TB Drugs:
Rifampin
How do they work? “Action”
Many antitubercular drugs are bacteriostatic against the M.
tuberculosis bacillus. These drugs usually act to inhibit bacterial
cell wall synthesis, which slows the multiplication rate of the
bacteria. Isoniazid is bactericidal, with rifampin and
streptomycin having some bactericidal activity.
Indications
• Treatment of TB in a protocol
Adverse reactions
• Nausea and vomiting
• Epigastric distress, heartburn, fatigue
• Vertigo (dizziness)
• Rash
• Reddish-orange discoloration of body fluids (urine, tears,
saliva, sweat, and sputum)
• Hematologic changes, renal insufficiency
(Ford 106)
Contraindications & Caution
Rifampin is contraindicated in patients with a history of
hypersensitivity to the drug. The drug is used with caution
during pregnancy (category C) and lactation and in patients
with hepatic or renal impairment.
(Ford 106)
Nursing alert
• Leprosy , also referred to as Hansen’s disease, is caused by
the bacterium Mycobacterium leprae. Leprosy is a chronic,
communicable disease that is not easily spread and has a
long incubation period. Since 1985, the prevalence of leprosy
has dropped by 90%. About 100 new cases are diagnosed
yearly in the United States (primarily the southern states,
Hawaii, and U.S. possessions).
• Peripheral nerves are affected, causing sensory loss and
muscle weakness. The traditional fear of leprosy relates to
skin involvement, which may present with lesions confined
to a few isolated areas or may be fairly widespread over the
entire body. Dapsone, clofazimine (Lamprene), rifampin
(Rifadin), and ethionamide (Trecator) are drugs currently used
to treat leprosy (Ford 106)
Generic Trade
Active TB, Hansen’s disease
Rifampin Rifadin, Rimactane
(Ford 109)
Nursing management
• Ask the patient what he or she thinks causes the symptoms;
promote health literacy by integrating the patient’s beliefs and
fears into how the bacteria invades the body and how the
drugs work to kill it.
• Discuss tuberculosis, its causes and communicability, and the
need for long-term therapy for disease control using simple,
non medical terms.
• Review the drug therapy regimen, including the prescribed
drugs, doses, and frequency of administration.
• Reassure the patient that various combinations of drugs are
effective in treating tuberculosis.
• Urge the patient to take the drugs exactly as prescribed and
not to omit, increase, or decrease the dosage unless directed
to do so by the health care provider.
• Instruct the patient about possible adverse reactions and the
need to notify the prescriber should any occur.
• Arrange for direct observation therapy with the patient and
family.
• Instruct the patient in measures to minimize gastrointestinal
upset.
• Advise the patient to avoid alcohol and the use of
nonprescription drugs, especially those containing aspirin,
unless use is approved by the health care provider.
• Reassure the patient and family that the results of therapy will
be monitored by periodic laboratory and diagnostic tests and
follow-up visits with the health care provider.
Interactions
• Antiretrovirals (efavirenz, nevirapine): Decreased serum
levels of antiretrovirals
• Digoxin: Decreased serum levels digoxin
• Oral contraceptives: Decreased contraceptive effectiveness
• Isoniazid: Higher risk of hepatotoxicity
• Oral anticoagulants: Increased risk for bleeding
• Oral hypoglycemics: Decreased effectiveness of oral
hypoglycemic agent
• Chloramphenicol: Increased risk for seizures
• Phenytoin: Decreased effectiveness of phenytoin
• Verapamil: Decreased effects of verapamil
Use Dose
10 mg/kg (up to 600 mg/day)
orally, IV (Ford 109)