Clinical beta
FMBM is currently in clinical beta. Content is for professional review/testing and must not replace local protocols, senior clinical judgment, or official prescribing references.
Drug Monograph
Rifampin
Rifamycin (PO, IV)
Indication
TB β’ MRSA prosthetic β’ HACEK β’ meningitis prophylaxis contacts β’ staph hardware
INDICATIONS (CORE USE)
**TB backbone** + **staph prosthetic** biofilm adjunct + **brucella** β **potent CYP450 inducer** β OCP failure, DOAC failure, transplant immunosuppression melt.
ADULT DOSE (STANDARD)
TB: 10 mg/kg PO daily max 600 mg; intermittent supervised therapy higher mg/kg β **program-specific**
MAX DOSE
600 mg/day typical adult TB; higher intermittent DOT
Route
PO, IV
PEDIATRIC DOSE
10β20 mg/kg/day max 600 mg TB; neonatal meningitis prophylaxis distinct
Must-not-miss safety points
Major warning
- **Drug interactions** β induces CYP3A/2C9 etc. β loss of efficacy of many drugs - **Hepatotoxicity** β LFTs baseline and periodic - Orange discoloration body fluids β warn patient - Flu-like syndrome intermittent dosing errors
USE IF: TB regimen, prosthetic MRSA adjunct, select zoonoses. AVOID IF: Cannot manage interactions (OCP, DOAC, transplant meds) without pharmacy/ID.
Primary
Secondary
Other
STANDARD (ADULT PO)
600 mg PO daily (TB) OR higher intermittent DOT supervised regimens
ADULT DOSE
600 mg PO daily or intermittent TB DOT schedules
PEDIATRIC DOSE
mg/kg per TB program.
MAX DOSE
600 mg daily standard adult; intermittent higher supervised
Practical Note
Take on empty stomach if possible TB β check program.
Clinical warnings
Adverse effects
Pediatrics
10β20 mg/kg/day max 600 mg TB; neonatal meningitis prophylaxis distinct
Pregnancy
TB: use in regimen; OCP ineffective β alternate contraception
Lactation
compatible generally.
Renal impairment
No major renal adjustment. **CrCl scaffold (FMBM β titrate to FDA/SFDA label + institutional pharmacy nomogram):** - **CrCl β₯50** β hepatic elimination dominant β standard TB dosing per program - **CrCl 10β50** β usually no CrCl table β monitor **LFTs** / interactions - **CrCl <10** β severe renal failure rarely changes core dose β **severe hepatic failure** β caution
Hepatic impairment
Acute hepatitis β hold rifampin; chronic mild elevation monitor.
Elderly
Drug interaction polypharmacy.
PO IV equivalent careful conversion; empty stomach TB.
Clinical Picture
**Life-threatening (first):** **fulminant hepatic failure**. **Secondary:** hepatitis; orange secretions (benign); flu-like (intermittent dosing errors).
Immediate Actions
Stop β LFTs; supportive
Antidote
No specific antidote; treat complications (e.g. anaphylaxis β epinephrine per ACLS)
Decontamination
Charcoal if early large ingestion
Escalation
Acute liver failure, fulminant hepatic failure β **ICU** / transplant center
Common mistakes, resistance logic, and bedside traps
**Interaction nuclear bomb** β every new prescription needs rifampin check. **TB** and **hardware MRSA** main uses. **Orange man** cosplay is benign β hepatitis is not.
DOT programs for adherence. Never staph monotherapy. Linezolid + rifampin hardware β ID literature. *Stewardship (all antimicrobials):* Empiric choice β syndrome severity + **local antibiogram**; shortest effective course.
Hepatic metabolism; auto-induction over days; penetrates cells/macros.
Inhibits DNA-dependent RNA polymerase.
Global data (no country-specific data available)
Saudi Arabia
(placeholder β verify local formulary)
Common trade names are curated examples only β formulations and availability vary. Verify the exact product name with your local pharmacy and national regulator before prescribing or dispensing.
Saudi Arabia
International