Rifampicin

Dose in renal impairment

Use with caution in renal impairment if dose is over 600 mg/day.

Use in hepatic impairment

• Use with caution in hepatic impairment. A daily dose of 8mg/kg should not be exceeded in patients with impaired liver function.
• Monitor LFTs before therapy, then once a week for two weeks, then every two weeks for the next six weeks.
• If signs of hepatocellular damage occur, rifampicin should be withdrawn.
• Additionally, FBC should be monitored in patients with hepatic impairment before and during therapy. 

Pregnancy

• Use only if potential benefits outweigh the risks.
• Avoid very high doses (particularly in first trimester).
• In the last few weeks of pregnancy, rifampicin may cause post-natal haemorrhage in mother and infant, for which vitamin K treatment may be indicated.

Breastfeeding

• Amount of drug in milk too small to be harmful

• If treatment is interrupted; re-introduce rifampicin at a low dosage and increase gradually. Discontinue permanently if serious side-effects develop.
• Rifampicin interacts with many drugs. Contact a pharmacist for further advice.
• Rifampicin may cause acute interstitial nephritis. Monitor renal function.
• Patients/ carers should be told how to recognise signs of liver disorder, and advised to discontinue treatment and seek immediate medical attention if symptoms such as persistent nausea, vomiting, malaise or jaundice develop.
• Patients on oral contraceptives should be advised to use alternative, non-hormonal methods of birth control during rifampicin therapy.
• Skin reactions may occur with rifampicin. Typically they consist of flushing and itching with or without a rash. Urticaria and more serious hypersensitivity cutaneous reactions have occurred but are uncommon.
• Rifampicin can discolour urine, sweat, tears, and soft contact lenses
• Use ideal body weight to calculate dose in obese patients, up to 1200mg/day in divided doses

• Summary of Product Characteristics (SPC) for Rifadin 300mg Capsules. Accessed via www.medicines.org.uk 26/03/18. Last updated 19/02/18
• The Renal Drug Database. Rifampicin. Accessed via renaldrugdatabase.com 26/03/18. Last updated 22/02/18
• BNF online accessed via www.medicinescomplete.com 14/1/19; last updated 11/12/18