Precautions and Warnings With Rifampin

Even though rifampin may be an effective antibiotic for many people, it can cause serious allergic reactions, dangerous side effects, or other complications for others. In particular, people who have kidney or liver disease should talk to their healthcare provider before taking rifampin. Other safety precautions include warnings for people who have diabetes or porphyria, as well as those who are taking certain medications.

 

What Should I Tell My Healthcare Provider?

You should talk with your healthcare provider prior to taking rifampin (Rifadin®) if you have:
 
  • Liver disease, such as hepatitis, cirrhosis, or liver failure
  • Kidney disease, such as kidney failure (renal failure)
  • Diabetes
  • Any of a group of rare medical conditions known as porphyria
  • Any allergies, including to foods, dyes, or preservatives.
 
Also, let your healthcare provider know if you are:
 
  • Pregnant or thinking of becoming pregnant
  • Breastfeeding.
 
You should also tell your healthcare provider about all other medications you are taking, including prescription and nonprescription medicines, vitamins, and herbal supplements.
 

Specific Rifampin Precautions and Warnings

Some warnings and precautions to be aware of prior to using this drug include the following:
 
  • Rifampin has been reported to cause life-threatening liver problems, especially in people who already have liver disease or are taking other medications that can damage the liver. Drinking alcohol can also increase your risk for liver damage during treatment. People who already have liver disease should only be treated with rifampin if absolutely necessary, and will need to be carefully monitored for signs of liver damage every two to four weeks during treatment.
 
  • Rifampin should be used cautiously in people with porphyria, a rare genetic condition associated with the abnormal production of heme (a substance found throughout the body, especially in the blood and bone marrow). Porphyria causes a buildup of chemicals called porphyrins in the body. Rifampin may worsen the condition.
 
  • This medication should not be used to treat meningococcal disease, as doing so may lead to the development of meningococcal bacteria that are resistant to rifampin. Instead, Rifampin should only be used for the short-term treatment of people who carry the meningococcal bacteria, but do not have symptoms.
 
  • People with diabetes should be treated cautiously with rifampin, as the medication can make the condition more difficult to manage. Rifampin also has the potential to interact with several medications used to treat diabetes (see Drug Interactions With Rifampin).
 
  • Rifampin should only be used to treat known bacterial infections. It will not work to treat viral infections, such as the common cold. Using rifampin inappropriately may increase the risk that bacteria will become resistant to the medication.
 
  • When used to treat tuberculosis, rifampin is normally given once a day. Some studies suggest that twice-a-week dosing (when used in combination with isoniazid) is also well tolerated. However, doses greater than 600 mg given once or twice a week have been reported to cause more side effects, including:
    • A "flu-like syndrome" of fever and chills
    • Blood disorders, such as anemia, low white blood cell counts, and low platelets
    • Skin reactions
    • Gastrointestinal (stomach and intestine) side effects
    • Liver problems
    • Kidney failure
    • Shortness of breath
    • A serious allergic reaction known as anaphylaxis
    • Shock, which is a life-threatening condition that occurs when the body is not getting enough blood or oxygen.
 
  • It is important to take this medication as prescribed, even if you start feeling better. Missing doses or failing to complete the entire course of treatment may increase the chance that your condition is not adequately treated or that the bacteria will become resistant to rifampin in the future. There have also been reports of rare but potentially serious kidney problems occurring when rifampin treatment was stopped and then restarted.
 
  • This medication can affect the way your body processes certain hormones and vitamins, which can lead to low blood levels of vitamin D, calcium, and phosphate, and high blood levels of a hormone known as parathyroid hormone. Your healthcare provider may order blood tests to check for these possible effects.
 
  • Injectable forms of rifampin are only intended for intravenous (IV, an injection into a vein) use. The medication should not be given as an injection into a muscle (an intramuscular, or IM, injection) or an injection under the skin (a subcutaneous or SC injection).
 
  • This medication can cause your urine, sweat, saliva, and tears to turn a reddish color. This side effect is harmless, and will go away after treatment. However, it may permanently stain soft contact lenses.
 
  • Treatment with rifampin requires careful monitoring to make sure the medication is working and to ensure you are not experiencing potentially serious side effects. You will need to see your healthcare provider at least once a month during treatment. You may also need blood tests. Make sure to keep all of your healthcare and laboratory appointments.
   
  • Rifampin is a pregnancy Category C medication, which means it may not be safe for use in women who are pregnant (see Rifadin and Pregnancy).
 
  • Rifampin passes through breast milk in humans. Therefore, if you are breastfeeding or plan to start, discuss this with your healthcare provider prior to taking the drug (see Rifadin and Breastfeeding).
 

Rifampin Antibiotic Information

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