Antimicrobials
Rifampin

Rifampin

Low
Good (70 to 90%)

Spectrum of Activity

Dosing

General Information

  • Mycobacterial infections
  • Brucellosis
  • Prosthetic joint infections due to Staphyloccocus aureus
  • Infections of other prosthetic material/devices
  • Meningitis due to penicillin and ceftriaxone non-susceptible S. pneumoniae

Always use in combination with other agents.

  • Periodic hepatic enzymes, CBC
  • Drug interactions
  • Discoloration of body fluids: reddish-orange color change to urine, tears, sweat. May cause permanent color change of soft contacts
  • GI intolerance: nausea/vomiting, diarrhea
  • Abnormal liver enzymes, hepatitis
  • Rash
  • Myopathy
  • Cytopenias
  • Hemolytic anemia

Substrate and potent inducer of CYP3A4. Also inducer of CYP2B6, 2C8, 2C9, 2C19, 2D6, and p-glycoprotein. Inductive effects typically take 1-2 weeks to reach steady state, and the inductive effects typically resolve 2 weeks after discontinuation of therapy.

REVIEW ALL MEDICATIONS CLOSELY FOR DRUG INTERACTIONS. THIS IS NOT AN ALL INCLUSIVE LIST.

  • Amiodarone: amiodarone serum concentration may be significantly decreased
  • Amlodipine: amlodipine serum concentrations may be significantly decreased
  • Atorvastatin: atorvastatin serum concentrations may be significantly decreased
  • Corticosteroids: corticosteroid serum concentrations may be significantly decreased
  • Digoxin: digoxin serum concentrations may be significantly decreased by 30-60%
  • HIV medication: interactions with several different HIV medications; please review in Lexicomp drug interaction checker
  • Fluconazole: fluconazole serum concentrations decreased by 23-56%
  • Glimepiride: glimepiride serum concentrations may be significantly decreased
  • Glyburide: glyburide serum concentrations may be significantly decreased
  • Levothyroxine: levothyroxine serum concentrations may be significantly decreased
  • Oral contraceptives: serum concentrations may be significantly decreased
  • Phenytoin: phenytoin serum concentrations may be significantly decreased
  • Rivaroxaban: avoid combination since rivaroxaban concentrations can be significantly decreased
  • Tacrolimus: monitor tacrolimus concentrations because may be significantly decreased
  • Voriconazole: combination contraindicated because voriconazole dose increases do not correct the decreased concentrations (93-96% decrease)
  • Warfarin: warfarin concentrations may be significantly decreased

Should never be used as monotherapy.

Distribution: widely distributed into most tissue and fluids including liver, lungs, bile, pleural fluid, prostate, seminal fluid, bone and saliva. Therapeutic CSF concentrations with inflamed meninges.