RIFAMPICIN (R)

Antituberculosis, anti-leprotic, and antibacterial properties. Abbreviated “R” in treatment regimens

Dosage Forms

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Tablets/capsules

150 mg
300 mg

FDC tablets

Rifampicin 60 mg + Isoniazid 30 mg
Rifampicin 75 mg + Isoniazid 50 mg
Rifampicin 150 mg + Isoniazid 75 mg
Rifampicin 300 mg + Isoniazid 150 mg
Rifampicin 60 mg + Isoniazid 30 mg + Pyrazinamide 150 mg
Rifampicin 1500 mg + Isoniazid 75 mg + Pyrazinamide 400 mg + Ethambutol 275 mg
Rifampicin 150 mg + Isoniazid 75 mg

Uses

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  • Paucibacillary leprosy
  • Multibacillary leprosy
  • Tuberculosis

Dose and Duration

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PB (with dapsone) and MB leprosy (with dapsone and clofazimine)
  • Adult and child >15 years: 600 mg once monthly
  • Child 10–14 years: 450 mg once monthly
  • Child under 10 years: 10 mg/kg once monthly

For PB leprosy, treatment is for 6 months

For MB leprosy, treatment is for 12 months

Tuberculosis (fixed dose combination with isoniazid, ethambutol, pyrazinamide)

Initial phase: Dose as in tables below once daily for 2–3 months

Adult and child over 12 years:

Weight (kg) Rifampicin (mg)
30–37 300
38–54 450
55–70 600
>70 750

Child >12 years:

Weight (kg) Rifampicin (mg)
4–7 70
8–11 140
12–15 210
16–24 280
>25 Use adult formulation

Continuation phase: Dose as below once daily for 4 months

Adult and child over 12 years:

Weight (kg) Rifampicin (mg)
30–37 300
38–54 450
55–70 600
>70 600

Child >12 years:

Weight (kg) Rifampicin (mg)
4–7 75
8–11 150
12–15 225
16–24 300
>25 Use adult doses and formulations

Contra-indications

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  • Allergy to rifampicin
  • Jaundice

Side Effects

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  • Orange-red discoloration of urine, tears, saliva, sputum
  • Stomach upset
  • Headache, drowsiness
  • Liver disorders (jaundice)
  • Rash
  • Fever
  • Influenza-like symptoms, shortness of breath
  • Shock
  • Haemolytic anaemia
  • Acute kidney failure

Interactions

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  • Nevirapine (reduced effect of nevirapine)
  • Oral contraceptives (reduced contraceptive effect)
  • Fluconazole (reduced effect of fluconazole)
  • Nifedipine (reduced effect of nifedipine)
  • Warfarin (reduced warfarin effect)
  • Phenytoin (reduced phenytoin effect)
  • Prednisolone (reduced effect of prednisolone)

Patient Instructions

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  • Take on an empty stomach
  • Report to the health worker immediately in case of yellowing of skin or eyes, persistent nausea, vomiting and feeling of sickness, or weakness
  • May cause urine to be orange/reddish; this is harmless, so do not worry
  • Take fluconazole at least 12 hours apart from rifampicin

Pregnancy

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  • Can be used

Breast-feeding

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  • Can be used

⚠️ Caution

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  • If jaundice develops, rifampicin should be discontinued until the symptoms resolve, then re-introduced. If severe reactions re-occur, discontinue permanently
  • If patient is taking oral contraceptives, advise her to use another method of contraception (e.g. condoms, medroxyprogesterone injection)