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Medication Safety Issues
Sound-alike/look-alike issues:
Rifadin® may be confused with Rifater®, Ritalin®
Rifampin may be confused with rifabutin, Rifamate®, rifapentine, rifaximin
Pronunciation
(rif AM pin)
U.S. Brand Names
Index Terms
Generic Available
Yes
Canadian Brand Names
Pharmacologic Category
Pharmacologic Category Synonyms
Use: Labeled Indications
Management of active tuberculosis in combination with other agents; elimination of meningococci from the nasopharynx in asymptomatic carriers
Use: Unlabeled/Investigational
Prophylaxis of Haemophilus influenzae type b infection; Legionella pneumonia; used in combination with other anti-infectives in the treatment of staphylococcal infections; treatment of M. leprae infections
Pregnancy Risk Factor
C
Pregnancy Considerations
Teratogenic effects have bee reported in animal studies. Rifampin crosses the human placenta. Due to the risk of tuberculosis to the fetus, treatment is recommended when the probability of maternal disease is moderate to high. Postnatal hemorrhages have been reported in the infant and mother with isoniazid administration during the last few weeks of pregnancy.
Lactation
Enters breast milk/not recommended (AAP rates “compatible”)
Contraindications
Hypersensitivity to rifampin, any rifamycins, or any component of the formulation; concurrent use of amprenavir, saquinavir/ritonavir (possibly other protease inhibitors)
Warnings/Precautions
Concerns related to adverse effects:
• Flu-like syndrome: Regimens of >600 mg once or twice weekly have been associated with a high incidence of adverse reactions including a flu-like syndrome.
• Hematologic effects: May cause thrombocytopenia, leukopenia, or anemia with regimens >600 mg once or twice weekly.
• Hyperbilirubinemia: Discontinue therapy if this occurs in conjunction with clinical symptoms or any signs of significant hepatocellular damage develop.
• Hypersensitivity: Hypersensitivity reactions have occurred in patients taking >600 mg once or twice weekly.
• Superinfection: Prolonged use may result in fungal or bacterial superinfection, including C. difficile-associated diarrhea (CDAD) and pseudomembranous colitis; CDAD has been observed >2 months postantibiotic treatment.
Disease-related concerns:
• Alcoholism: Use with caution in patients with a history of alcoholism (even if ethanol consumption is discontinued during therapy).
• Hepatic impairment: Use with caution in patients with liver impairment; dosage modification recommended.
• Meningococcal disease: Do not use for meningococcal disease, only for short-term treatment of asymptomatic carrier states.
• Porphyria: Use with caution in patients with porphyria; exacerbations have been reported due to enzyme-inducing properties.
Concurrent drug therapy issues:
• Medications associated with hepatotoxicity: Use with caution in patients receiving concurrent medications associated with hepatotoxicity.
Other warnings/precautions:
• Appropriate administration: Do not administer I.V. form via I.M. or SubQ routes; restart infusion at another site if extravasation occurs.
• Compliance: Monitor for compliance in patients on intermittent therapy.
• Contact lenses: Remove soft contact lenses during therapy since permanent staining may occur.
• Red/orange discoloration: Urine, feces, saliva, sweat, tears, and CSF may be discolored to red/orange.
Adverse Reactions
Frequency not defined:
Cardiovascular: Edema, flushing
Central nervous system: Ataxia, behavioral changes, concentration impaired, confusion, dizziness, drowsiness, fatigue, fever, headache, numbness, psychosis
Dermatologic: Pemphigoid reaction, pruritus, urticaria
Endocrine & metabolic: Adrenal insufficiency, menstrual disorders
Hematologic: Agranulocytosis (rare), DIC, eosinophilia, hemoglobin decreased, hemolysis, hemolytic anemia, leukopenia, thrombocytopenia (especially with high-dose therapy)
Hepatic: Hepatitis (rare), jaundice
Neuromuscular & skeletal: Myalgia, osteomalacia, weakness
Ocular: Exudative conjunctivitis, visual changes
Renal: Acute renal failure, BUN increased, hemoglobinuria, hematuria, interstitial nephritis, uric acid increased
Miscellaneous: Flu-like syndrome
1% to 10%:
Dermatologic: Rash (1% to 5%)
Gastrointestinal (1% to 2%): Anorexia, cramps, diarrhea, epigastric distress, flatulence, heartburn, nausea, pseudomembranous colitis, pancreatitis vomiting
Hepatic: LFTs increased (up to 14%)
Metabolism/Transport Effects
Induces CYP1A2 (strong), 2A6 (strong), 2B6 (strong), 2C8 (strong), 2C9 (strong), 2C19 (strong), 3A4 (strong)
Drug Interactions
Alfentanil: Rifamycin Derivatives may increase the metabolism of Alfentanil. Risk D: Consider therapy modification
Amiodarone: Rifamycin Derivatives may increase the metabolism of Amiodarone. Risk C: Monitor therapy
Angiotensin II Receptor Blockers: Rifamycin Derivatives may increase the metabolism of Angiotensin II Receptor Blockers. Exceptions: Candesartan; Eprosartan; Olmesartan; Telmisartan; Valsartan. Risk C: Monitor therapy
Antidiabetic Agents (Thiazolidinedione): Rifampin may increase the metabolism of Antidiabetic Agents (Thiazolidinedione). Risk C: Monitor therapy
Antiemetics (5HT3 Antagonists): Rifamycin Derivatives may increase the metabolism of Antiemetics (5HT3 Antagonists). Exceptions: Dolasetron; Granisetron; Palonosetron. Risk C: Monitor therapy
Antifungal Agents (Azole Derivatives, Systemic): May increase the serum concentration of Rifamycin Derivatives. Only rifabutin appears to be affected. Rifamycin Derivatives may decrease the serum concentration of Antifungal Agents (Azole Derivatives, Systemic). Exceptions: Miconazole. Risk D: Consider therapy modification
Aprepitant: Rifamycin Derivatives may increase the metabolism of Aprepitant. Risk C: Monitor therapy
Atovaquone: Rifamycin Derivatives may decrease the serum concentration of Atovaquone. Risk D: Consider therapy modification
Barbiturates: Rifamycin Derivatives may increase the metabolism of Barbiturates. Risk C: Monitor therapy
Bendamustine: CYP1A2 Inducers (Strong) may decrease the serum concentration of Bendamustine. Concentrations of active metabolites may be increased. Risk C: Monitor therapy
Benzodiazepines (metabolized by oxidation): Rifamycin Derivatives may increase the metabolism of Benzodiazepines (metabolized by oxidation). Risk D: Consider therapy modification
Beta-Blockers: Rifamycin Derivatives may decrease the serum concentration of Beta-Blockers. Exceptions: Atenolol; Carteolol; Levobunolol; Metipranolol; Nadolol. Risk C: Monitor therapy
BusPIRone: Rifamycin Derivatives may increase the metabolism of BusPIRone. Risk D: Consider therapy modification
Calcium Channel Blockers: Rifamycin Derivatives may increase the metabolism of Calcium Channel Blockers. This primarily affects oral forms of calcium channel blockers. Risk D: Consider therapy modification
Caspofungin: Rifampin may decrease the serum concentration of Caspofungin. Risk D: Consider therapy modification
Chloramphenicol: Rifampin may increase the metabolism of Chloramphenicol. Risk D: Consider therapy modification
Clopidogrel: Rifamycin Derivatives may enhance the therapeutic effect of Clopidogrel. Risk C: Monitor therapy
Contraceptive (Progestins): Rifamycin Derivatives may decrease the serum concentration of Contraceptive (Progestins). Contraceptive failure is possible. Risk D: Consider therapy modification
Corticosteroids (Systemic): Rifamycin Derivatives may increase the metabolism of Corticosteroids (Systemic). Risk C: Monitor therapy
Coumarin Derivatives: Rifamycin Derivatives may increase the metabolism of Coumarin Derivatives. Risk C: Monitor therapy
CycloSPORINE: Rifamycin Derivatives may increase the metabolism of CycloSPORINE. Risk D: Consider therapy modification
CYP1A2 Substrates: CYP1A2 Inducers (Strong) may increase the metabolism of CYP1A2 Substrates. Risk C: Monitor therapy
CYP2A6 Substrates: CYP2A6 Inducers (Strong) may increase the metabolism of CYP2A6 Substrates. Risk C: Monitor therapy
CYP2B6 Substrates: CYP2B6 Inducers (Strong) may increase the metabolism of CYP2B6 Substrates. Risk C: Monitor therapy
CYP2C19 Substrates: CYP2C19 Inducers (Strong) may increase the metabolism of CYP2C19 Substrates. Risk C: Monitor therapy
CYP2C8 Substrates (High risk with Highly Effective Inducers): CYP2C8 Inducers (Highly Effective) may increase the metabolism of CYP2C8 Substrates (High risk with Highly Effective Inducers). Risk C: Monitor therapy
CYP2C9 Substrates (High risk with Highly Effective Inducers): CYP2C9 Inducers (Highly Effective) may increase the metabolism of CYP2C9 Substrates (High risk with Highly Effective Inducers). Risk C: Monitor therapy
CYP3A4 Substrates: CYP3A4 Inducers (Strong) may increase the metabolism of CYP3A4 Substrates. Risk C: Monitor therapy
Dapsone: Rifamycin Derivatives may increase the metabolism of Dapsone. Risk D: Consider therapy modification
Delavirdine: May decrease the metabolism of Rifamycin Derivatives. Rifamycin Derivatives may increase the metabolism of Delavirdine. Risk D: Consider therapy modification
Disopyramide: Rifamycin Derivatives may increase the metabolism of Disopyramide. Risk D: Consider therapy modification
Efavirenz: Rifampin may decrease the serum concentration of Efavirenz. Management: Efavirenz dose adjustment (to 800mg daily) may be required, particularly for patients weighing more than 60kg. Risk C: Monitor therapy
Erlotinib: Rifampin may increase the metabolism of Erlotinib. Risk D: Consider therapy modification
Etravirine: Rifamycin Derivatives may decrease the serum concentration of Etravirine. Risk X: Avoid combination
Exemestane: Rifampin may increase the metabolism of Exemestane. Risk D: Consider therapy modification
Fentanyl: Rifamycin Derivatives may decrease the serum concentration of Fentanyl. Risk C: Monitor therapy
Fexofenadine: Rifampin may decrease the serum concentration of Fexofenadine. Risk C: Monitor therapy
Fluconazole: May decrease the metabolism of Rifamycin Derivatives. This appears only affect rifabutin. Rifamycin Derivatives may increase the metabolism of Fluconazole. Risk C: Monitor therapy
Fosaprepitant: Rifampin may decrease the serum concentration of Fosaprepitant. More specifically, rifampin may decrease concentrations of the active metabolite aprepitant. Risk C: Monitor therapy
Gefitinib: Rifamycin Derivatives may increase the metabolism of Gefitinib. Risk D: Consider therapy modification
HMG-CoA Reductase Inhibitors: Rifamycin Derivatives may increase the metabolism of HMG-CoA Reductase Inhibitors. Exceptions: Rosuvastatin. Risk D: Consider therapy modification
Imatinib: Rifamycin Derivatives may increase the metabolism of Imatinib. Risk D: Consider therapy modification
Isoniazid: Rifamycin Derivatives may enhance the hepatotoxic effect of Isoniazid. Even so, this is a frequently employed combination regimen. Risk C: Monitor therapy
Lamotrigine: Rifampin may increase the metabolism of Lamotrigine. Risk C: Monitor therapy
Macrolide Antibiotics: May decrease the metabolism of Rifamycin Derivatives. Exceptions: Azithromycin; Dirithromycin [Off Market]; Spiramycin. Risk D: Consider therapy modification
Maraviroc: CYP3A4 Inducers may decrease the serum concentration of Maraviroc. Risk D: Consider therapy modification
Methadone: Rifamycin Derivatives may increase the metabolism of Methadone. Risk C: Monitor therapy
Morphine Sulfate: Rifamycin Derivatives may decrease the serum concentration of Morphine Sulfate. Risk C: Monitor therapy
Mycophenolate: Rifamycin Derivatives may decrease the serum concentration of Mycophenolate. Specifically, rifamycin derivatives may decrease the concentration of the active metabolite mycophenolic acid. Risk X: Avoid combination
Nevirapine: Rifampin may decrease the serum concentration of Nevirapine. Risk D: Consider therapy modification
Nilotinib: CYP3A4 Inducers (Strong) may decrease the serum concentration of Nilotinib. Risk X: Avoid combination
Oral Contraceptive (Estrogens): Rifamycin Derivatives may decrease the serum concentration of Oral Contraceptive (Estrogens). Contraceptive failure is possible. Risk D: Consider therapy modification
Phenytoin: Rifamycin Derivatives may increase the metabolism of Phenytoin. Risk D: Consider therapy modification
Propafenone: Rifamycin Derivatives may increase the metabolism of Propafenone. Risk D: Consider therapy modification
Protease Inhibitors: Rifamycin Derivatives may increase the metabolism of Protease Inhibitors. Rifampin administration should be avoided. Dosage adjustments with both rifabutin and the protease inhibitors are necessary if used together. Protease Inhibitors may decrease the metabolism of Rifamycin Derivatives. Specifically rifabutin. Risk D: Consider therapy modification
Pyrazinamide: May enhance the hepatotoxic effect of Rifampin. Severe (even fatal) liver injury has been reported in patients receiving these 2 drugs as a 2-month treatment regimen for latent TB infection. Risk D: Consider therapy modification
Quinidine: Rifamycin Derivatives may increase the metabolism of Quinidine. Risk D: Consider therapy modification
Raltegravir: Rifampin may decrease the serum concentration of Raltegravir. Risk C: Monitor therapy
Ramelteon: Rifamycin Derivatives may increase the metabolism of Ramelteon. Risk C: Monitor therapy
Ranolazine: Rifampin may decrease the serum concentration of Ranolazine. Risk X: Avoid combination
Repaglinide: Rifamycin Derivatives may increase the metabolism of Repaglinide. Risk C: Monitor therapy
Sirolimus: Rifampin may increase the metabolism of Sirolimus. Risk D: Consider therapy modification
Sorafenib: CYP3A4 Inducers (Strong) may decrease the serum concentration of Sorafenib. Risk D: Consider therapy modification
Sulfonylureas: Rifampin may increase the metabolism of Sulfonylureas. Risk C: Monitor therapy
Sunitinib: Rifamycin Derivatives may increase the metabolism of Sunitinib. Risk D: Consider therapy modification
Tacrolimus: Rifamycin Derivatives may increase the metabolism of Tacrolimus. Risk D: Consider therapy modification
Tamoxifen: Rifamycin Derivatives may increase the metabolism of Tamoxifen. Risk C: Monitor therapy
Temsirolimus: Rifamycin Derivatives may decrease the serum concentration of Temsirolimus. Rifamycins will likely cause an even greater decrease in the concentration of the active metabolite sirolimus. Management: Temsirolimus prescribing information recommends against coadministration with strong CYP3A4 inducers such as rifampin; however, if concurrent therapy is necessary, an increase in temsirolimus dose to 50 mg/week should be considered. Risk D: Consider therapy modification
Terbinafine: Rifamycin Derivatives may increase the metabolism of Terbinafine. Risk D: Consider therapy modification
Thyroid Products: Rifampin may decrease the serum concentration of Thyroid Products. Risk C: Monitor therapy
Tocainide: Rifamycin Derivatives may increase the metabolism of Tocainide. Risk C: Monitor therapy
Typhoid Vaccine: Antibiotics may diminish the therapeutic effect of Typhoid Vaccine. Only the live attenuated Ty21a strain is affected. Risk D: Consider therapy modification
Valproic Acid: Rifampin may decrease the serum concentration of Valproic Acid. Risk D: Consider therapy modification
Voriconazole: May increase the serum concentration of Rifamycin Derivatives. Rifamycin Derivatives may decrease the serum concentration of Voriconazole. Risk X: Avoid combination
Zaleplon: Rifamycin Derivatives may increase the metabolism of Zaleplon. Risk C: Monitor therapy
Zidovudine: Rifamycin Derivatives may increase the metabolism of Zidovudine. Risk D: Consider therapy modification
Zolpidem: Rifamycin Derivatives may increase the metabolism of Zolpidem. Risk C: Monitor therapy
Ethanol/Nutrition/Herb Interactions
Ethanol: Avoid ethanol (may increase risk of hepatotoxicity).
Food: Food decreases the extent of absorption; rifampin concentrations may be decreased if taken with food.
Herb/Nutraceutical: St John's wort may decrease rifampin levels.
Storage
Rifampin powder is reddish brown. Intact vials should be stored at room temperature and protected from excessive heat and light. Reconstituted vials are stable for 24 hours at room temperature.
Stability of parenteral admixture at room temperature (25°C) is 4 hours for D5W and 24 hours for NS.
Reconstitution
Reconstitute powder for injection with SWFI. Prior to injection, dilute in appropriate volume of compatible diluent (eg, 100 mL D5W).
Compatibility
Variable stability (consult detailed reference) in D5W, NS.
Y-site administration: Incompatible: Diltiazem.
Compatibility when admixed: Incompatible: Minocycline.
Mechanism of Action
Inhibits bacterial RNA synthesis by binding to the beta subunit of DNA-dependent RNA polymerase, blocking RNA transcription
Pharmacodynamics/Kinetics
Duration: ?24 hours
Absorption: Oral: Well absorbed; food may delay or slightly reduce peak
Distribution: Highly lipophilic; crosses blood-brain barrier well
Relative diffusion from blood into CSF: Adequate with or without inflammation (exceeds usual MICs)
CSF:blood level ratio: Inflamed meninges: 25%
Protein binding: 80%
Metabolism: Hepatic; undergoes enterohepatic recirculation
Half-life elimination: 3-4 hours; prolonged with hepatic impairment; End-stage renal disease: 1.8-11 hours
Time to peak, serum: Oral: 2-4 hours
Excretion: Feces (60% to 65%) and urine (?30%) as unchanged drug
Dosage
Usual dosage ranges: Oral, I.V.:
Infants & Children: 10-20 mg/kg/day as a single dose or in 2 divided doses; maximum: 600 mg/day
Adults: 600 mg once or twice daily
Indication-specific dosing: Oral, I.V.:
H. influenzae
prophylaxis (unlabeled use):
Infants and Children: 20 mg/kg/day every 24 hours for 4 days, not to exceed 600 mg/dose
Adults: 600 mg every 24 hours for 4 days
Leprosy (unlabeled use): Adults:
Multibacillary: 600 mg once monthly for 24 months in combination with ofloxacin and minocycline
Paucibacillary: 600 mg once monthly for 6 months in combination with dapsone
Single lesion: 600 mg as a single dose in combination with ofloxacin 400 mg and minocycline 100 mg
Meningitis
(Pneumococcus
or
Staphylococcus)
(unlabeled use): Recommended only for organisms known to be rifampin-susceptible and highly penicillin- or cephalosporin-resistant. May be used in place of or in addition to vancomycin when dexamethasone therapy employed.
Infants and Children: 20 mg/kg/day as a single dose or in 2 divided doses; maximum: 600 mg/day
Adults: 600 mg once daily
Meningococcal meningitis prophylaxis (unlabeled use):
Infants <1 month: 10 mg/kg/day in divided doses every 12 hours for 2 days
Infants ?1 month and Children: 20 mg/kg/day in divided doses every 12 hours for 2 days (maximum: 600 mg/dose)
Adults: 600 mg every 12 hours for 2 days
Nasal carriers of
Staphylococcus aureus
(unlabeled use):
Children: 15 mg/kg/day divided every 12 hours for 5-10 days in combination with other antibiotics
Adults: 600 mg/day for 5-10 days in combination with other antibiotics
Nontuberculous mycobacterium (
M. kansasii
) (unlabeled use): Adults: 10 mg/kg/day (maximum: 600 mg/day) for duration to include 12 months of culture-negative sputum; typically used in combination with ethambutol and isoniazid
Synergy for
Staphylococcus aureus
infections (unlabeled use): Adults: 300-600 mg twice daily with other antibiotics
Tuberculosis, active: Note: A four-drug regimen (isoniazid, rifampin, pyrazinamide, and ethambutol) is preferred for the initial, empiric treatment of TB. When the drug susceptibility results are available, the regimen should be altered as appropriate.
Infants and Children <12 years:
Daily therapy: 10-20 mg/kg/day usually as a single dose (maximum: 600 mg/day)
Twice weekly directly observed therapy (DOT): 10-20 mg/kg (maximum: 600 mg)
Adults:
Daily therapy: 10 mg/kg/day (maximum: 600 mg/day)
Twice weekly directly observed therapy (DOT): 10 mg/kg (maximum: 600 mg); 3 times/week: 10 mg/kg (maximum: 600 mg)
Tuberculosis, latent infection (LTBI): As an alternative to isoniazid:
Children: 10-20 mg/kg/day (maximum: 600 mg/day) for 6 months
Adults: 10 mg/kg/day (maximum: 600 mg/day) for 4 months. Note: Combination with pyrazinamide should not generally be offered (MMWR, Aug 8, 2003).
Dosing adjustment in hepatic impairment: Dose reductions may be necessary to reduce hepatotoxicity
Hemodialysis or peritoneal dialysis: Plasma rifampin concentrations are not significantly affected by hemodialysis or peritoneal dialysis.
Administration: Oral
Administer on an empty stomach with a glass of water (ie, 1 hour prior to, or 2 hours after meals or antacids) to increase total absorption (food may delay and reduce the amount of rifampin absorbed). The compounded oral suspension must be shaken well before using. May mix contents of capsule with applesauce or jelly.
Administration: I.M.
Do not administer I.M. or SubQ
Administration: I.V.
Administer I.V. preparation once daily by slow I.V. infusion over 30 minutes to 3 hours at a final concentration not to exceed 6 mg/mL.
Administration: I.V. Detail
Avoid extravasation.
pH: 7.8-8.8
Monitoring Parameters
Periodic (baseline and every 2-4 weeks during therapy) monitoring of liver function (AST, ALT, bilirubin), CBC; hepatic status and mental status, sputum culture, chest x-ray 2-3 months into treatment
Test Interactions
Positive Coombs' reaction [direct], rifampin inhibits standard assay's ability to measure serum folate and B12; transient increase in LFTs and decreased biliary excretion of contrast media
Dietary Considerations
Rifampin should be taken on an empty stomach.
Patient Education
Do not take any new medication during therapy without consulting prescriber. Rifampin may be prescribed in conjunction with another medication; maintain dosing schedule of both drugs as directed. Take rifampin on an empty stomach, 1 hour before or 2 hours after meals. It is extremely important that you complete full course of therapy and do not skip doses. Keep appointments for scheduled laboratory tests and chest x-rays. This medication will discolor urine, stool, saliva, tears, sweat, and other body fluid a red-brown color. Stains on contact lenses and clothing are permanent. Report persistent vomiting or diarrhea; rash; fever, chills, or flu-like symptoms; unusual bruising or bleeding; or other persistent adverse effects. Pregnancy precaution: Inform prescriber if you are or intend to become pregnant. This drug may interfere with effectiveness of oral/systemic contraceptives; consult prescriber for alternative contraceptive measures.
Geriatric Considerations
Rifampin, in combination with isoniazid, is the foundation of tuberculosis treatment. Since most older patients acquired their Mycobacterium tuberculosis infection before effective chemotherapy was available, either a 9-month regimen of isoniazid and rifampin or a 6-month regimen of isoniazid and rifampin with pyrazinamide (the first 2 months) should be effective.
Anesthesia and Critical Care Concerns/Other Considerations
Rifampin causes body secretions to turn orange and may stain contact lenses.
Dental Health: Effects on Dental Treatment
No significant effects or complications reported
Dental Health: Vasoconstrictor/Local Anesthetic Precautions
No information available to require special precautions
Mental Health: Effects on Mental Status
May cause drowsiness, dizziness, confusion, behavioral changes, or ataxia; report of cognitive disturbances, delusions, and hallucinations
Mental Health: Effects on Psychiatric Treatment
May cause leukopenia; use caution with clozapine and carbamazepine; rifampin is a potent hepatic enzyme inducer; monitor for altered clinical effects when used concurrently with psychotropics
Nursing: Physical Assessment/Monitoring
Assess potential for interactions with other pharmacological agents patient may be taking (eg, concurrent use with rifampin may decrease levels/effects of multiple other drugs, including some oral contraceptives, anticoagulants, hypoglycemics, and beta-blockers). See Administration for infusion specifics; infusion site must be monitored to prevent extravasation. Assess results of periodic laboratory tests and chest x-ray, therapeutic effectiveness, and adverse reactions (eg, hypersensitivity reactions, hepatotoxicity, CNS changes, hematologic changes, visual disturbances, and gastrointestinal upset) on a regular basis during therapy. Monitor patient compliance with treatment regimen. Teach patient proper use, possible side effects/appropriate interventions, and adverse symptoms to report.
Dosage Forms
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Capsule: 150 mg, 300 mg
Injection, powder for reconstitution: 600 mg
Pricing: U.S. (www.drugstore.com)
Capsules (Rifadin)
150 mg (60): $136.70
Capsules (Rifampin)
300 mg (30): $59.99
Extemporaneously Prepared
For pediatric and adult patients with difficulty swallowing or where lower doses are needed, the package insert lists an extemporaneous liquid suspension as follows:
Rifampin 1% w/v suspension (10 mg/mL) can be compounded using one of four syrups (Syrup NF, simple syrup, Syrpalta® syrup, or raspberry syrup)
Empty contents of four 300 mg capsules or eight 150 mg capsules onto a piece of weighing paper
If necessary, crush contents to produce a fine powder
Transfer powder blend to a 4 oz amber glass or plastic prescription bottle
Rinse paper and spatula with 20 mL of syrup and add the rinse to bottle; shake vigorously
Add 100 mL of syrup to the bottle and shake vigorously
This compounding procedure results in a 1% w/v suspension containing 10 mg rifampin/mL; stability studies indicate suspension is stable at room temperature (25°C ± 3°C) or in refrigerator (2°C to 8°C) for 4 weeks; shake well prior to administration
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International Brand Names
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Last full review/revision August 2008
Content last modified August 2008
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