. Risk of maternal and neonatal bleeding disorders when the mother receives rifampicin in late pregnancy: administer phytomenadione (vitamin K) to the mother and the neonate to reduce the risk.
• Breast-feeding: no contra-indication

Remarks

• For patients sensitive to first-line antituberculosis treatment, rifampicin is given as part of a fixed dose combination.

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