Rifampin

(rif' am pin)

Brand Name(s): Rifadin^®, Rimactane^®, Rifamate^® (as a combination product containing Isoniazid, Rifampin), Rifater^® (as a combination product containing Isoniazid, Pyrazinamide, Rifampin); also available generically

WHY is this medicine prescribed?

Rifampin is used with other medications to treat tuberculosis (TB; a serious infection that affects the lungs and sometimes other parts of the body). Rifampin is also used to treat some people who have Neisseria meningitidis (a type of bacteria that can cause a serious infection called meningitis) infections in their noses or throats. These people have not developed symptoms of the disease, and this treatment is used to prevent them from infecting other people. Rifampin should not be used to treat people who have developed symptoms of meningitis. Rifampin is in a class of medications called antimycobacterials. It works by killing the bacteria that cause infection.

Antibiotics such as rifampin will not work for colds, flu, or other viral infections. Using antibiotics when they are not needed increases your risk of getting an infection later that resists antibiotic treatment.

Are there OTHER USES for this medicine?

Rifampin is also sometimes used to treat infections caused by other types of bacteria and to prevent infection in people who have been in close contact with a person who has certain serious bacterial infections. Talk to your doctor about the risks of using this medication for your condition.

This medication may be prescribed for other uses; ask your doctor or pharmacist for more information.

HOW should this medicine be used?

Rifampin comes as a capsule to take by mouth. It should be taken with a full glass of water on an empty stomach, 1 hour before or 2 hours after a meal. When rifampin is used to treat tuberculosis, it is taken once daily. When rifampin is used to prevent the spread of Neisseria meningitidis bacteria to other people, it is taken twice daily for 2 days or once daily for 4 days. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take rifampin exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor.

Tell your doctor or pharmacist if you cannot swallow the capsules. Your pharmacist can prepare a liquid for you to take instead.

If you are taking rifampin to treat tuberculosis, your doctor may tell you to take rifampin for several months or longer. Continue to take rifampin until you finish the prescription even if you feel better, and be careful not to miss doses. If you stop taking rifampin too soon, your infection may not be completely treated and the bacteria may become resistant to antibiotics. If you miss doses of rifampin, you may develop uncomfortable or serious symptoms when you begin to take the medication again.

What SPECIAL PRECAUTIONS should I follow?

Before taking rifampin,

• tell your doctor and pharmacist if you are allergic to rifampin, rifabutin (Mycobutin), rifapentine (Priftin), any other medications, or any of the ingredients in rifampin capsules. Ask your doctor or pharmacist for a list of the ingredients.

• tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take. Be sure to mention any of the following: anticoagulants ('blood thinners') such as warfarin (Coumadin, Jantoven); antifungals such as fluconazole (Diflucan), itraconazole (Onmel, Sporanox), and ketoconazole; atovaquone (Mepron, in Malarone); barbiturates such as phenobarbital; beta blockers such as atenolol (Tenormin), labetalol (Trandate), metoprolol (Lopressor, Toprol XL), nadolol (Corgard), and propranolol (Inderal, Innopran); calcium channel blockers such as diltiazem (Cardizem, Cartia, Tiazac), nifedipine (Adalat, Procardia), and verapamil (Calan, Verelan); chloramphenicol; clarithromycin (Biaxin); cyclosporine (Gengraf, Neoral, Sandimmune); daclatasvir (Daklinza); dapsone; diazepam (Valium); doxycycline (Monodox, Oracea, Vibramycin); efavirenz (Sustiva); enalapril (Vaseretic); fluoroquinolone antibiotics such as ciprofloxacin (Cipro) and moxifloxacin (Avelox); gemfibrozil (Lopid); haloperidol (Haldol); hormonal contraceptives (birth control pills, patches, rings, or injections); hormone replacement therapy (HRT); indinavir (Crixivan); irinotecan (Camptosar); isoniazid (in Rifater, Rifamate); levothyroxine (Levoxyl, Synthroid, Tirosint); losartan (Cozaar); medications for irregular heartbeat such as digoxin (Lanoxin), disopyramide (Norpace), mexiletine, propafenone (Rythmol), and quinidine (in Nuedexta); medications for seizures such as phenytoin (Dilantin, Phenytek); methadone (Dolophine, Methadose); narcotic medications for pain such as oxycodone (Oxaydo, Xtampza) and morphine (Kadian); ondansetron (Zofran, Zuplenz); oral medications for diabetes such as glipizide (Glucotrol), glyburide (Diabeta), and rosiglitazone (Avandia); probenecid (Probalan); quinine (Qualquin); simvastatin (Flolipid, Zocor), steroids such as dexamethasone (Decadron), methylprednisolone (Medrol), and prednisone; sofosbuvir (Sovaldi); tamoxifen (Soltamox); toremifene (Fareston); trimethoprim and sulfamethoxazole (Bactrim, Septra); tacrolimus(Prograf); theophylline (Elixophyllin, Theo-24); tricyclic antidepressants such as amitriptyline and nortriptyline (Pamelor); zidovudine (Retrovir, in Trizivir), and zolpidem (Ambien). Many other medications may interact with rifampin, so be sure to tell your doctor about all the medications you are taking, even those that do not appear on this list. Your doctor may need to change the doses of your medications or monitor you carefully for side effects.

• if you are taking antacids, take rifampin at least 1 hour before you take the antacids.

• tell your doctor if you are taking or using hormonal contraceptives (birth control pills, patches, rings, implants, and injections). Rifampin can decrease the effectiveness of hormonal contraceptives. You should use another method of birth control while taking this medication. Talk to your doctor about birth control while taking rifampin.

• tell your doctor if you are taking any of the following medications: atazanavir (Reyataz), darunavir (Prezista), fosamprenavir (Lexiva), praziquantel (Biltricide), saquinavir (Invirase), tipranavir (Aptivus), or ritonavir (Norvir) and saquinavir (Invirase) taken together. Your doctor will probably tell you not to take rifampin if you are taking any of these medications. If you are taking rifampin and need to take praziquantal (Biltricide), you should wait at least 4 weeks after you stop taking rifampin before you begin to take praziquantel.

• tell your doctor if you have or have ever had diabetes, porphyria (condition in which certain natural substances build up in the body and may cause stomach pain, changes in thinking and behavior, or other symptoms), any condition that affects your adrenal gland (small gland next to the kidney that produces important natural substances) or liver disease.

• tell your doctor if you are pregnant, plan to become pregnant, or are breastfeeding. If you become pregnant while taking rifampin, call your doctor.

• tell your doctor if you wear soft contact lenses. Rifampin may cause permanent red stains on your contact lenses if you wear them during your treatment with rifampin.

What SPECIAL DIETARY instructions should I follow?

Unless your doctor tells you otherwise, continue your normal diet.

What should I do IF I FORGET to take a dose?

Do not miss doses of rifampin. Missing doses may increase the risk that you will experience serious side effects. If you do miss a dose, take the missed dose as soon as you remember it. However, if it is almost time for the next dose, skip the missed dose and call your doctor. Do not take a double dose to make up for a missed one.

What SIDE EFFECTS can this medicine cause?

Rifampin may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:

• temporary discoloration (yellow, reddish-orange, or brown color) of your skin, teeth, saliva, urine, stool, sweat, and tears)
• itching
• flushing
• headache
• drowsiness
• dizziness
• lack of coordination
• difficulty concentrating
• confusion
• changes in behavior
• muscle weakness
• numbness
• pain in the arms, hands, feet, or legs
• heartburn
• stomach cramps
• loss of appetite
• nausea
• vomiting
• diarrhea
• gas
• painful or irregular menstrual periods
• vision changes

Some side effects can be serious. If you experience any of the following symptoms, call your doctor immediately:

• watery or bloody stools, stomach cramps, or fever during treatment or for up to two or more months after stopping treatment
• rash; hives; fever; chills; swelling of the eyes, face, lips, tongue, or throat; difficulty swallowing or breathing; shortness of breath; wheezing; swollen lymph nodes; sore throat; pink eye; flu- like symptoms; unusual bleeding or bruising; or joint swelling or pain
• nausea, vomiting, loss of appetite, dark urine, or yellowing of the skin or eyes

If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration's (FDA) MedWatch Adverse Event Reporting program online (http://www.fda.gov/Safety/MedWatch) or by phone (1-800-332-1088).

Rifampin may cause other side effects. Call your doctor if you have any unusual problems while you are taking this medication.

What should I know about STORAGE and DISPOSAL of this medication?

Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from excess heat and moisture (not in the bathroom).

It is important to keep all medication out of sight and reach of children as many containers (such as weekly pill minders and those for eye drops, creams, patches, and inhalers) are not child-resistant and young children can open them easily. To protect young children from poisoning, always lock safety caps and immediately place the medication in a safe location – one that is up and away and out of their sight and reach. http://www.upandaway.org

Unneeded medications should be disposed of in special ways to ensure that pets, children, and other people cannot consume them. However, you should not flush this medication down the toilet. Instead, the best way to dispose of your medication is through a medicine take-back program. Talk to your pharmacist or contact your local garbage/recycling department to learn about take-back programs in your community. See the FDA's Safe Disposal of Medicines website (http://goo.gl/c4Rm4p) for more information if you do not have access to a take-back program.

What should I do in case of OVERDOSE?

In case of overdose, call the poison control helpline at 1-800-222-1222. Information is also available online at https://www.poisonhelp.org/help. If the victim has collapsed, had a seizure, has trouble breathing, or can't be awakened, immediately call emergency services at 911.

Symptoms of overdose may include the following:

• nausea
• vomiting
• stomach pain
• itching
• headache
• loss of consciousness
• yellowing of the skin or eyes
• reddish brown discoloration of the skin, saliva, urine, feces, sweat, and tears
• tenderness in the upper right part of the stomach
• swelling of the eyes or face
• fast or irregular heartbeat
• seizures

What OTHER INFORMATION should I know?

Keep all appointments with your doctor and the laboratory. Your doctor will order certain lab tests to check your response to rifampin.

Before having any laboratory test, including drug screening tests, tell the laboratory personnel that you are taking rifampin. Rifampin may cause the results of certain drug screening tests to be positive even though you have not taken the drugs.

Do not let anyone else take your medication. Ask your pharmacist any questions you have about refilling your prescription.

It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies.

This report on medications is for your information only, and is not considered individual patient advice. Because of the changing nature of drug information, please consult your physician or pharmacist about specific clinical use.

The American Society of Health-System Pharmacists, Inc. represents that the information provided hereunder was formulated with a reasonable standard of care, and in conformity with professional standards in the field. The American Society of Health-System Pharmacists, Inc. makes no representations or warranties, express or implied, including, but not limited to, any implied warranty of merchantability and/or fitness for a particular purpose, with respect to such information and specifically disclaims all such warranties. Users are advised that decisions regarding drug therapy are complex medical decisions requiring the independent, informed decision of an appropriate health care professional, and the information is provided for informational purposes only. The entire monograph for a drug should be reviewed for a thorough understanding of the drug's actions, uses and side effects. The American Society of Health-System Pharmacists, Inc. does not endorse or recommend the use of any drug. The information is not a substitute for medical care.

AHFS^® Patient Medication Information™. © Copyright, 2024. The American Society of Health-System Pharmacists^®, 4500 East-West Highway, Suite 900, Bethesda, Maryland. All Rights Reserved. Duplication for commercial use must be authorized by ASHP.

Selected Revisions: April 15, 2019.