Rifampicin

Type of Medication: Antibiotic

Indications: Treatment and prophylaxis of Tuberculosis but always as a combination with other drugs. Used for the treatment of severe Staphylococcal pneumonia. Used as part of MRSA eradication protocol

Side Effects: GI upset (including anorexia,nausea, vomiting and diahorrea),headache, drowsiness, influenza type symptoms, haemolytic anaemia, acute renal failure, thrombocytopenic purpura, jaundice, deranged LFTs, urticaria, flushing, rashes, oedema, muscle weakness, myopathy, leucopenia, eosinophilia, orange coloured secretions, may stainsoft contact lenses, hepatitis, dyspnoea, menstrual disturbance, hypotension.

Route of administration: Adult (Oral)

Dose: For tuberculosis see BTS guidelines. MRSA eradication – 600mg od for one month in combination with sodium fusidate

Administration: 150mg or 300mg caps available. Also available as combination products. Patients should be told how to recognise signs of liver disease and that Rifampicin changes urine and secretions orange.

Route of administration: Paediatric (Oral)

Dose: For tuberculosis see BTS guidelines. MRSA eradication 20mg/kg up to 600mg od.

Administration: as per adults

Examples of some Drug Interactions

Interacting drug: Antacids

reduced absorption of rifampicin

Interacting drug: Anti arrythmics

their metabolism is increased by rifampicin

Interacting drug: Antidepressants (tricyclics)

metabolism is increased by rifampicin for some agents

Interacting drug: Antiepileptics (lamotrigine, phenytoin)

metabolism is increased by rifampicin

Interacting drug: Antifungal (itraconazole, ketoconazole,fluconazole)

metabolism is increased by rifampicin and concentration of rifampicin may be reduced by ketoconazole. Plasma concentration of rifabucin increased by fluconazole.

Interacting drug: Beta blockers

metabolism is increased by rifampicin

Interacting drug: Calcium channel blockers

metabolism is increased by rifampicin

Interacting drug: Chloramphenicol

metabolism is increased by rifampicin

Interacting drug: Cimetidine

metabolism is increased by rifampicin

Interacting drug: Clarithromycin and other macrolides

increase plasma concentration of rifabutin

Interacting drug: Corticosteroids

metabolism is increased by rifampicin. Double the steroid dose

Interacting drug: Cyclosporin

metabolism is increased by rifampicin

Interacting drug: Haloperidol

rifampicin accelerates metabolism

Interacting drug: Levothyroxine

metabolism is increased by rifampicin

Interacting drug: Methadone

increased metabolism of methadone

Interacting drug: Mycophenolate

reduces plasma concentration

Interacting drug: Oral contraceptive

metabolism is increased by rifampicin. Inform patient

Interacting drug: Posaconazole

rifampicin reduces plasma concentration

Interacting drug: Rosiglitazone

reduces plasma concentration. Consider increasing dose of rosiglitazone

Interacting drug: Sulphonylureas

metabolism is increased by rifampicin

Interacting drug: Tacrolimus , Sirolimus

metabolism is increased by rifampicin

Interacting drug: Theophylline

metabolism is increased by rifampicin

Interacting drug: Voriconazole

plasma concentration decreased by rifampicin ; avoid concomitant use.

Interacting drug: Warfarin

metabolism is increased by rifampicin