RIFAMPICIN = R oral

Last updated: June 2021

Prescription under medical supervision


Therapeutic action

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

Indications

– Tuberculosis, in combination with other antituberculosis antibacterials
– Latent tuberculosis, as monotherapy or in combination with isoniazid 

– Paucibacillary and multibacillary leprosy, in combination with dapsone and clofazimine
– Brucellosis, in combination with another antibacterial

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.
Storage: below 25 °C -