Rimactane (Oral)

Rifampin is used with other medicines to treat tuberculosis (TB) in various parts of the body. It is also used by patients who have bacteria that cause meningitis in their nose or throat but do not show symptoms of the infection, to prevent spreading the bacteria to others. Rifampin is an antibiotic that works to kill or stop the growth of bacteria. However, it will not work for colds, flu, or other viral infections.

This medicine is available only with your doctor's prescription.

It is very important that your doctor checks your or your child's progress during regular visits. Blood and urine tests may be needed to check for side effects.

Do not use this medicine if you or your child are also taking certain medicines for HIV infection (such as atazanavir, darunavir, fosamprenavir, ritonavir, saquinavir, tipranavir, Aptivus®, Fortovase®, Invirase®, Lexiva®, Norvir®, Prezista®, or Reyataz®).

Do not use this medicine with praziquantel. If you or your child need to take praziquantel, you must stop using rifampin 4 weeks before starting praziquantel. You can restart rifampin one day after the last dose of praziquantel.

Liver problems may be more likely if you drink alcohol regularly while using this medicine. Regular alcohol use may prevent this medicine from working properly. Therefore, you should strictly limit how much alcohol you drink while using this medicine.

Check with your doctor right away if you or your child have fever, chills, cough, sore throat, swollen, painful, or tender lymph glands in the neck, armpit, or groin, or yellow skin or eyes while using this medicine. These could be signs of a serious condition called drug reaction with eosinophilia and systemic symptoms (DRESS).

Check with your doctor right away if you or your child have pain or tenderness in the upper stomach, pale stools, dark urine, loss of appetite, nausea, unusual tiredness or weakness, or yellow eyes or skin. These could be signs of a serious liver problem.

Serious skin reactions (such as Stevens-Johnson syndrome, toxic epidermal necrolysis, and acute generalized exanthematous pustulosis) can occur with this medicine. Check with your doctor right away if you or your child have blistering, peeling, or loosening of the skin, red skin lesions, severe acne or skin rash, sores or ulcers on the skin, or fever or chills while using this medicine.

Tell your doctor right away if you have chest pain, cough, coughing or spitting up blood, difficulty breathing, sore throat, muscle aches, night sweats, sudden high fever, or unusual tiredness. These could be signs of a paradoxical drug reaction to this medicine. If your symptoms do not improve within a few days or if they get worse, check with your doctor.

This medicine may cause blood clotting problems, which can lead to bleeding. Check with your doctor right away if you or your child cough up blood, have bleeding gums, difficulty breathing or swallowing, dizziness, headache, increased menstrual flow or vaginal bleeding, nosebleeds, prolonged bleeding from cuts, red or dark brown urine, or red or black, tarry stools after using this medicine.

This medicine may cause lung or breathing problems (such as interstitial lung disease, pneumonitis, pneumonia, respiratory failure, pulmonary fibrosis, acute respiratory distress syndrome), which can be life-threatening and need immediate medical attention. Check with your doctor right away if you have chest pain, chills, dry cough, fever, a general feeling of discomfort or illness, thickening of bronchial secretions, or trouble breathing.

Rifampin will cause urine, saliva, sputum, sweat, teeth, and tears to turn a reddish-orange to reddish-brown color. This is expected while using this medicine. This effect may also cause soft contact lenses to become permanently discolored. Standard cleaning solutions may not remove all the discoloration. So, it is best not to wear soft contact lenses while using this medicine. Hard contact lenses are not discolored by this medicine. This condition will return to normal once you stop using this medicine. If you have any questions about this, check with your doctor.

If you or your child develop a skin rash, hives, or any allergic reaction to this medicine, check with your doctor right away.

This medicine may cause thrombotic microangiopathy (damage in the smallest blood vessels), including hemolytic uremic syndrome and thrombotic thrombocytopenic purpura. Tell your doctor right away if you have a change in mental status, dark or bloody urine, decreased urine output, difficulty speaking, fever, pale skin, pinpoint red spots on the skin, seizures, severe chest pain, sudden weakness in the arms or legs, unusual bleeding or bruising, or yellow eyes or skin.

Birth control pills may not work properly while you are using this medicine. To prevent pregnancy, use another form of birth control along with your birth control pills. Other forms include condoms, diaphragms, or contraceptive foams or jellies.

Before you have any medical tests, tell the doctor in charge that you or your child are using this medicine. Some test results may be affected by this medicine.

Do not take other medicines unless your doctor has discussed them with you. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal or vitamin supplements.

In deciding to use a medicine, the risks of using the medicine must be weighed against the beneficial it will do. This is a decision you and your physician will make. For this medication, the following should be considered:

Allergies

Inform your doctor if you have ever had any unusual or allergic reaction to this medication or any other medicines. Also inform your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.

Pediatric

Appropriate studies performed to date have not demonstrated pediatric-specific issues that would limit the usefulness of rifampin in children.

Geriatric

Appropriate studies performed to date have not demonstrated geriatric-specific issues that would limit the usefulness of rifampin in the elderly.

Breast Feeding

Studies in women suggest that this medication poses minimal risk to the infant when used during breastfeeding.

Interactions with Medications

Although certain drugs should not be used together at all, in other cases two different medications may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are using this drug, it is especially critical that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Using this medication with any of the following medicines is not advised. Your physician may decide not to treat you with this medication or change some of the other medications you take.

• Artemether
• Atazanavir
• Bictegravir
• Boceprevir
• Cabotegravir
• Cobicistat
• Daclatasvir
• Darunavir
• Dasabuvir
• Delamanid
• Doravirine
• Elbasvir
• Elvitegravir
• Fosamprenavir
• Fostemsavir
• Glecaprevir
• Grazoprevir
• Isavuconazonium
• Lenacapavir
• Lopinavir
• Lorlatinib
• Lurasidone
• Maraviroc
• Mavacamten
• Nelfinavir
• Nirmatrelvir
• Ombitasvir
• Pacritinib
• Paritaprevir
• Pibrentasvir
• Praziquantel
• Ranolazine
• Rilpivirine
• Ritonavir
• Saquinavir
• Sofosbuvir
• Telaprevir
• Tenofovir Alafenamide
• Tipranavir
• Velpatasvir
• Voriconazole
• Voxilaprevir

Using this medication with any of the following medicines is usually not recommended, but may be required in some cases. If both medications are prescribed together, your clinician may change the dose or how often you use one or both of the medicines.

• Abemaciclib
• Abiraterone Acetate
• Abrocitinib
• Acalabrutinib
• Adagrasib
• Afatinib
• Alfentanil
• Alpelisib
• Amiodarone
• Amlodipine
• Amprenavir
• Apixaban
• Apremilast
• Aprepitant
• Aripiprazole
• Atogepant
• Atovaquone
• Avacopan
• Avapritinib
• Avatrombopag
• Axitinib
• Bedaquiline
• Belumosudil
• Bendamustine
• Benzhydrocodone
• Berotralstat
• Betrixaban
• Bortezomib
• Bosutinib
• Brexpiprazole
• Brigatinib
• Brivaracetam
• Buprenorphine
• Bupropion
• Cabozantinib
• Cannabidiol
• Capmatinib
• Cariprazine
• Ceritinib
• Cholera Vaccine, Live
• Clopidogrel
• Clozapine
• Cobimetinib
• Codeine
• Copanlisib
• Crizotinib
• Cyclosporine
• Dabigatran Etexilate
• Daprodustat
• Daridorexant
• Darolutamide
• Dasatinib
• Deferasirox
• Deflazacort
• Delavirdine
• Desogestrel
• Dexamethasone
• Dienogest
• Digoxin
• Dihydrocodeine
• Dolutegravir
• Doxorubicin
• Doxorubicin Hydrochloride Liposome
• Dronedarone
• Drospirenone
• Duvelisib
• Edoxaban
• Efavirenz
• Elacestrant
• Elagolix
• Elexacaftor
• Eliglustat
• Eluxadoline
• Encorafenib
• Entrectinib
• Enzalutamide
• Eravacycline
• Erdafitinib
• Erlotinib
• Estetrol
• Estradiol
• Ethinyl Estradiol
• Ethionamide
• Ethynodiol
• Etonogestrel
• Etrasimod
• Etravirine
• Everolimus
• Exemestane
• Fedratinib
• Fenfluramine
• Fentanyl
• Fexinidazole
• Finerenone
• Fosaprepitant
• Fosnetupitant
• Fosphenytoin
• Fostamatinib
• Futibatinib
• Gefitinib
• Gepirone
• Gestodene
• Gilteritinib
• Glasdegib
• Halothane
• Hemin
• Hydrocodone
• Hydroxychloroquine
• Ibrexafungerp
• Ibrutinib
• Idelalisib
• Ifosfamide
• Imatinib
• Indinavir
• Infigratinib
• Irinotecan
• Irinotecan Liposome
• Isoniazid
• Istradefylline
• Itraconazole
• Ivabradine
• Ivacaftor
• Ivosidenib
• Ixabepilone
• Ixazomib
• Ketoconazole
• Lamotrigine
• Lapatinib
• Larotrectinib
• Ledipasvir
• Lefamulin
• Lemborexant
• Leniolisib
• Letermovir
• Levoketoconazole
• Levonorgestrel
• Linagliptin
• Lorcainide
• Lumateperone
• Lurbinectedin
• Macimorelin
• Macitentan
• Manidipine
• Maribavir
• Medroxyprogesterone
• Meperidine
• Mestranol
• Methadone
• Methotrexate
• Metoprolol
• Midostaurin
• Mifepristone
• Mirtazapine
• Mitapivat
• Mobocertinib
• Momelotinib
• Mycophenolate Mofetil
• Mycophenolic Acid
• Naloxegol
• Neratinib
• Netupitant
• Nevirapine
• Nifedipine
• Nilotinib
• Nimodipine
• Nintedanib
• Nomegestrol
• Norelgestromin
• Norethindrone
• Norgestimate
• Norgestrel
• Olanzapine
• Olaparib
• Olutasidenib
• Omaveloxolone
• Omeprazole
• Osimertinib
• Oxcarbazepine
• Oxycodone
• Ozanimod
• Palbociclib
• Paliperidone
• Palovarotene
• Panobinostat
• Pazopanib
• Pemigatinib
• Pentazocine
• Perampanel
• Pexidartinib
• Phenobarbital
• Phenytoin
• Pimavanserin
• Piperaquine
• Pirtobrutinib
• Pitavastatin
• Pitolisant
• Ponatinib
• Ponesimod
• Posaconazole
• Pralsetinib
• Pretomanid
• Primidone
• Pyrazinamide
• Quetiapine
• Quinine
• Quizartinib
• Regorafenib
• Relugolix
• Revefenacin
• Ribociclib
• Rimegepant
• Ripretinib
• Risperidone
• Ritlecitinib
• Rivaroxaban
• Roflumilast
• Rolapitant
• Romidepsin
• Ruxolitinib
• Samidorphan
• Segesterone
• Selexipag
• Selpercatinib
• Selumetinib
• Sildenafil
• Simeprevir
• Siponimod
• Sirolimus
• Sirolimus Protein-Bound
• Sonidegib
• Sorafenib
• Sotagliflozin
• Sotorasib
• Sparsentan
• Stiripentol
• Sufentanil
• Sunitinib
• Tacrolimus
• Tamoxifen
• Tasimelteon
• Tazemetostat
• Telithromycin
• Temsirolimus
• Tezacaftor
• Thiotepa
• Ticagrelor
• Tivozanib
• Tofacitinib
• Tolvaptan
• Trabectedin
• Tramadol
• Tucatinib
• Ubrogepant
• Ulipristal
• Upadacitinib
• Valbenazine
• Vandetanib
• Vemurafenib
• Venetoclax
• Vilazodone
• Vincristine
• Vincristine Sulfate Liposome
• Vinflunine
• Voclosporin
• Vonoprazan
• Vorapaxar
• Vortioxetine
• Voxelotor
• Zanubrutinib
• Zavegepant
• Zolpidem
• Zuranolone

Using this medication with any of the following medications may cause an increased chance of certain side effects, but using both drugs may be the best treatment for you. If both medications are prescribed together, your clinician may change the dose or how frequently you use one or both of the drugs.

• Acetyldigoxin
• Aliskiren
• Anisindione
• Aripiprazole Lauroxil
• Atorvastatin
• Betamethasone
• Bexarotene
• Bosentan
• Buspirone
• Carbamazepine
• Carvedilol
• Caspofungin
• Chloramphenicol
• Chlorpropamide
• Citalopram
• Clarithromycin
• Clofibrate
• Cortisone
• Dicumarol
• Diltiazem
• Disopyramide
• Doxycycline
• Eltrombopag
• Enalaprilat
• Enalapril Maleate
• Etoricoxib
• Fluconazole
• Fludrocortisone
• Gliclazide
• Glyburide
• Haloperidol
• Isradipine
• Levomethadyl
• Levothyroxine
• Linezolid
• Losartan
• Mefloquine
• Metformin
• Methylprednisolone
• Morphine
• Morphine Sulfate Liposome
• Moxifloxacin
• Nisoldipine
• Ospemifene
• Phenprocoumon
• Pioglitazone
• Pirmenol
• Prednisolone
• Prednisone
• Propafenone
• Raltegravir
• Repaglinide
• Rofecoxib
• Rosiglitazone
• Sertraline
• Simvastatin
• Tadalafil
• Theophylline
• Tocainide
• Triazolam
• Trimetrexate
• Valproic Acid
• Warfarin
• Zaleplon
• Zidovudine

Interactions with Food/Tobacco/Alcohol

Certain drugs should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Other Medical Issues

The presence of other medical issues may affect the use of this medicine. Make sure you tell your physician if you have any other medical problems, especially:

• Adrenal gland problems or
• Blood clotting problems or
• Diabetes, history of or
• Liver disease or
• Porphyria (an enzyme problem) or
• Vitamin K deficiency—Use with caution. May make these conditions worse.

• Alcohol abuse, or history of—Use with caution. May cause side effects to become worse.

• Liver disease, chronic or
• Patients with poor nutrition status—Use with caution. May raise chance for vitamin K deficiency, which may lead to excessive bleeding.

• Meningococcal disease (including infections of the lining of the brain and spinal cord [meningitis] and bloodstream [eg, bacteremia, septicemia)—Should not be used in patients with this condition.

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor immediately if any of the following side effects occur:

Rare

• Agitation
• Bleeding gums
• Blood in the urine or stools
• Bruising
• Chest tightness
• Confusion
• Cough
• Coughing or vomiting blood
• Dark urine
• Darkening of the skin
• Decreased frequency or amount of urine
• Difficulty in breathing and swallowing
• Dizziness
• Fainting
• Fast heartbeat
• Fever with or without chills
• General feeling of tiredness or weakness
• Headache
• Hives
• Hoarseness
• Hostility
• Increased blood pressure
• Increased thirst
• Irritability
• Light-colored stools
• Loss of appetite
• Lower back or side pain
• Mental depression
• Nausea
• Painful or difficult urination
• Persistent bleeding or oozing from puncture sites, mouth, or nose
• Puffiness or swelling of the eyelids or around the eyes, face, lips, or tongue
• Skin itching, rash, or redness
• Sores, ulcers, or white spots on the lips or in the mouth
• Stomach pain
• Swelling of the face, ankles, fingers, hands, or lower legs
• Unusual bleeding or bruising
• Unusual drowsiness, dullness, tiredness, weakness, or feeling of sluggishness
• Vomiting
• Weight gain
• Yellow eyes or skin

Incidence not known

• Bleeding under the skin
• Blistering, peeling, or loosening of the skin
• Bloating
• Bloody, severe, or watery diarrhea
• Bloody nose
• Bone pain
• Chest pain
• Chills
• Cold, clammy skin
• Diarrhea
• Difficulty with speaking
• Double vision
• Dry cough
• Fast, weak pulse
• General feeling of discomfort or illness
• Heavier menstrual periods
• Inability to move the arms, legs, or facial muscles
• Inability to speak
• Increased menstrual flow or vaginal bleeding
• Joint or muscle pain
• Lightheadedness
• Muscle aches
• Night sweats
• Nosebleeds
• Pale skin
• Paralysis
• Pinpoint red spots on the skin
• Prolonged bleeding from cuts
• Red or black, tarry stools
• Red or dark brown urine
• Red skin lesions, often with a purple center
• Red, irritated eyes
• Runny nose
• Shivering
• Slow speech
• Sore throat
• Sores, welts, blisters
• Sweating
• Swelling of the fingers, feet, or lower legs
• Swelling or puffiness of the face
• Swollen glands
• Trouble sleeping
• Unpleasant breath odor
• Unusual weight loss

Get emergency help immediately if any of the following symptoms of overdose occur:

Symptoms of overdose

• Blurred vision
• Dizziness, faintness, or lightheadedness when getting up suddenly from a lying or sitting position
• Fast, pounding, or irregular heartbeat or pulse
• Feeling of fullness in the upper abdomen or stomach
• Low blood pressure or slow pulse
• Pain in the upper abdomen or stomach
• Reddish-orange to reddish-brown color of the urine, stool, saliva, sputum, sweat, and tears
• Seizures
• Swelling around the eyes or face
• Unconsciousness
• Yellow eyes or skin

Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

Rare

• Feeling that others are watching you or controlling your behavior
• Feeling that others can hear your thoughts
• Feeling, seeing, or hearing things that are not there
• Muscle tenderness, wasting, or weakness
• Severe mood or mental changes
• Unusual behavior

Incidence not known

• Belching
• Bloated or full feeling
• Excess air or gas in the stomach or bowels
• Indigestion
• Not able to concentrate
• Pain or discomfort in the chest, upper stomach, or throat
• Tooth discoloration

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

In the U.S.

• Rifadin
• Rimactane

Available Dosage Forms:

• Capsule

Therapeutic Class: Antitubercular

Chemical Class: Rifamycin

Take this medicine only as directed by your doctor. Do not take more of it, do not take it more often, and do not take it for a longer time than your doctor ordered. To do so may increase the chance for side effects.

To help clear up your tuberculosis (TB) completely, it is very important that you keep using this medicine for the full time of treatment, even if you begin to feel better after a few weeks. If you have TB, you might have to take rifampin every day for several months. It is important that you do not miss any doses.

Take the capsule on an empty stomach, 1 hour before or 2 hours after a meal, with a full of glass water. It is important to take this medicine on a regular schedule.

If this medicine upsets your stomach, take it with food. Antacids may also help. However, do not take aluminum-containing antacids (eg, Maalox®, Mylanta®) within 1 hour of the time you take rifampin. They may keep this medicine from working properly.

For patients unable to swallow the capsule:

• A special liquid form of the medicine can be prepared by your pharmacist.
• Shake the bottle well before each dose.
• Measure the liquid with a marked measuring spoon, oral syringe, or medicine cup. The average household teaspoon may not hold the right amount of liquid.

If you are taking itraconazole, do not use rifampin 2 weeks before and during itraconazole treatment.

Dosing

The dose of this medicine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

• For oral dosage form (capsules): For the treatment of meningitis bacteria in the nose or throat: Adults—600 milligrams (mg) 2 times a day for 2 days. Children 1 month of age and older—Dose is based on body weight and must be determined by your doctor. The dose is 10 mg per kilogram (kg) of body weight every 12 hours for 2 days. Children younger than 1 month of age—Dose is based on body weight and must be determined by your doctor. The dose is 5 mg per kg of body weight every 12 hours for 2 days. For the treatment of tuberculosis: Adults—Dose is based on body weight and must be determined by your doctor. The dose is 10 milligrams (mg) per kilogram (kg) of body weight once a day. Your doctor may increase your dose as needed. However, the dose is usually not more than 600 mg per day. Children—Dose is based on body weight and must be determined by your doctor. The dose is 10 to 20 mg per kg of body weight once a day. Your doctor may increase your dose as needed. However, the dose is usually not more than 600 mg per day.

Missed Dose

If you miss a dose of this medicine, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses.

If rifampin is taken on an irregular schedule, side effects may occur more often and may be more serious than usual. If you have any questions about this, check with your doctor.

Storage

Keep out of the reach of children.

Do not keep outdated medicine or medicine no longer needed.

Ask your healthcare professional how you should dispose of any medicine you do not use.

Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Keep from freezing.

The specially prepared oral liquid form may be kept at room temperature or in a refrigerator for 4 weeks. Do not use the liquid after the expiration date on the label.

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