Rifampicin

Rifampicin belongs to the group of complex macrocyclic antibiotic. Rifampicin is a zwitterionic. Rifampicin results from a condensation reaction between 3-formylrifamycin SV and 1-amino 4-methylpiperazine. Most gram positive and many gram negative bacteria are sensitive to it. It is the major drug in the treatment of tuberculosis. It is effective in combination with ethambutol, isoniazid, streptomycin and the majority of second line drugs.

Rifampicin is primarily indicated in conditions like Epilepsy (monotherapy), Iron-deficiency anaemia with chronic renal failure, Leprosy, Meningitis, Meningitis prophylaxis, Mycobacterial infection, Paget's disease of bone, Tuberculosis, Urinary tract infection, and can also be given in adjunctive therapy as an alternative drug of choice in Brucellosis, Endocarditis, Gonorrhoea, Legionnaires' disease.

Rifampicin is contraindicated in conditions like Hepatic disease, Jaundice.

The severe or irreversible adverse effects of Rifampicin, which give rise to further complications include Thrombocytopenic purpura, Flu-like syndrome. Rifampicin produces potentially life-threatening effects which include Sensitization, Shock- like syndrome. which are responsible for the discontinuation of Rifampicin therapy. The signs and symptoms that are produced after the acute overdosage of Rifampicin include Edema, Cardiovascular collapse, Nausea & vomiting, Pruritus, Red Man syndrome, Cutaneous pigmentation. The symptomatic adverse reactions produced by Rifampicin are more or less tolerable and if they become severe, they can be treated symptomatically, these include Nausea, Vomiting, Anorexia, Abdominal discomfort, Orange coloration of secretions.

Rifampicin should be used during pregnancy or lactation only if clearly needed. Alcohol can reduce the effectiveness of this medication and increase side effects. Minimize alcohol consumption while taking rifampicin. Rifampicin can decrease the effectiveness of oral contraceptives. It should be used with caution in patients with liver problems.

Drug should not be given to patients suffering from Liver Malfunction.If prescribing authority justifies the benefits of the drug against the possible damages he/she should reevaluate them and consult the reference material and previous studies.

450 to 600 mg (520 (525)) As recommended. PO — In 2-4 div.doses. Maximum dose: 600mg. Give 30 min before breakfast. Duration may vary according to indication.

10 to 20 mg/kg (15 (15)) 24 hourly Oral — Max 60mg/day

10 to 20 mg/kg (15 (15)) 24 hourly Oral —

Rifampicin is known to interact with other drugs, the details of drug interactions is as follows:DrugDetailsSeverityOnsetManagementAbacavirRifampicin reduces plasma concentration of abacavir. Adefovir DipivoxilAfatinibmay decrease the level of afatinibuse alternative or increased afatinib daily doseAluminium Hydroxide and OxideAminophyllineAmprenavirPlasma concentration of Amprenavir significantly reduced by Rifampicin. ADVICE: Avoid concomitant use.MajorArtesunateConcurrent use may decrease artesunate serum concentrations. Avoid co-administration if possible. Monitor closely for therapeutic efficacy. Artesunate dose may need to be increased with co-administration.AtovaquonePlasma concentration of Atovaquonone reduced by rifampicin (possible therapeutic failure of atovaquone). Beclomethasone (Dipropionate)Rifampicin reduce the activity of corticosteroids by accelerating their metabolismBetamethasoneRifampicin reduce activity of corticosteroids by accelerating metabolism of betamethaosoneDose reduction is necessaryBisoprolol (Fumarate)Metabolism of Bisoprolol accelerated by Rifampicin (plasma concentration significantly reduced)ModerateBromazepamCalcifediolCanagliflozinco administration may decrease efficacy of canagliflozinincreaes the dose to 300mg once dailyCarvedilolCelecoxibChloramphenicolRifampicin causes subtherapeutic concentration of chloramphenicol.ChloramphenicolChlorpropamideCholecalciferolCiprofloxacinRifampin induces the metabolism of ciprofloxacin.ClofazimineClofazimineClofibrateCorticotropinCortisone (Acetate)Co-TrimoxazoleCyclosporin ACyclosporin ADabigatranreduces exposure to dabigatran It should generally be avoided.DabrafenibStrong CYP3A4 inducers may decrease levels of dabrafenibconsider alternate therapyDapsoneDapsoneDesogestrelDesonideDexamethasoneDiazepamDienoestrolDigitoxinDigitoxinDigoxinDiltiazem (HCl)DisopyramideDisopyramideDisulfiramDolutegravirRifampin (600 mg) decreases dolutegravir AUC and Cmin the dolutegravir dosage should be increasedDoxycyclineDydrogesteroneEnalapril (Maleate)ErlotinibDecreased levels/effect of erlotinibEstazolamEstradiol (Valerate)Estradiol.EthinyloestradiolEthionamideHepatitis occurs with jaundice mostly when both drugs are co administeredEthynodiol (Diacetate)FelodipineFluconazoleRifampicin induce metabolism of fluconazoleFludrocortisone (Acetate)FlunisolideFluprednisoloneFluticasone PropionateFosphenytoinGallopamilGestodeneGestrinoneGliclazideHaloperidolHexobarbitone (Na)HydrocortisoneIloprostImidaprilRifampicin reduces plasma concentration of active metabolite of Imidapril (reduced antihypertensive effect)IsoniazidIsoniazidIsradipineItraconazoleKetoconazoleKetoconazoleLercanidipine (HCl)LevonorgestrelLinagliptinRifampicin decreases AUC and Cmax of Linagliptin by 39.6% and 43.8% respectivelyLurasidoneRifampicin is a strong CYP3A4 inducer, decreases Cmax and AUC of LurasidoneContraindicatedLynoestrenolMacitentanrifampin significantly reduce macitentan exposureConcomitant use of macitentan with strong CYP3A4 inducers should be avoidedMegestrol (Acetate)MeprobamateMestranolMethadoneMethylprednisoloneMexiletineMontelukastRifampicin may have the same effect as montelukast. Therefore, the dose of montelukast may need to be reduced when given concurrently with rifampicin. Employ appropriate clinical monitoring.MycophenolateNelfinavirNevirapineNilotinibsystemic exposure to nilotinib was decreased approximately 80%.NorethisteroneNorgestimateOndansetron (HCl)By concurrent use the clearance of ondansetron was significantly increased and ondansetron blood concentrations were decreased. However, on the basis of available data, no dosage adjustment for ondansetron is recommended for patients on these drugs.No dosage adjustment for ondansetron is recommended for patients on these drugs.Oxtriphylline (Choline Theophyllinate)Para-Amino Salicylic AcidPitavastatinRifampin significantly increased pitavastatin exposure. In patients taking rifampin, a dose of PIVASTATIN 2 mg once daily should not be exceededPrajmalium Bitartaraterifampicin increases hepatic metabolism of prajmalium bitartarate.Prednisolone and PrednisoneRifampicin accelerate metabolism of prednisolone and prednisonePrednisolone TebutateRifampicin decrease activity of Prednisolone Tebutate.ProbenecidProgesteronePropafenone (HCl)ProthionamideQuinestrolRifampicin and other liver enzyme inducers e.g griseofulvin enhances the metabolism of quinestrol.QuinidineQuinidineQuinineRanolazineRifampin (600 mg once daily) decreases the plasma concentration of ranolazine (1000 mg twice daily) by approximately 95% by induction of CYP3A and, probably, P-gp.Avoid co-administration of ranolazinen and CYP3A inducers such as rifampin, rifabutin, rifapentin, phenobarbital, phenytoin and carbamazepine.RepaglinideRifampicin may decrease the levels/effects of repaglinide.RiluzoleRifampicin could increase the rate of riluzole elimination. RitonavirRivaroxabanCYP3A4 inducer (other e.g; phenytoin, carbamazedine, phenobarbital ) it may reduce plasma concentration of Rivaroxaban.Co administer with cautionRofecoxibCo-administration of Rofecoxib with rifampin produced an approximate 50% decrease in rofecoxib plasma concentrations.Rosiglitazone (Maleate)Rifampicin may decrease the AUC of rosiglitazone. SaquinavirSorafenibreduction of sorafenib AUCModerateDose may increaseStilboestrolSulphasalazineSunitinibMay decrease sunitinib concentrations.TacrolimusTerbinafine (HCl)TheophyllineTheophyllineTiboloneTicagrelor CYP3A4 inducer, deccrease Cmax and AUC of Ticagrelor by 73% and 86%, decrease efficasy and exposureTocainide (HCl)TrimethoprimVandetanibRifampicin is a CYP3A4 inducer, decreases vandetanib plasma exposure about 40%.It should be avoided.VemurafenibRifampin induces P-gp and CYP3A4.Verapamil (HCl)Verapamil (HCl)VilazodoneCyp3A4 inducer e.g Rifampicin may decrease vilazodone exposureVORICONAZOLERifampin may decrease the serum concentration of voriconazole likely by increasing its metabolism Concomitant therapy is contraindicated.Warfarin (Na)ZidovudineZiprasidoneLiver enzyme inducers (e.g rifampicin) accelerates the metabolism of ziprasidone.Zolpidem (Tartrate)Zopiclone These interactions are sometimes beneficial and sometimes may pose threats to life. Always consult your physician for the change of dose regimen or an alternative drug of choice that may strictly be required.

Inj (reconstituted soln) Store at room temperature. Use within 24 hrs if kept at room temperature. Tab, Caps, Susp Store in a well closed container, Below 40°C. Protect from Sunlight, Moisture and Heat.