rif-AM-pin

• Active tuberculosis (with other agents).
• Elimination of meningococcal carriers.

Unlabeled Use:

• Prevention of disease caused by Haemophilus influenzae type B in close contacts.
• Synergy with other antimicrobial agents for S. aureus infections.

• Inhibits RNA synthesis by blocking RNA transcription in susceptible organisms.

• Bactericidal action against susceptible organisms.

Spectrum:

• Broad spectrum notable for activity against:
  • Mycobacterium spp.,
  • Staphylococcus aureus,
  • H. influenzae,
  • Legionella pneumophila,
  • Neisseria meningitidis.

Absorption: Well absorbed following oral administration.

Distribution: Widely distributed; enters CSF. Crosses placenta; enters breast milk.

Protein Binding: 80%.

Metabolism/Excretion: Mostly metabolized by the liver; 60% eliminated in feces via biliary elimination.

Half-life: 3 hr.

Contraindicated in:

• Hypersensitivity
• Concurrent use of atazanavir, darunavir, fosamprenavir, praziquantel, saquinavir, tipranavir, or ritonavir-boosted saquinavir.

Use Cautiously in:

• History of liver disease (↑ risk of hepatotoxicity)
• Chronic liver disease, poor nutritional status, or prolonged use of antibacterial drugs or anticoagulants (↑ risk of vitamin K deficiency and subsequent coagulation disorders)
• Diabetes
• Concurrent use of other hepatotoxic agents
• OB: Safety not established in pregnancy
• Lactation: Safety not established in breastfeeding.

Derm: ACUTE GENERALIZED EXANTHEMATOUS PUSTULOSIS, DRUG REACTION WITH EOSINOPHILIA AND SYSTEMIC SYMPTOMS (DRESS), STEVENS-JOHNSON SYNDROME, TOXIC EPIDERMAL NECROLYSIS, rash, pruritus.

EENT: red discoloration of tears.

GI: HEPATOTOXICITY, abdominal pain, diarrhea, flatulence, heartburn, nausea, vomiting, red discoloration of saliva and teeth.

GU: red discoloration of urine.

Hemat: bleeding, hemolytic anemia, thrombocytopenia.

MS: arthralgia, muscle weakness, myalgia.

Neuro: ataxia, confusion, drowsiness, fatigue, headache, weakness.

Misc: HYPERSENSITIVITY REACTIONS (INCLUDING ANGIOEDEMA), flu-like syndrome.

Drug-Drug:

• Significantly ↓ levels and effectiveness of atazanavir, darunavir, fosamprenavir, praziquantel, saquinavir, and tipranavir; concurrent use contraindicated.
• Significantly ↓ levels and effectiveness of , efavirenz, indinavir, quinine, sofosbuvir, ticagrelor, and zidovudine; avoid concomitant use.
• Significantly ↓ levels and effectiveness of hormonal contraceptives; use nonhormonal birth control during rifampin therapy.
• May ↓ levels and effectiveness of numerous drugs, including chloramphenicol, clarithromycin, cyclosporine, dapsone, diazepam, diltiazem, disopyramide, doxycycline, fluconazole, glipizide, glyburide, haloperidol, ketoconazole, levothyroxine, losartan, lovastatin, metoprolol, mexiletine, morphine, moxifloxacin, nifedipine, nortriptyline, ondansetron, oxycodone, phenytoin, prednisolone, propafenone, propranolol, rosiglitazone, quinidine, simvastatin, tamoxifen, theophylline, toremifene, verapamil, and zolpidem.
• May ↑ levels of active metabolite of clopidogrel, which may ↑ risk of bleeding; avoid concomitant use.
• May ↓ levels and effectiveness of warfarin; monitor INR regularly during concurrent therapy.
• May significantly ↓ levels and effectiveness of itraconazole; avoid use 2 wk before and during itraconazole therapy.
• May significantly ↓ levels and effectiveness of irinotecan; avoid use 2 wk before and during irinotecan therapy.
• May ↓ levels and effectiveness of digoxin; closely monitor serum digoxin concentrations and ↑ digoxin dose by 20–40%, if needed.
• May significantly ↓ levels and effectiveness of tacrolimus; monitor tacrolimus whole blood concentrations regularly and ↑ tacrolimus dose as necessary.
• May ↓ levels and effectiveness of methadone, which may ↑ risk of withdrawal symptoms.
• Absorption may be ↓ by antacids; administer rifampin 1 hr prior to antacids.
• Probenecid and trimethoprim/sulfamethoxazole may ↑ levels and risk of toxicity.
• Concurrent use with atovaquone may ↓ atovaquone levels and effectiveness and ↑ levels and risk of toxicity of rifampin; avoid concomitant use.

Tuberculosis

• PO, IV (Adults): 600 mg/day or 10 mg/kg/day (up to 600 mg/day) single dose; may also be given twice weekly.
• PO, IV (Children and Infants): 10–20 mg/kg/day single dose or divided every 12 hr (not to exceed 600 mg/day); may also be given twice weekly.

Asymptomatic Carriers of Meningococcus

• PO, IV (Adults): 600 mg every 12 hr for 2 days.
• PO, IV (Children 1 mo): 10 mg/kg every 12 hr for 2 days (max: 600 mg/dose).
• PO (Infants <1 mo): 5 mg/kg every 12 hr for 2 days.

H. influenzae Prophylaxis

• PO (Adults): 600 mg/day for 4 days.
• PO (Children): 20 mg/kg/day for 4 days (max: 600 mg/dose).
• PO (Neonates): 10 mg/kg/day for 4 days.

Synergy for S. aureus infections

• PO (Adults): 300–600 mg twice daily.
• PO (Children and Neonates): 5–20 mg/kg/day divided every 12 hr (max: 600 mg/dose).

• Do not confuse rifampin with rifaximin or Rifamate (isoniazid/rifampin).
• May use vitamin K supplementation in patients at risk for vitamin K deficiency.
• PO: Administer medication on an empty stomach at least 1 hr before or 2 hr after meals with a full glass (240 mL) of water. If GI irritation becomes a problem, may be administered with food. Antacids may also be taken 1 hr prior to administration. Capsules may be opened and contents mixed with applesauce or jelly for patients with difficulty swallowing.
  • Pharmacist can compound a syrup for patients unable to swallow solids.

IV Administration:

• Intermittent Infusion: Reconstitution: Reconstitute each 600-mg vial with 10 mL of sterile water for injection for a concentration of 60 mg/mL.
  Diluent: Dilute further in 100 mL or 500 mL of D5W or 0.9% NaCl. Reconstituted vials are stable for 24 hr at room temperature. Infusion is stable at room temperature for 4 hr (in D5W) or 24 hr (in 0.9% NaCl).Concentration: Not to exceed 6 mg/mL.
• Rate: Administer solutions diluted in 100 mL over 30 min and solutions diluted in 500 mL over 3 hr.
• Y-Site Compatibility:
  • amiodarone
  • bumetanide
  • ciprofloxacin
  • daptomycin
  • midazolam
  • pantoprazole
  • tigecycline
  • vancomycin
• Y-Site Incompatibility:
  • diltiazem
.

Rifadin, Rimactane

Rofact

Therapeutic Classification: antituberculars

Pharmacologic Classification: rifamycins

(Generic available)

• Capsules: 150 mg; 300 mg;
• Powder for injection: 600 mg/vial;

(blood levels)

• Perform mycobacterial studies and susceptibility tests prior to and periodically during therapy to detect possible resistance.
• Assess lung sounds and character and amount of sputum periodically during therapy.
• Monitor for signs and symptoms of DRESS (fever, rash, lymphadenopathy, and/or facial swelling), associated with involvement of other organ systems (hepatitis, nephritis, hematologic abnormalities, myocarditis, myositis) during therapy. May resemble an acute viral infection. Eosinophilia is often present. Discontinue therapy if signs occur.

• Evaluate renal function, CBC, and urinalysis periodically and during therapy.
  • Monitor hepatic function at least monthly during therapy. May cause ↑ BUN, AST, ALT, and serum alkaline phosphatase, bilirubin, and uric acid concentrations.
  • May cause false-positive direct Coombs’ test results. May interfere with folic acid and vitamin B assays.
  • May interfere with dexamethasone suppression test results; discontinue rifampin 15 days prior to test.
  • May interfere with methods for determining serum folate and vitamin B levels and with urine tests based on color reaction.
  • Monitor coagulation tests (PT, INR, aPTT) during therapy in patients at risk for vitamin K deficiency.

• Advise patient to take medication once daily (unless biweekly regimens are used), as directed, and not to skip doses or double up on missed doses. Emphasize the importance of continuing therapy even after symptoms have subsided. Length of therapy for tuberculosis depends on regimen being used and underlying disease states. Patients on short-term prophylactic therapy should also be advised of the importance of compliance with therapy.
• Advise patient to notify health care professional promptly if signs and symptoms of hepatitis (yellow eyes and skin, nausea, vomiting, anorexia, unusual tiredness, weakness) or of thrombocytopenia (unusual bleeding or bruising) occur.
• Caution patient to avoid the use of alcohol during this therapy, because this may increase the risk of hepatotoxicity.
• Instruct patient to report the occurrence of flu-like symptoms (fever, chills, myalgia, headache) promptly.
• Rifampin may occasionally cause drowsiness. Caution patient to avoid driving or other activities requiring alertness until response to medication is known.
• Inform patient that saliva, sputum, teeth, sweat, tears, urine, and feces may become red-orange to red-brown and that soft contact lenses may become permanently discolored.
• Rep: Advise females of reproductive potential to notify health care professional if pregnancy is planned or suspected and to avoid breastfeeding during therapy.
• Emphasize the importance of regular follow-up exams to monitor progress and to check for side effects.

• Decreased fever and night sweats.
• Diminished cough and sputum production.
• Negative sputum cultures.
• Increased appetite.
• Weight gain.
• Reduced fatigue.
• Sense of well-being in patients with tuberculosis.
• Prevention of meningococcal meningitis.
• Prevention of H. influenzae type B infection. Prophylactic course is usually short term.

NDC Code^*

• 0068- Sanofi-Aventis U.S. LLC
  • 0068-0508- Rifadin
    • 0068-0508-60- 60 CAPSULE in 1 BOTTLE (0068-0508-60)

• 0068- Sanofi-Aventis U.S. LLC
  • 0068-0510- Rifadin
    • 0068-0510-30- 30 CAPSULE in 1 BOTTLE (0068-0510-30)

• 0068- Sanofi-Aventis U.S. LLC
  • 0068-0597- Rifadin IV
    • 0068-0597-01- 1 VIAL, GLASS in 1 CARTON (0068-0597-01) > 10 mL in 1 VIAL, GLASS

• 0068- Sanofi-Aventis U.S. LLC
  • 0068-0599- Rifadin IV NOVAPLUS
    • 0068-0599-01- 1 VIAL, GLASS in 1 CARTON (0068-0599-01) > 10 mL in 1 VIAL, GLASS

• 0068- Sanofi-Aventis U.S. LLC
  • 0068-0599- Rifadin IV NOVAPLUS
    • 0068-0599-10- 10 CARTON in 1 CARTON (0068-0599-10) > 1 VIAL, GLASS in 1 CARTON > 10 mL in 1 VIAL, GLASS

• 0143- West-Ward Pharmaceuticals Corp
  • 0143-9230- Rifampin
    • 0143-9230-01- 1 INJECTION, POWDER, LYOPHILIZED, FOR SOLUTION in 1 VIAL (0143-9230-01)

• 0185- Eon Labs, Inc.
  • 0185-0799- Rifampin
    • 0185-0799-01- 100 CAPSULE in 1 BOTTLE (0185-0799-01)

• 0185- Eon Labs, Inc.
  • 0185-0799- Rifampin
    • 0185-0799-05- 500 CAPSULE in 1 BOTTLE (0185-0799-05)

• 0185- Eon Labs, Inc.
  • 0185-0799- Rifampin
    • 0185-0799-30- 30 CAPSULE in 1 BOTTLE (0185-0799-30)

• 0185- Eon Labs, Inc.
  • 0185-0799- Rifampin
    • 0185-0799-60- 60 CAPSULE in 1 BOTTLE (0185-0799-60)

• 0185- Eon Labs, Inc.
  • 0185-0801- Rifampin
    • 0185-0801-01- 100 CAPSULE in 1 BOTTLE (0185-0801-01)

• 0185- Eon Labs, Inc.
  • 0185-0801- Rifampin
    • 0185-0801-30- 30 CAPSULE in 1 BOTTLE (0185-0801-30)

• 0527- Lannett Company, Inc.
  • 0527-1315- Rifampin
    • 0527-1315-01- 100 CAPSULE in 1 BOTTLE (0527-1315-01)

• 0527- Lannett Company, Inc.
  • 0527-1315- Rifampin
    • 0527-1315-06- 60 CAPSULE in 1 BOTTLE (0527-1315-06)

• 0527- Lannett Company, Inc.
  • 0527-1315- Rifampin
    • 0527-1315-30- 30 CAPSULE in 1 BOTTLE (0527-1315-30)

• 0527- Lannett Company, Inc.
  • 0527-1393- Rifampin
    • 0527-1393-01- 100 CAPSULE in 1 BOTTLE (0527-1393-01)

• 0527- Lannett Company, Inc.
  • 0527-1393- Rifampin
    • 0527-1393-30- 30 CAPSULE in 1 BOTTLE (0527-1393-30)

• 0904- Major Pharmaceuticals
  • 0904-5282- RIFAMPIN
    • 0904-5282-61- 100 BLISTER PACK in 1 CARTON (0904-5282-61) > 1 CAPSULE in 1 BLISTER PACK

• 17478- AKORN, Inc.
  • 17478-151- Rifampin
    • 17478-151-42- 1 VIAL in 1 BOX, UNIT-DOSE (17478-151-42) > 10 mL in 1 VIAL

• 23155- Heritage Pharmaceuticals Inc. d/b/a Avet Pharmaceuticals Inc.
  • 23155-340- Rifampin
    • 23155-340-31- 10 mL in 1 VIAL, GLASS (23155-340-31)

• 50090- A-S Medication Solutions
  • 50090-0963- Rifampin
    • 50090-0963-0- 30 CAPSULE in 1 BOTTLE (50090-0963-0)

• 50090- A-S Medication Solutions
  • 50090-0963- Rifampin
    • 50090-0963-3- 60 CAPSULE in 1 BOTTLE (50090-0963-3)

• 50090- A-S Medication Solutions
  • 50090-2633- Rifampin
    • 50090-2633-0- 30 CAPSULE in 1 BOTTLE (50090-2633-0)

• 53002- RPK Pharmaceuticals, Inc.
  • 53002-6430- Rifampin
    • 53002-6430-2- 20 CAPSULE in 1 BOTTLE (53002-6430-2)

• 53002- RPK Pharmaceuticals, Inc.
  • 53002-6430- Rifampin
    • 53002-6430-3- 30 CAPSULE in 1 BOTTLE (53002-6430-3)

• 53002- RPK Pharmaceuticals, Inc.
  • 53002-6430- Rifampin
    • 53002-6430-6- 60 CAPSULE in 1 BOTTLE (53002-6430-6)

• 53002- RPK Pharmaceuticals, Inc.
  • 53002-6430- Rifampin
    • 53002-6430-7- 70 CAPSULE in 1 BOTTLE (53002-6430-7)

• 61748- VersaPharm Inc. - an Akorn Company
  • 61748-015- Rifampin
    • 61748-015-11- 10 BLISTER PACK in 1 CARTON (61748-015-11) > 10 CAPSULE in 1 BLISTER PACK

• 61748- VersaPharm Inc. - an Akorn Company
  • 61748-015- Rifampin
    • 61748-015-30- 30 CAPSULE in 1 BOTTLE, PLASTIC (61748-015-30)

• 61748- VersaPharm Inc. - an Akorn Company
  • 61748-018- Rifampin
    • 61748-018-01- 100 CAPSULE in 1 BOTTLE, PLASTIC (61748-018-01)

• 61748- VersaPharm Inc. - an Akorn Company
  • 61748-018- Rifampin
    • 61748-018-11- 10 BLISTER PACK in 1 CARTON (61748-018-11) > 10 CAPSULE in 1 BLISTER PACK

• 61748- VersaPharm Inc. - an Akorn Company
  • 61748-018- Rifampin
    • 61748-018-30- 30 CAPSULE in 1 BOTTLE, PLASTIC (61748-018-30)

• 61748- VersaPharm Inc. - an Akorn Company
  • 61748-018- Rifampin
    • 61748-018-60- 60 CAPSULE in 1 BOTTLE, PLASTIC (61748-018-60)

• 63323- Fresenius Kabi USA, LLC
  • 63323-351- Rifampin
    • 63323-351-20- 1 VIAL in 1 BOX (63323-351-20) > 1 INJECTION, POWDER, LYOPHILIZED, FOR SOLUTION in 1 VIAL

• 63629- Bryant Ranch Prepack
  • 63629-4042- Rifampin
    • 63629-4042-1- 30 CAPSULE in 1 BOTTLE (63629-4042-1)

• 63629- Bryant Ranch Prepack
  • 63629-4042- Rifampin
    • 63629-4042-2- 60 CAPSULE in 1 BOTTLE (63629-4042-2)

• 63629- Bryant Ranch Prepack
  • 63629-4042- Rifampin
    • 63629-4042-3- 20 CAPSULE in 1 BOTTLE (63629-4042-3)

• 63739- McKesson Corporation dba SKY Packaging
  • 63739-415- Rifampin
    • 63739-415-10- 10 BLISTER PACK in 1 BOX, UNIT-DOSE (63739-415-10) > 10 CAPSULE in 1 BLISTER PACK

• 67457- Mylan Institutional LLC
  • 67457-445- Rifampin
    • 67457-445-60- 1 VIAL in 1 CARTON (67457-445-60) > 10 mL in 1 VIAL

• 68084- American Health Packaging
  • 68084-357- Rifampin
    • 68084-357-21- 30 BLISTER PACK in 1 BOX, UNIT-DOSE (68084-357-21) > 1 CAPSULE in 1 BLISTER PACK (68084-357-11)

• 68084- American Health Packaging
  • 68084-358- Rifampin
    • 68084-358-01- 100 BLISTER PACK in 1 BOX, UNIT-DOSE (68084-358-01) > 1 CAPSULE in 1 BLISTER PACK (68084-358-11)

• 68180- Lupin Pharmaceuticals, Inc.
  • 68180-658- rifampin
    • 68180-658-01- 60 CAPSULE in 1 BOTTLE (68180-658-01)

• 68180- Lupin Pharmaceuticals, Inc.
  • 68180-658- rifampin
    • 68180-658-06- 30 CAPSULE in 1 BOTTLE (68180-658-06)

• 68180- Lupin Pharmaceuticals, Inc.
  • 68180-659- rifampin
    • 68180-659-01- 100 CAPSULE in 1 BOTTLE (68180-659-01)

• 68180- Lupin Pharmaceuticals, Inc.
  • 68180-659- rifampin
    • 68180-659-06- 30 CAPSULE in 1 BOTTLE (68180-659-06)

• 68180- Lupin Pharmaceuticals, Inc.
  • 68180-659- rifampin
    • 68180-659-07- 60 CAPSULE in 1 BOTTLE (68180-659-07)

• 70518- REMEDYREPACK INC.
  • 70518-0051- Rifampin
    • 70518-0051-0- 30 CAPSULE in 1 BLISTER PACK (70518-0051-0)

• 70518- REMEDYREPACK INC.
  • 70518-2404- rifampin
    • 70518-2404-0- 30 CAPSULE in 1 BLISTER PACK (70518-2404-0)

• 76413- Central Texas Community Health Centers
  • 76413-136- Rifampin
    • 76413-136-04- 4 CAPSULE in 1 BOTTLE, PLASTIC (76413-136-04)

• 76413- Central Texas Community Health Centers
  • 76413-136- Rifampin
    • 76413-136-12- 12 CAPSULE in 1 BOTTLE, PLASTIC (76413-136-12)

• 76413- Central Texas Community Health Centers
  • 76413-137- Rifampin
    • 76413-137-04- 4 CAPSULE in 1 BOTTLE, PLASTIC (76413-137-04)

• 76413- Central Texas Community Health Centers
  • 76413-137- Rifampin
    • 76413-137-08- 8 CAPSULE in 1 BOTTLE, PLASTIC (76413-137-08)