Pharmacologic class: Rifamycin derivative
Therapeutic class: Antitubercular
Pregnancy risk category C
Inhibits RNA synthesis by blocking RNA transcription in susceptible organisms (mycobacteria and some gram-positive and gram-negative bacteria)
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.
• Mycobacterium avium intracellulare complex infection
• Hypersensitivity to drug or other rifamycin derivatives
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.
• 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.
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
Metabolic: hyperuricemia, hypovolemia, hyperkalemia
Musculoskeletal: gout, arthritis, joint pain
Skin: rash, pruritus, acne, urticaria, discolored skin and sweat
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
• 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.
☞ 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.
- Must be used in combination with other agents.
Time/action profile (blood levels)
Adverse Reactions/Side Effects
Central nervous system
- pseudomembranous colitis (life-threatening)
- ↑ liver enzymes
- urinary casts
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/DosageMust be used in combination with other antituberculars
- 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 DiagnosesRisk for infection (Indications)
Noncompliance (Patient/Family Teaching)
- 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.
- 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.
- 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.