Pregnancy Category: C
Treatment of pulmonary tuberculosis:
- Must be used in combination with other agents.
Inhibits DNA-dependent RNA polymerase.
Bactericidal action against intracellular and extracellular susceptible strains of Mycobacterium tuberculosis.
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)
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
- 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
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.
Tablets: 150 mg
- 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.