Rifampicin (R)

Therapeutic action

– Antibacterial (rifamycin) with bactericidal activity

Presentation

– 150 mg and 300 mg tablets or capsules
Also comes in 100 mg/5 ml oral suspension.

Dosage

– Child under 30 kg: 15 mg/kg (10 to 20 mg/kg) once daily
– Child over 30 kg and adult: 10 mg/kg (8 to 12 mg/kg) once daily
– Maximum dose: 600 mg daily

Weight
(kg)

Daily dose
(mg)

300 mg
tablet or capsule

150 mg
tablet
1

100 mg per 5 ml
oral suspension

5

50-100

4 ml

6

60-120

5 ml

7

70-140

5 ml

8

80-160

6 ml

9

90-180

7 ml

10

100-200

8 ml

11

110-220

1 tab

12

120-240

1 tab

13

130-260

1½ tab

14

140-280

1½ tab

15

150-300

1½ tab

16

160-320

1 tab

17

170-340

1 tab

18

180-360

1 tab

19

190-380

1 tab

20

200-400

1 tab

21

210-420

1 tab

22

220-440

1 tab

23

230-460

1 tab

24

240-480

1 tab

25

250-500

1 tab

26

260-520

1 tab

27

270-540

1 tab

28

280-560

1 tab

29

290-580

1 tab


30-35

300

1 tab

36-45

450

1½ tab

46-55

450

1½ tab

56-70

600

2 tab

> 70

600

2 tab


Contra-indications, adverse effects, precautions

– Do not administer to patients with jaundice, history of allergy or severe blood disorders (thrombocytopenia, purpura) during a previous treatment with a rifamycin.
– Avoid or administer with caution to patients with hepatic impairment (do not exceed 8 mg/kg/day).
– Do not combine with bedaquiline. In patients taking nevirapine, indinavir, nelfinavir, lopinavir/ritonavir, atazanavir/ritonavir, use rifabutin in place of rifampicin.
– May cause:
• orange-red discolouration of body fluids;
• gastrointestinal disturbances, headache, drowsiness, hepatic disorders;
• thrombocytopenia, hypersensitivity reactions.
– For the management of adverse effects, see Chapter 9 and Appendix 10.
– Rifampicin reduces the effect of many drugs (antimicrobials, some antiretrovirals, some hormones, antidiabetics, corticoids, phenytoin, etc.):
• In women under contraception, use injectable medroxyprogesterone or a non-hormonal contraception or, as a last resort, an oral contraceptive used contains 50 μg ethinylestradiol per tablet.
• For concomitant fluconazole administration, administer each drug 12 hours apart (rifampicin in the morning, fluconazole in the evening).
• For other drugs, adjust dosage if necessary.
Pregnancy and breast-feeding: no contra-indication. If used in late pregnancy, administer phytomenadione (vitamin K) to the mother and the newborn to reduce the risk of bleeding disorders.

Monitoring

– Symptomatic monitoring, liver function in elderly patients and patients with hepatic disease

Patient instructions

– Take without food on an empty stomach.
– Rifampicin causes a harmless orange-red discoloration of the urine, faeces, sweat, saliva, sputum, tears, and other body fluids.

Remarks

– For patients on first-line treatment, rifampicin is given as part of a fixed dose combination.
 Storage: below 25°C -  - 


Footnotes
Ref Notes
1

If only 150 mg capsules are available: 1 capsule daily for children 8 to 15 kg.