rifapentine


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rifapentine

 [-pen´tēn]
a synthetic rifamycin antibiotic used in treatment of pulmonary tuberculosis, administered orally.

rifapentine

Pharmacologic class: Rifamycin derivative

Therapeutic class: Antitubercular

Pregnancy risk category C

Action

Inhibits RNA synthesis by blocking RNA transcription in susceptible organisms (mycobacteria and some gram-positive and gram-negative bacteria)

Availability

Tablets: 150 mg

Indications and dosages

Pulmonary tuberculosis (TB)

Adults:Intensive-phase treatment-600 mg P.O. twice weekly for 2 months, with doses spaced 72 hours apart; must be given with at least one other antitubercular. Continuation-phase treatment-600 mg P.O. once weekly for 4 months, given with another antitubercular.

Off-label uses

Mycobacterium avium intracellulare complex infection

Contraindications

• Hypersensitivity to drug or other rifamycin derivatives

Precautions

Use cautiously in:
• hepatic disorders, porphyria
• concurrent protease inhibitor therapy for human immunodeficiency virus infection
• elderly patients
• pregnant or breastfeeding patients
• children younger than age 12.

Administration

• Know that drug is given with at least one other antitubercular.
• Expect to give drug with pyridoxine to adolescents, malnourished patients, and patients at risk for neuropathy.

Adverse reactions

CNS: headache, fatigue, anxiety, dizziness, aggressive behavior

CV: hypertension, peripheral edema

EENT: visual disturbances; discolored tears, sputum, and saliva

GI: nausea, vomiting, diarrhea, dyspepsia, esophagitis, gastritis, discolored feces, anorexia, pancreatitis

GU: hematuria, pyuria, proteinuria, urinary casts, discolored urine

Hematologic: anemia, thrombocytosis, hematoma, purpura, eosinophilia, neutropenia, leukopenia

Hepatic: hepatitis

Metabolic: hyperuricemia, hypovolemia, hyperkalemia

Musculoskeletal: gout, arthritis, joint pain

Skin: rash, pruritus, acne, urticaria, discolored skin and sweat

Other: edema

Interactions

Drug-drug.Amitriptyline, anticoagulants, barbiturates, beta-adrenergic blockers, chloramphenicol, clofibrate, cortico-steroids, cyclosporine, dapsone, delavirdine, diazepam, digoxin, diltiazem, disopyramide, doxycycline, fentanyl, fluconazole, fluoroquinolones, haloperidol, hormonal contraceptives, indinavir, itraconazole, ketoconazole, methadone, mexiletine, nelfinavir, nifedipine, nortriptyline, oral hypoglycemics, phenothiazines, progestin, quinidine, quinine, ritonavir, saquinavir, sildenafil, tacrolimus, theophylline, thyroid preparations, tocainide, verapamil, warfarin, zidovudine: decreased actions of these drugs

Antiretroviral drugs: decreased efficacy of these drugs

Drug-diagnostic tests.Alanine aminotransferase, alkaline phosphatase, aspartate aminotransferase, bilirubin, eosinophils, lactate dehydrogenase, potassium, uric acid: increased levels

Folate, vitamin B12 assays: interference with standard assays

Hemoglobin, neutrophils, platelets, white blood cells: decreased values

Patient monitoring

• Monitor CBC, uric acid level, and liver function tests. Watch for signs and symptoms of blood dyscrasias and hepatitis.
• Assess vital signs and fluid intake and output. Stay alert for hypertension and edema.
• Closely monitor nutritional status and hydration.

Patient teaching

Instruct patient to immediately report fever, malaise, appetite loss, nausea, vomiting, or yellowing of skin or eyes.
• Emphasize importance of taking with companion drugs, as prescribed, to prevent growth of resistant TB strains.
• Tell patient drug may color tears, urine, and other body fluids reddish or brownish orange. Instruct him not to wear contact lenses during therapy, because drug may stain them permanently.
• Advise patient to take with meals and to minimize GI upset by eating small, frequent servings of healthy food and drinking plenty of fluids.
• Tell patient to monitor his weight and report sudden gains. Also tell him to report swelling.

Instruct patient to immediately report rash or unusual bleeding or bruising.

Caution patient to avoid driving and other hazardous activities until he knows how drug affects concentration, vision, and alertness.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs and tests mentioned above.

rifapentine

/rif·a·pen·tine/ (-pen´tēn) a synthetic rifamycin antibiotic used in the treatment of pulmonary tuberculosis.

rifapentine

an antitubercular.
indications Rifapentine is used to treat pulmonary tuberculosis. It must be used in combination with at least one other antitubercular.
contraindication Known hypersensitivity to rifamycin prohibits its use.
adverse effects Life-threatening effects include pancreatitis, hematuria, proteinuria, thrombocytopenia, leukopenia, neutropenia, lymphopenia, and leukocytosis. Other adverse effects include rash, pruritus, urticaria, acne, visual disturbances, gout, arthrosis, edema, aggressive reaction, bilirubinemia, hepatitis, increased AST/ALT, pyuria, urinary casts, headache, fatigue, anxiety, dizziness, anemia, purpura, and hematoma. Common side effects include nausea, vomiting, anorexia, diarrhea, and heartburn.

rifapentine

Priftin® Infectious disease An agent used for pulmonary TB and MAC with other agents–INH, pyrazinamide, ethambutol, streptomycin. See AIDS, Tuberculosis.
References in periodicals archive ?
The 3HP group was given once weekly, directly observed treatment with rifapentine (brand name Priftin; 900 mg) plus isoniazid (brand name Nydrazid, also known as isonicotinic acid hydrazide or INH; 15-25 mg/kg) for 3 months.
A trial comparing 9INH with 3 months of once weekly directly observed INH combined with rifapentine (3INH-RPT) has just been completed.
Activities of Sparfloxacin, Azithromycin, Temafloxacin, and Rifapentine Compared with That of Clarithromycin Against Multiplication of Mycobacterium Avium Complex Within Human Macrophages.
the antimycobacterials rifabutin, rifampin, rifapentine
Short-course chemotherapy with TMC207 and rifapentine in a murine model of latent tuberculosis infection.
Both fluoroquinolones have pharmacokinetics amenable to weekly dosing, as does rifapentine, a long-acting rifamycin developed in the 1990s.
Eviplera should not be taken with any of the following as significant decreases in the plasma concentrations of rilpivirine may occur which may cause loss of therapeutic effect of Eviplera: -the anticonvulsants carbamazepine, oxcarbazepine, phenobarbital, phenytoin -the antimycobacterials rifabutin, rifampicin, rifapentine -proton pump inhibitors, such as omeprazole, esomeprazole, lansoprazole, pantoprazole, rabeprazole -the systemic glucocorticoid dexamethasone, except as a single dose treatment -St John's wort (Hypericum perforatum).
Comparative antimycobacterial activities of rifampin, rifapentine, and KRM-1648 against a collection of rifampin-resistant Mycobacterium tuberculosis isolates with known rpoB mutations.
HIV-infected adults should be dosed the same as those without HIV, but rifampin or rifabutin should be used instead of rifapentine because of high rates of relapse among HIV patients given rifapentine, the recommendations state.
A study published in the New England Journal of Medicine showed that more patients completed the 12-dose, once-weekly regimen of directly observed rifapentine and INH than 9 months of daily self-administered INH.
phenytoin, carbamazepine, rifampicin, rifabutin, rifapentine, phenobarbital) should be avoided, or used with caution during treatment with ZYTIGA[sup.
The PREVENT TB Study (TB Trials Consortium Study 26) of 3 months of once-weekly rifapentine plus INH vs.