Priftin

rifapentine

(rif-a-pen-teen) ,

Priftin

(trade name)

Classification

Therapeutic: antituberculars
Pregnancy Category: C

Indications

Treatment of pulmonary tuberculosis:
  • Must be used in combination with other agents.

Action

Inhibits DNA-dependent RNA polymerase.

Therapeutic effects

Bactericidal action against intracellular and extracellular susceptible strains of Mycobacterium tuberculosis.

Pharmacokinetics

Absorption: 70% absorbed following oral administration.
Distribution: Widely distributed in body tissues and fluids.
Protein Binding: Rifapentine—97.7%;desacetyl rifapentine—93.2%.
Metabolism and Excretion: Mostly metabolized by the liver; 17% excreted by the kidneys; some conversion to another active compound (25-desacetyl rifapentine).
Half-life: 13 hr (rifapentine and desacetyl rifapentine).

Time/action profile (blood levels)

ROUTEONSETPEAKDURATION
POunknown5–6 hrunknown

Contraindications/Precautions

Contraindicated in: Hypersensitivity to rifapentine or other rifamycins (rifampin or rifabutin).
Use Cautiously in: History of liver disease; Obstetric / Lactation / Pediatric: Pregnancy, lactation, or children <12 yr (safety not established).
Exercise Extreme Caution in: Concurrent protease inhibitor therapy.

Adverse Reactions/Side Effects

Central nervous system

  • dizziness
  • headache

Respiratory

  • hemoptysis

Cardiovascular

  • hypertension

Gastrointestinal

  • pseudomembranous colitis (life-threatening)
  • anorexia
  • diarrhea
  • dyspepsia
  • ↑ liver enzymes
  • nausea
  • vomiting

Genitourinary

  • hematuria
  • proteinuria
  • pyuria
  • urinary casts

Dermatologic

  • acne
  • pruritus
  • rash

Hematologic

  • anemia
  • leukopenia
  • lymphopenia
  • neutropenia
  • thrombocytosis

Musculoskeletal

  • arthralgia

Miscellaneous

  • pain

Interactions

Drug-Drug interaction

↑ metabolism and may ↓ levels of phenytoin, disopyramide, mexiletine, quinidine, chloramphenicol, clarithromycin, dapsone, doxycycline, fluoroquinolones, warfarin, fluconazole, itraconazole, ketoconazole, some sedative/hypnotics (benzodiazepines and barbiturates ), some beta blockers, some calcium channel blockers, corticosteroids, digoxin, hormonal contraceptives, haloperidol, protease inhibitors (indinavir, ritonavir, nelfinavir, saquinavir ), sulfonylurea oral hypoglycemic agents, cyclosporine, tacrolimus, levothyroxine, some opioids, progestins, quinine, reverse transcriptase inhibitors (delavirdine, zidovudine ), sildenafil, theophylline, some reverse transcriptase inhibitors, and tricyclicantidepressants ; dosage adjustments may be necessary.Antacids ↓ absorption.Food ↑ absorption.

Route/Dosage

Must be used in combination with other antituberculars
Oral (Adults) Intensive phase—600 mg twice weekly (not less than 72 hr between doses) for 2 mo;continuation phase—600 mg once weekly for 4 mo.

Availability

Tablets: 150 mg

Nursing implications

Nursing assessment

  • Mycobacterial studies and susceptibility tests should be performed prior to and periodically throughout therapy to detect possible resistance.
  • Assess lung sounds and character and amount of sputum periodically throughout therapy.
  • Monitor bowel function. Diarrhea, abdominal cramping, fever, and bloody stools should be reported to health care professional promptly as a sign of pseudomembranous colitis. May begin up to several weeks following cessation of therapy.
  • Lab Test Considerations: Assess hepatic enzymes, bilirubin, CBC, and platelet count prior to therapy. Monitor at least monthly, especially in relation to adverse reactions. Patients with liver disease or abnormal liver tests should have liver tests (especially AST and ALT) monitored every 2–4 weeks. Signs of worsening disease may require discontinuation.
    • May interfere with methods for determining serum folate and vitamin B levels and with urine tests based on color reaction.
    • Hyperuricemia is common during intensive phase, especially when combined with pyrazinamide.

Potential Nursing Diagnoses

Risk for infection (Indications)
Noncompliance (Patient/Family Teaching)

Implementation

  • Rifapentine is not administered alone. When used with isoniazid, pyridoxine (vitamin B) is administered concurrently in patients who are malnourished, predisposed to neuropathy (patients with alcoholism or diabetes), or adolescents to prevent neuropathy.
  • Oral: May be administered with food to minimize nausea, vomiting, or GI upset.
    • Antacids should not be administered within 1 hr before or 2 hr after rifapentine.

Patient/Family Teaching

  • Advise patient to take medication exactly as directed; not to skip doses or double up on missed doses of daily companion medications. 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.
  • Advise patient to notify health care professional promptly if fever, malaise, darkened urine, yellow eyes and skin, nausea, vomiting, anorexia, or pain or swelling of joints occur.
  • Instruct patient to notify health care professional if fever and diarrhea develop, especially if stool contains blood, pus, or mucus. Advise patient not to treat diarrhea without consulting health care professional.
  • Caution patient to avoid the use of alcohol during this therapy, because this may increase the risk of hepatotoxicity.
  • Rifapentine may occasionally cause dizziness. Caution patient to avoid driving or other activities requiring alertness until response to medication is known.
  • Inform patient that saliva, sputum, teeth, tongue, sweat, tears, CSF, urine, and feces may become red-orange, and that soft contact lenses may become permanently discolored.
  • Advise patient that this medication has teratogenic properties and may decrease the effectiveness of oral contraceptives. Counsel patient to use a nonhormonal form of contraception throughout therapy.
  • Emphasize the importance of regular follow-up exams to monitor progress and to check for side effects.

Evaluation/Desired Outcomes

  • Decreased fever and night sweats.
    • Diminished cough and sputum production.
    • Negative sputum cultures.
    • Increased appetite.
    • Weight gain.
    • Reduced fatigue.
    • Increased sense of well-being in patients with tuberculosis.

Priftin®

Rifapentine, see there.
Mentioned in ?
References in periodicals archive ?
1, 2015 /PRNewswire/ -- Sanofi announced today the launch of a new 24-count tablet pack of Priftin (rifapentine) for the treatment of latent tuberculosis infection (LTBI) in patients two years of age and older who are at high risk of progression to tuberculosis (TB) disease.
Sanofi also announced today the introduction of 32-count blister package of Priftin which is tailored for use in the treatment of active TB.
In December 2014, Sanofi announced the FDA approval of Priftin in combination with isoniazide (INH) for the treatment of LTBI caused by Mycobacterium tuberculosis in patients at high risk of progression to tuberculosis disease.
Sanofi has a long-standing history in the fight against TB and believes that the availability of new Priftin packaging reinforces its commitment to patients.
Active Pulmonary Tuberculosis Priftin (rifapentine) is indicated in adults and children 12 years and older for the treatment of active pulmonary tuberculosis caused by Mycobacterium tuberculosis.
Limitations of Use Do not use Priftin monotherapy in either the initial or the continuation phases of active antituberculosis treatment.
Priftin is an antimycobacterial that has been approved since 1998, in combination with one or more antituberculosis drugs, for the treatment of active pulmonary TB caused by Mycobacterium tuberculosis.
The new approval for Priftin exemplifies the commitment to treating TB upheld by Sanofi for more than a half century.
The new approval for Priftin was based in part on the PREVENT TB study conducted by the CDC-Tuberculosis Trials Consortium (TBTC) and published in the New England Journal of Medicine in 2011.
Priftin must always be used in combination with one or more antituberculosis drugs to which the isolate is susceptible.
In Priftin studies, the most common adverse reactions with the regimen for active pulmonary tuberculosis (greater than or equal to 1%) are anemia, lymphopenia, neutropenia, increased alanine aminotransferase (ALT), arthralgia, conjunctivitis, headache, vomiting, nausea, diarrhea, rash, pruritus, anorexia and lymphadenopathy.
Please click here for full Prescribing Information for Priftin (rifapentine): http://products.