Mindanao State University – Iligan Institute of Technology

COLLEGE OF NURSING
Student: _________________________ Block:___________

PHARMACOLOGICAL MANAGEMENT

DRUG STUDY

Rifadin
Brand Name: ________________________________________________ Generic Name:Rifampin rifamycins
_____________________________ Drug Classification: ___________________________________

Dosage, Route & Frequency
Drug Action
Recommended Prescribed
Tuberculosis Inhibits RNA synthesis by
blocking RNA transcription
PO, IV (Adults): insusceptible organisms.
600 mg/day or 10
mg/kg/day (up to Therapeutic Effects:
600 mg/day) single Bactericidal action against
dose; may also be susceptible organisms.
given twice weekly. Spectrum: Broad spectrum
notable for activity against:
Asymptomatic Mycobacterium
Carriers of spp.,Staphylococcus
Meningococcus aureus, H. influenzae,
Legionella pneumophila,
PO, IV (Adults):
Neisseria meningitidis.
600 mg q 12 hr for
2 days. Pharmacokinetics
H. influenzae
Absorption: Well
Prophylaxis
absorbed following oral
administration.
PO (Adults): 600
mg/day for 4 days. Distribution: Widely
distributed; enters CSF.
Synergy for
Crosses placenta; enters
S.aureus
breast milk.
infections
Protein Binding: 80%.
PO (Adults): 300–
600 mg BID.
Metabolism and
Excretion: Mostly
metabolized by the liver;
Drug-Drug & Drug-Food
Interactions
Drug-Drug
Increase risk of
hepatotoxicity with
ritonavirboosted
saquinavir; concurrent use
contraindicated.
Significantly lower blood
levels of atazanavir,
darunavir, fosamprenavir,
saquinavir, and tipranavir;
concurrent use
contraindicated.
Increase risk of
hepatotoxicity with other
hepatotoxic agents,
including alcohol,
ketoconazole, isoniazid,
pyrazinamide (concurrent
use with pyrazinamide
may result in potentially
fatal hepatotoxicity and
should be avoided).
Significantly decrease
blood levels of delavirdine,
indinavir, and nelfinavir.
Side Effects Adverse Reactions
Indications Contraindications
(By System) (By System)
Active tuberculosis Contraindicated in: CNS: ataxia, Misc: DRUG
(with other agents). Hypersensitivity; confusion, REACTION WITH
Elimination of Concurrent use of drowsiness, fatigue, EOSINOPHILIA AND
meningococcal atazanavir, darunavir, headache, SYSTEMIC
carriers. fosamprenavir, SYMPTOMS
saquinavir, tipranavir, weakness. (DRESS),
Unlabeled Use: or ritonavir-boosted HYPERSENSITIVITY
Prevention of disease Derm: rash, pruritus.
saquinavir. REACTIONS
caused by
EENT: red (including angio
Haemophilus Use Cautiously in:
discoloration of tears. edema)
influenzae type B in History of liver disease;
close contacts. Diabetes; Concurrent GI: abdominal pain,
Synergy with other use of other
diarrhea, flatulence,
antimicrobial agents hepatotoxic agents;
for S. aureus heartburn, nausea,
OB, Lactation:
infections. vomiting, increase
Pregnancy or lactation.
liver enzymes, red
discoloration of saliva.
GU: red discoloration
of urine.
Hemat: hemolytic
anemia,
thrombocytopenia.
MS: arthralgia,
muscle weakness,
myalgia.
 60% eliminated in feces via
biliary elimination.
Half-life: 3 hr
Pharmacodynamics
R: PO
Rifampin stimulates liver Misc: (including
enzymes, which may angioedema), flu-like
increase metabolism and syndrome.
decrease effectiveness of
other drugs, including
ritonavir, nevirapine, and
efavirenz

O: Rapid

P: 2-4 hr

D: 12 hr to 24 hr

R: IV

O: Rapid

P: end of infusion

D: 12 hr to 24 hr

Responsibilities in the Nursing Process (ADPIE) Responsibilities in the Nursing Process (ADPIE)
Assessment
● Perform mycobacterial studies and susceptibility tests prior to and periodically during
therapy to detect possible resistance.
● Assess lung sounds and character and amount of sputum periodically during
therapy
● Monitor for signs and symptoms of DRESS (fever, rash, lymphadenopathy, and/or
facial swelling, associated with involvement of other organ systems (hepatitis,
nephritis, hematologic abnormalities, myocarditis, myositis) during therapy. May
resemble an
acute viral infection. Eosinophilia is often present.
Discontinue therapy if signs occur.
● Lab Test Considerations: Evaluate renal function, CBC, and urinalysis periodically
and during therapy.
● Monitor hepatic function at least monthly during therapy. May cause increase in
BUN, AST, ALT, and serum alkaline phosphatase, bilirubin, and uric acid
concentrations.
● May cause false-positive direct Coombs’ test results. May interfere with folic acid
and vitamin B assays.
● May interfere with dexamethasone suppression test results; discontinue rifampin 15
days prior to test.
● May interfere with methods for determining serum folate and vitamin B levels and
with urine tests based on color reaction.
● May delay hepatic uptake and excretion of sulfobromophthalein (SBP) during SBP
uptake and excretion tests; perform test prior to daily dose of rifampin.
Potential Nursing Diagnoses
Risk for infection (Indications)
Noncompliance (Patient/Family Teaching)
Planning
● The patient will decrease signs and symptoms of tubercolosis/Infection
● The patient will decrease fever and night sweats
● The patient will reduce/lessen cough and sputum production
● The patient will increase appetite.
● The patient will have an increase in activity tolerance and sense of well being
Implementation
● Do not confuse rifampin with rifaximin or Rifamate (isoniazid/rifampin).
● PO: Administer medication on an empty stomach at least 1 hr before or 2 hr after meals
with a full glass (240 mL) of water. If GI irritation becomes a problem, may be administered
with food. Antacids may also be taken 1 hr prior to administration. Capsules may be
opened and contents mixed with applesauce or jelly for patients with difficulty swallowing.
● Pharmacist can compound a syrup for patients unable to swallow solids. IV
Administration
● Intermittent Infusion: Reconstitute each 600-mg vial with 10 mL of sterile water for
injection for a
concentration of 60 mg/mL. Diluent: Dilute further in 100 mL or 500 mL of D5W or 0.9%
NaCl. Reconstituted vials are stable for 24 hr at room temperature. Infusion is stable at
room temperature for 4 hr (in D5W) or 24 hr (in 0.9% NaCl). Concentration: Not to exceed
6 mg/mL. Rate: Administer solutions diluted in 100 mL over 30 min and solutions diluted in
500 mL over 3 hr.
● Y-Site Compatibility: amiodarone, bumetanide, ciprofloxacin, daptomycin, midazolam,
pantopra zole, tigecycline, vancomycin.
● Y-Site Incompatibility: diltiazem.
Patient/Family Teaching
● Advise patient to take medication once daily, as directed, and not to
skip doses or double up on missed doses. Emphasize the importance of continuing
therapy even after symptoms have subsided. Length of therapy for tuberculosis depends
on regimen being used and underlying disease states. Patients on short-term prophylactic
therapy should also be advised of the importance of compliance with therapy.
● Advise patient to notify health care professional promptly if signs and symptoms of
hepatitis (yellow eyes and skin, nausea, vomiting, anorexia, unusual tiredness, weakness)
or of thrombocytopenia (unusual bleeding or bruising) occur.
● Caution patient to avoid the use of alcohol during this therapy, because this may
increase the risk of hepatotoxicity.
● Instruct patient to report the occurrence of flu-like symptoms (fever, chills, myalgia,
headache)
promptly.
● Rifampin may occasionally cause drowsiness. Caution patient to avoid driving or other
activities requiring alertness until response to medication is
known.
● Inform patient that saliva, sputum, sweat, tears, urine, and feces may become red-
orange to redbrown and that soft contact lenses may become permanently discolored.
● Advise patient that this medication has teratogenic properties and may decrease the
effectiveness of oral contraceptives. Counsel patient to use a nonhormonal form of
contraception throughout therapy.
● Emphasize the importance of regular follow-up exams to monitor progress and to check
for side effects.
Evaluation/Desired Outcomes
 ● Decreased fever and night sweats.
● Diminished cough and sputum production.
● Negative sputum cultures.
● Increased appetite.
● Weight gain.
● Reduced fatigue.
● Sense of well-being in patients with tuberculosis.
● Prevention of meningococcal meningitis.
● Prevention of H. influenzae type B infection. Prophylactic course is usually short term.

References:

1. Kizior, R., Hodgson, K. (2019). Saunders Nursing Drug Handbook 2019.

2. Sanoski and Vallerand. (2019). Davis’s Drug Guide for Nurses 16th Edition, pp. 1094-1096