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1 Use Cautiously in: History of liver disease; Diabetes; Concurrent use of other hep-
atotoxic agents; OB, Lactation: Pregnancy or lactation.
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rifampin (rif-am-pin) Adverse Reactions/Side Effects
Rifadin, Rofact CNS: ataxia, confusion, drowsiness, fatigue, headache, weakness. Derm: rash, pru-
Classification ritus. EENT: red discoloration of tears. GI: abdominal pain, diarrhea, flatulence,
Therapeutic: antituberculars heartburn, nausea, vomiting,qliver enzymes, red discoloration of saliva. GU: red
Pharmacologic: rifamycins discoloration of urine. Hemat: hemolytic anemia, thrombocytopenia. MS: arthral-
Pregnancy Category C gia, muscle weakness, myalgia. Misc: flu-like syndrome.
Interactions
Indications Drug-Drug: qrisk of hepatotoxicity with ritonavir-boosted saquinavir;
Active tuberculosis (with other agents). Elimination of meningococcal carriers. Un- concurrent use contraindicated. Significantlypblood levels of atazanavir, da-
labeled Use: Prevention of disease caused by Haemophilus influenzae type B in runavir, fosamprenavir, saquinavir, and tipranavir; concurrent use contrain-
close contacts. Synergy with other antimicrobial agents for S. aureus infections. dicated.qrisk of hepatotoxicity with other hepatotoxic agents, including alcohol,
ketoconazole, isoniazid, pyrazinamide (concurrent use with pyrazinamide
Action may result in potentially fatal hepatotoxicity and should be avoided). Significantlyp
Inhibits RNA synthesis by blocking RNA transcription in susceptible organisms. blood levels of delavirdine, indinavir, and nelfinavir. Rifampin stimulates liver
Therapeutic Effects: Bactericidal action against susceptible organisms. Spec- enzymes, which mayqmetabolism andpeffectiveness of other drugs, including rito-
trum: Broad spectrum notable for activity against: Mycobacterium spp, Staphylo- navir, nevirapine, and efavirenz (dose adjustment may be necessary), ciproflox-
coccus aureus, H. influenzae, Legionella pneumophila, Neisseria meningitidis. acin, clarithromycin, corticosteroids, cyclosporine, diazepam, diltiazem,
disopyramide, doxycycline, levothyroxine, methadone, nifedipine, quini-
Pharmacokinetics dine, opioid analgesics, oral hypoglycemic agents, warfarin, estrogens,
Absorption: Well absorbed following oral administration. phenytoin, phenobarbital, tacrolimus, verapamil, fluconazole, ketocona-
Distribution: Widely distributed; enters CSF. Crosses placenta; enters breast milk. zole, itraconazole, quinidine, theophylline, zidovudine, chloramphenicol,
Protein Binding: 80%. and hormonal contraceptive agents.
Metabolism and Excretion: Mostly metabolized by the liver; 60% eliminated in
feces via biliary elimination. Route/Dosage
Half-life: 3 hr. Tuberculosis
TIME/ACTION PROFILE (blood levels) PO, IV (Adults): 600 mg/day or 10 mg/kg/day (up to 600 mg/day) single dose; may
ROUTE ONSET PEAK DURATION also be given twice weekly.
PO, IV (Children and Infants): 10– 20 mg/kg/day single dose or divided q 12 h
PO rapid 2–4 hr 12–24 hr
(not to exceed 600 mg/day); may also be given twice weekly.
IV rapid end of infusion 12–24 hr
Asymptomatic Carriers of Meningococcus
Contraindications/Precautions PO, IV (Adults): 600 mg q 12 hr for 2 days.
Contraindicated in: Hypersensitivity; Concurrent use of atazanavir, darunavir, PO, IV (Children ⱖ1 mo): 10 mg/kg q 12 hr for 2 days (max: 600 mg/dose).
fosamprenavir, saquinavir, tipranavir, or ritonavir-boosted saquinavir. PO (Infants ⬍1 mo): 5 mg/kg q 12 hr for 2 days.
⫽ Canadian drug name. ⫽ Genetic Implication. CAPITALS indicate life-threatening, underlines indicate most frequent. Strikethrough ⫽ Discontinued.
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2 Implementation
● Do not confuse rifampin with rifabutin.
H. influenzae Prophylaxis ● PO: Administer medication on an empty stomach at least 1 hr before or 2 hr after PDF Page #2
PO (Adults): 600 mg/day for 4 days. meals with a full glass (240 mL) of water. If GI irritation becomes a problem, may
PO (Children): 20 mg/kg/day for 4 days (max: 600 mg/dose). be administered with food. Antacids may also be taken 1 hr prior to administra-
PO (Neonates): 10 mg/kg/day for 4 days. tion. Capsules may be opened and contents mixed with applesauce or jelly for pa-
tients with difficulty swallowing.
Synergy for S.aureus infections ● Pharmacist can compound a syrup for patients unable to swallow solids.
PO (Adults): 300– 600 mg BID. IV Administration
PO (Children and Neonates): 5– 20 mg/kg/day divided q 12 h (max: 600 mg/ ● pH: 7.8– 8.8.
dose). ● Intermittent Infusion: Reconstitute each 600-mg vial with 10 mL of sterile wa-
ter for injection for a concentration of 60 mg/mL. Diluent: Dilute further in 100
NURSING IMPLICATIONS mL or 500 mL of D5W or 0.9% NaCl. Reconstituted vials are stable for 24 hr at
room temperature. Infusion is stable at room temperature for 4 hr (in D5W) or
Assessment 24 hr (in 0.9% NaCl). Concentration: Not to exceed 6 mg/mL. Rate: Admin-
● Perform mycobacterial studies and susceptibility tests prior to and periodically ister solutions diluted in 100 mL over 30 min and solutions diluted in 500 mL over
during therapy to detect possible resistance. 3 hr.
● Assess lung sounds and character and amount of sputum periodically during ther- ● Y-Site Compatibility: amiodarone, bumetanide, midazolam, pantoprazole, van-
apy. comycin.
● Lab Test Considerations: Evaluate renal function, CBC, and urinalysis periodi- ● Y-Site Incompatibility: diltiazem.
cally and during therapy. Patient/Family Teaching
● Monitor hepatic function at least monthly during therapy. May causeqBUN, AST, ● Advise patient to take medication once daily (unless biweekly regimens are used),
ALT, and serum alkaline phosphatase, bilirubin, and uric acid concentrations. as directed, and not to skip doses or double up on missed doses. Emphasize the
● May cause false-positive direct Coombs’ test results. May interfere with folic acid importance of continuing therapy even after symptoms have subsided. Length of
and vitamin B assays. therapy for tuberculosis depends on regimen being used and underlying disease
● May interfere with dexamethasone suppression test results; discontinue rifampin states. Patients on short-term prophylactic therapy should also be advised of the
15 days prior to test. importance of compliance with therapy.
● Advise patient to notify health care professional promptly if signs and symptoms of
● May interfere with methods for determining serum folate and vitamin B levels and
hepatitis (yellow eyes and skin, nausea, vomiting, anorexia, unusual tiredness,
with urine tests based on color reaction. weakness) or of thrombocytopenia (unusual bleeding or bruising) occur.
● May delay hepatic uptake and excretion of sulfobromophthalein (SBP) during ● Caution patient to avoid the use of alcohol during this therapy, because this may
SBP uptake and excretion tests; perform test prior to daily dose of rifampin. increase the risk of hepatotoxicity.
● Instruct patient to report the occurrence of flu-like symptoms (fever, chills, myal-
Potential Nursing Diagnoses gia, headache) promptly.
Risk for infection (Indications) ● Rifampin may occasionally cause drowsiness. Caution patient to avoid driving or
Noncompliance (Patient/Family Teaching) other activities requiring alertness until response to medication is known.
䉷 2015 F.A. Davis Company CONTINUED
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rifampin
● Inform patient that saliva, sputum, sweat, tears, urine, and feces may become red-
orange to red-brown and that soft contact lenses may become permanently discol-
ored.
● 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.
Evaluation/Desired Outcomes
● Decreased fever and night sweats.
● Diminished cough and sputum production.
● Negative sputum cultures.
● Increased appetite.
● Weight gain.
● Reduced fatigue.
● Sense of well-being in patients with tuberculosis.
● Prevention of meningococcal meningitis.
● Prevention of H. influenzae type B infection. Prophylactic course is usually short-
term.
Why was this drug prescribed for your patient?

⫽ Canadian drug name. ⫽ Genetic Implication. CAPITALS indicate life-threatening, underlines indicate most frequent. Strikethrough ⫽ Discontinued.