1- The primary indications for rifampicin are for treatment of tuberculosis and inactive meningitis , along with isoniazid , ethambutol , pyrazinamide and streptomycin . It must be administered regularly daily for several months without break otherwise, the risk of drug-resistant tuberculosis is greatly increased . In fact, this is the primary reason that it is used in tandem with the three aforementioned drugs, particularly isoniazid . This is also the primary motivation behind directly observed therapy for tuberculosis.Rifampicin resistance develops quickly during treatment and rifampicin monotherapy should not be used to treat these infections — it should be used in combination with other antibiotics .
Asymptomatic elevations of liver enzymes and hepatitis.
Shortness of breath; wheezing.
Ataxia; muscular weakness; pain in extremities; osteomalacia; myopathy; menstrual disturbances; fever;elevated serum uric acid; possible immunosuppression; abnormal growth of lung tumors; reduced 25-hydroxycholecalciferol levels; edema of face and extremities; discoloration of body fluids.
1- Rifampicin is contraindicated in known cases of hypersensitivity to the drug.
2- It may be contraindicated in pregnancy (because of teratogenicity noted in animal studies and since the effects of drugs on fetus has not been established) except in the presence of a disease such as severe tuberculosis.
3- It is contraindicated in alcoholics with severely impaired liver function and with jaundice.
Rifampicin is readily absorbed fromGIT (90%). Peak plasma concentration occurs at1.5 to 4hrs after an oral dose,Absorption decreased 30% when taken with food .
Intravenous rifampicin has the same distribution as in oral route , Diffuses well into most body tissues and fluids, including CSF.Crosses placenta and distributes into breast milk. Protein binding is 89%.
May inhibit standard microbiological assays for serum folate and vitamin B 12 . Thus, use alternate assay methods. Transient abnormalities in LFTs (eg, elevation in serum bilirubin, abnormal bromsulfophthalein excretion, alkaline phosphatase, serum transaminases) and reduced biliary excretion of contrast media used for visualization of gallbladder may occur. Therefore, perform these tests before the morning dose of rifampin
1- Instruct patient to take drug on empty stomach, 1 h before or 2 h after meals.
2- Inform patient that body fluids may turn red-orange in color and that soft contact lenses may become permanently stained. Advise patient to wear glasses during course of therapy.
3- Instruct patient to notify health care provider of persistent anorexia, nausea, vomiting, diarrhea, jaundice, fever, change in color or consistency of stools, malaise or right upper quadrant abdominal pain, unusual bleeding or bruising, petechiae, hematuria, bleeding gums, or pallor.
4- Tell patient to notify health care provider of drowsiness, fatigue, dizziness, inability to concentrate, confusion, or visual or behavioral changes.
5- Advise patient who uses oral contraceptives to use nonhormonal form of contraception during therapy.
6- Advise patient that drug may cause drowsiness and to use caution while driving or performing other tasks requiring mental alertness.
7- Advise patient of importance of medication compliance in treatment of tuberculosis. Medication noncompliance reduces efficacy and promotes resistance.
8- Caution patient to avoid alcohol
9- In patients receiving anticoagulants and rifampicin concurrently, it is recommended that the prothrombin timebe performed daily or as frequently as necessary to establish and maintain the required dose of anticoagulant.