Rifadin


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Related to Rifadin: rifampin

rifampin

(rif-am-pin) ,

Rifadin

(trade name),

Rofact

(trade name)

Classification

Therapeutic: antituberculars
Pharmacologic: rifamycins
Pregnancy Category: C

Indications

Active tuberculosis (with other agents).Elimination of meningococcal carriers.Prevention of disease caused by Haemophilus influenzae type B in close contacts.Synergy with other antimicrobial agents for S. aureus infections.

Action

Inhibits RNA synthesis by blocking RNA transcription in susceptible organisms.

Therapeutic effects

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

Pharmacokinetics

Absorption: Well absorbed following oral administration.
Distribution: Widely distributed; enters CSF. Crosses placenta; enters breast milk.
Protein Binding: 80%.
Metabolism and Excretion: Mostly metabolized by the liver; 60% eliminated in feces via biliary elimination.
Half-life: 3 hr.

Time/action profile (blood levels)

ROUTEONSETPEAKDURATION
POrapid2–4 hr12–24 hr
IVrapidend of infusion12–24 hr

Contraindications/Precautions

Contraindicated in: Hypersensitivity;Concurrent use of atazanavir, darunavir, fosamprenavir, saquinavir, tipranavir, or ritonavir-boosted saquinavir.
Use Cautiously in: History of liver disease;Diabetes;Concurrent use of other hepatotoxic agents; Obstetric / Lactation: Pregnancy or lactation.

Adverse Reactions/Side Effects

Central nervous system

  • ataxia
  • confusion
  • drowsiness
  • fatigue
  • headache
  • weakness

Dermatologic

  • rash
  • pruritus

Ear, Eye, Nose, Throat

  • red discoloration of tears (most frequent)

Gastrointestinal

  • abdominal pain (most frequent)
  • diarrhea (most frequent)
  • flatulence (most frequent)
  • heartburn (most frequent)
  • nausea (most frequent)
  • vomiting (most frequent)
  • ↑ liver enzymes
  • red discoloration of saliva

Genitourinary

  • red discoloration of urine (most frequent)

Hematologic

  • hemolytic anemia
  • thrombocytopenia

Musculoskeletal

  • arthralgia
  • muscle weakness
  • myalgia

Miscellaneous

  • flu-like syndrome

Interactions

Drug-Drug interaction

↑ risk of hepatotoxicity with ritonavir-boosted saquinavir ; concurrent use contraindicated.Significantly ↓ blood levels of atazanavir, darunavir, fosamprenavir, saquinavir, and tipranavir ; concurrent use contraindicated.↑ risk of hepatotoxicity with other hepatotoxic agents, including alcohol, ketoconazole, isoniazid, pyrazinamide (concurrent use with pyrazinamide may result in potentially fatal hepatotoxicity and should be avoided).Significantly ↓ blood levels of delavirdine, indinavir, and nelfinavir.Rifampin stimulates liver enzymes, which may ↑ metabolism and ↓ effectiveness of other drugs, including ritonavir, nevirapine, and efavirenz (dose adjustment may be necessary), ciprofloxacin, clarithromycin, corticosteroids, cyclosporine, diazepam, diltiazem, disopyramide, doxycycline, levothyroxine, methadone, nifedipine, quinidine, opioid analgesics, oral hypoglycemic agents, warfarin, estrogens, phenytoin, phenobarbital, tacrolimus, verapamil, fluconazole, ketoconazole, itraconazole, quinidine, theophylline, zidovudine, chloramphenicol, and hormonal contraceptive agents.

Route/Dosage

Tuberculosis
Oral Intravenous (Adults) 600 mg/day or 10 mg/kg/day (up to 600 mg/day) single dose; may also be given twice weekly.
Oral Intravenous (Children and Infants) 10–20 mg/kg/day single dose or divided q 12 h (not to exceed 600 mg/day); may also be given twice weekly.
Asymptomatic Carriers of Meningococcus
Oral Intravenous (Adults) 600 mg q 12 hr for 2 days.
Oral Intravenous (Children ≥1 mo) 10 mg/kg q 12 hr for 2 days (max: 600 mg/dose).
Oral (Infants <1 mo) 5 mg/kg q 12 hr for 2 days.
H. influenzae Prophylaxis
Oral (Adults) 600 mg/day for 4 days.
Oral (Children) 20 mg/kg/day for 4 days (max: 600 mg/dose).
Oral (Neonates) 10 mg/kg/day for 4 days
Synergy for S.aureus infections
Oral (Adults) 300–600 mg BID.
Oral (Children and Neonates) 5–20 mg/kg/day divided q 12 h (max: 600 mg/dose).

Availability (generic available)

Capsules: 150 mg, 300 mg
Powder for injection: 600 mg/vial
In combination with: isoniazid (IsonaRif, Rifamate); isoniazid and pyrazinamide (Rifater). See combination drugs.

Nursing implications

Nursing assessment

  • 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.
  • Lab Test Considerations: 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.
    • May delay hepatic uptake and excretion of sulfobromophthalein (SBP) during SBP uptake and excretion tests; perform test prior to daily dose of rifampin.

Potential Nursing Diagnoses

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

Implementation

  • Do not confuse rifampin with rifabutin.
  • Oral: 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.
  • Intravenous Administration
  • pH: 7.8–8.8.
  • Intermittent Infusion: 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, midazolam, pantoprazole, vancomycin
  • Y-Site Incompatibility: diltiazem

Patient/Family Teaching

  • 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, sweat, tears, urine, and feces may become red-orange to red-brown 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.
    • 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.

Rifadin

(rĭf′ə-dĭn′)
A trademark for the drug rifampin.

Rifadin

a trademark for an antibacterial (rifampin).

Rifadin

A brand name for RIFAMPICIN.