Rifampicin (R)

Update: January 2022

Forms and strengths

• 300 mg capsule and 150 mg tablet

Dosage

• Child under 30 kg: 15 mg/kg (10 to 20 mg/kg) once daily 
• Child 30 kg and over and adult: 10 mg/kg (8 to 12 mg/kg) once daily
• Maximum dose: 600 mg daily
• Hepatic impairment: 8 mg/kg once daily max.

Contra-indications, adverse effects, precautions

• Do not administer to patients with hypersensitivity reaction or severe haematologic disorders (thrombocytopenia, purpura) during a previous treatment with a rifamycin.
• Avoid or administer with caution to patients with hepatic disorders.
• May cause:
  • hepatotoxicity;
  • influenza-like symptoms, thrombocytopenia, hypersensitivity reactions.
• For the management of adverse effects, see Appendix 17.
• 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 antiretrovirals, see Appendix 19; 
  • 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 and breastfeeding: no contra-indication. If used in late pregnancy, administer phytomenadione (vitamin K₁) to the mother and the neonate.

Monitoring

• Symptomatic monitoring.
• Liver function in patients with hepatic disease.

Patient instructions

• Take without food (or with a small amount of food to increase gastrointestinal tolerance).
• Harmless orange-red discoloration of the urine, faeces, sweat, saliva, sputum, tears and other body fluids.

Remarks

• For patients on drug-susceptible TB treatment, rifampicin is given as part of a fixed-dose combination.
• For the 6HRZEto regimen for drug-susceptible TB meningitis, the dose of rifampicin is 20 mg/kg once daily (max. 600 mg daily).
• Rifampicin is also used in the treatment of latent TB infection.

Storage