Rifampicin Intravenous Infusion for Adults

Who can administer

May be administered by registered competent doctor or nurse/midwife

Important information

• See monitoring requirements - see below
• There are numerous important interactions - check current BNF
• See under 'Dose' for adjustments required in renal impairment

Available preparations

Rifadin 600mg vial

Reconstitution

Solvent provided

• 10mL solvent per 600mg vial
• Swirl vial gently to completely dissolve powder
• The solution is red in colour

Dilute further prior to administration

Infusion fluids

Sodium chloride 0.9% or Glucose 5%

Methods of intravenous administration

Intermittent intravenous infusion

• Add required dose to 500mL infusion fluid and administer over 2 to 3 hours
• Fluid restricted (use a large vein): 600mg in 100mL infusion fluid over 30 minutes (unlicensed). This solution is less stable, watch closely for precipitation ^{(ref 1)}

Dose in adults

Tuberculosis, in combination with other anti-tuberculous drugs

• Give 8 to 12mg/kg (to a maximum of 600mg ^{(ref 3)}) as a single daily dose
• A reduced dose (e.g. 8mg per kg daily) is recommended in elderly or frail patients

Non-tuberculous infections (for example: Brucellosis, Legionnaires disease, endocarditis and serious staphylococcal infections (in combination with other drugs)

• For patients over 50kg: Give 450mg twice daily, or 300mg three times daily

Hepatic impairment

• A daily dose of 8mg/kg should not be exceeded in patients with impaired liver function

Renal impairment ^{(ref 2)}

• If eGFR less than 30mL/min/1.73m²
  • Tuberculosis: Usual dose ^{(ref 4)}
  • Other infections: use 50 to 100% of dose. Use doses >600mg with caution
• There is no increase in half-life in severe renal impairment for doses less than 600mg daily

Monitoring

• Monitor baseline LFTs, FBC and platelets. Monitor Bilirubin, serum creatinine
• Hypersensitivity phenomena may occur (affecting platelets, vascular tissues and renal function)
• Anaphylaxis may occur, especially with intermittent therapy (e.g.two to three times weekly dosing)
• If hepatic impairment, use with caution. Use lower doses and monitor LFTs every two to four weeks during therapy

Further information

• Avoid extravasation during injection; local irritation and inflammation due to extravascular infiltration of the infusion have been observed. If these occur, the infusion should be discontinued and restarted at another site
• May cause red discolouration of urine, sweat, sputum and tears
• Consider IV to oral switch as soon as possible as excellent bioavailability

Storage

• Store below 25⁰C
• The prepared infusion bag must be used within 6 hours

References

SPC September 2024

1. Injectable Medicines Administration Guide Medusa, downloaded 08/05/2025

2. Renal Drug Database accessed online 08/05/2025

3. Martindale- accessed online via Medicines complete 20/05/2025

4. GAPP app- -accessed 20/05/2025

Therapeutic classification

Antibiotic