rifapentine


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rifapentine

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

rifapentine

Priftin

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

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 ?
TBTC Study 35 is a Phase I/II dose finding and safety study of rifapentine and isoniazid in HIV-infected and HIV-uninfected children with latent tuberculosis infection.
Our analysis did not consider 3 months of once-weekly isoniazid and rifapentine as an LTBI treatment modality because it was not universally available.
Therefore, CDC recommends either 3 months of once-weekly rifapentine plus isoniazid or 4 months of daily rifampin for treatment of LTBI; these regimens may be used instead of longer courses of isoniazid alone (10).
Cost is another barrier: preventive therapy for latent TB (based on rifapentine and isoniazid regimen) is very effective but expensive: "we need to find a way to do global negotiations for quality assured standardized drug procurement so that we can reduce the cost of this regimen and make it more affordable for people" said Dr Nhung.
This prospective observational study aimed to compare the incidences of hepatitis and side effects between a new 2-month combination regimen of isoniazid, rifampin and pyrazinamid (2HRZ) plus excipient and the standard 3-month regimen of isoniazid and rifapentine (3HP) for LTBI treatment in Taiwan.
'What we have successfully done in Karachi [Pakistan] in terms of patient compliance is to employ shorter treatment regimens to treat latent TB infection: Rifapentine and isoniazid once weekly dosing for three months was offered as an alternative to the usual six months of isoniazid as preventive treatment.
As shown in Table 1, all of the compounds tested inhibited MMP in all three cell types tested, and some of these compounds, such as antimycin A, lasalocid, rifampicin, rifapentine, and thidiazuron, exhibited similar potencies across the three cell types.
Study participants were randomly assigned to a one-month course of rifapentine and Isoniazid or a nine-month course of Isoniazid.
RIF is not taken together with rifapentine. The latter tinge urine and tears an orange color.
With LTBI there are now 4 treatment options for patients and physicians to consider: (9) isoniazid given daily or twice weekly for either 6 or 9 months; isoniazid and rifapentine given once weekly for 3 months; or rifampin given daily for 4 months.
Antituberculosis therapy (300 mg/d of isoniazid, 750 mg/d of ethambutol, and 450 mg rifapentine twice a week) was administered to her, owing to the positive PPD result.