Drugs Used to Treat Tuberculosis

                                                                                         

Rifampicin (Rimactane, Rifampin, Rifa)

It is an antibiotic which has revolutionized the treatment of tuberculosis in recent years. It kills the bacteria (bactericidal effect). It attacks the nucleus of the bacterial cell (causing disappearance of its ribosome). Bacterial resistance to rifampicin can be reduced by combining it with isoniazid or other drugs as described hereafter. It increases the activity of oxidizing enzymes of the liver and thus can reduce the effect of various drugs metabolized by these enzymes. The doses of such drugs should be increased to have an adequate effect. It is always included in short course chemotherapy of tuberculosis.

Adverse Effects: Its adverse effects are mild and include abdominal distress and cramps, aches in the muscles and joints, and cramps in the legs during the first few week of therapy. Liver damage (hepatitis) is a dose related adverse effect and is more likely to occur if the liver function is already impaired or when rifampicin is combined with isoniazid or other drugs which are toxic to the liver. Elevation of the liver enzyme (SGPT more than 100 units/ml) occurs in about 4% of the patients treated with rifampicin in combination with isoniazid, but jaundice is not observed commonly.

Other adverse effects include itching rash, allergic reaction with a flu-like syndrome, difficulty in breathing, bone pains, and rarely kidney damage. These are more common when a high dose (900 to 1200 mg) is used intermittently.

Rifampicin and its metabolite impart a reddish orange colour to the urine, faeces, saliva, sweat, and tears. However, this is of no consequence but you should know it lest you are alarmed!

Precautions

Food reduces absorption of rifampicin, therefore it should always be taken on empty stomach, early in the morning.

The doctor should be informed if yellow discolouration of eyes, nails, or skin occurs.

The liver function should be monitored in alcoholics and in patients with pre-existing liver disease.

The doctor should consulted if any adverse effects like itching, allergy, pain in the muscles occur.

If other drugs like digoxin. corticosteroids, oral anti-diabetics, quinidine, ketoconazole, dapsone, disopyramide, warfarin, and methadone are being taken, the doctor should be consulted for increasing their doses as rifampicin increases their metabolism.

Urine, stool, saliva, sweat, and tears may become reddish orange. Do not worry about this.

Women who are taking oral contraceptives (OCs) may become pregnant if rifampicin is also taken. This is because rifampicin increases inactivation of OCs so they become less effective! Therefore, they should use alternative contraceptive method!!

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