Rifapentine adverse reactions
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Chetan Lokhande, M.B.B.S [2]
Adverse Reactions
Serious and Otherwise Important Adverse Reactions
The following serious and otherwise important adverse drug reactions are discussed in greater detail in other sections of labeling:
- Hypersensitivity [see Contraindications ]
- Hepatotoxicity [see Warnings and Precautions ]
- Hyperbilirubinemia [see Warnings and Precautions ]
- Discoloration of Body Fluids [see Warnings and Precautions ]
- Porphyria [see Warnings and Precautions ]
- Clostridium difficile-Associated Diarrhea [see Warnings and Precautions ]
Treatment-emergent adverse reactions reported during treatment and post-treatment through the first three months of follow-up in <1% of the rifapentine combination therapy patients are presented below by body system in order of frequency.
Renal & Urinary
Urethral disorder, dysuria, pyelonephritis, urinary incontinence, urination disorder.
Metabolic & Nutritional
Weight decrease, BUN increased, diabetes mellitus, alkaline phosphatase increased, hypophosphatemia, hypercalcemia, hypovolemia, weight increase.
Hematologic
Lymphocytosis, hematoma, purpura, anemia hypochromic, anemia normocytic, thrombosis.
Body as a Whole - General
Laboratory test abnormal, edema legs, asthenia, edema face, abscess, edema peripheral, malaise.
Dermatologic
Skin ulceraction, urticaria, dry skin, furunculosis, skin discoloration, dermatitis fungal, nail disorder, alopecia, rash erythematous.
Respiratory
Abnormal breath sounds, pneumothorax, pneumonia, pleural effusion, rhinitis, dyspnea, pneumonitis, sinusitis, sputum increased, pulmonary fibrosis, upper respiratory congestion, asthma, chest x-ray abnormal, bronchospasm, laryngeal edema, laryngitis, respiratory disorder.
Gastrointestinal
Tooth disorder, gastroenteritis, gastritis, esophagitis, cheilitis, dry mouth, pancreatitis, proctitis, salivary gland enlargement, tenesmus, gastrointestinal disorder not specified.
Infectious Disease
Infection fungal, infection parasitic, infection protozoan.
Hepatic & Biliary
Bilirubinemia, hepatomegaly, jaundice.
Neurologic
Somnolence, seizure not specified, dysphonia, hypoesthesia, torticollis, hypertonia, hyporeflexia, meningitis, migraine headache, stupor.
Psychiatric
Anxiety, confusion, drug abuse, aggressive reaction, agitation.
Musculoskeletal
Myalgia, myositis, bone fracture, muscle weakness, muscle spasm.
Cardiovascular
Syncope, tachycardia, palpitation, hypotension orthostatic, pericarditis.
Reproductive Disorders
Penis disorder, vaginitis, vaginal hemorrhage, cervical smear test positive, leukorrhea, mastitis male, prostatic disorder.
Hearing & Vestibular
Ear disorder not specified, otitis media, earache, otitis externa, tympanic membrane perforation.
Ophthalmologic
Eye pain, eye abnormality.
Neoplasms
Pulmonary carcinoma, neoplasm not specified, carcinoma, lipoma.
Vascular (Extracardiac)
Thrombophlebitis deep, vascular disorder, vasodilation.
Special Senses Other
Taste loss.
Pregnancy, puerperium and perinatal conditions
Abortion
In another randomized, open-label trial in 1075 HIV seronegative and seropositive patients with pulmonary tuberculosis the overall adverse event rate did not differ substantially from the previous trial. Patients who had completed an initial 2 month phase of treatment with 4 drugs were randomly assigned to receive either rifapentine 600 mg and isoniazid once weekly or rifampin and isoniazid twice weekly for the 4 month continuation phase.
In the rifapentine arm, 502 HIV seronegative and 36 HIV seropositive patients were randomized and in the rifampin arm 502 HIV seronegative and 35 HIV seropositive patients were randomized to treatment.
The death rate among all study participants was 71/1075 (6.6%) and did not differ between the two treatment groups (6.5% for the rifapentine combination regimen compared to 6.7% for the rifampin combination regimen; P = 0.87).
There were 526 treatment-emergent adverse events regardless of causality reported from 251 patients treated with the rifapentine combination regimen and 513 adverse events reported from 248 patients treated with the rifampin combination regimen. On both study arms the most frequently reported adverse events were hyperglycemia, pneumonia, liver toxicity, and death and were consistent with concurrent underlying conditions that included alcohol abuse, pancreatitis and HIV.
There was a greater percentage of patients in the rifampin combination arm who developed hepatic adverse events (35/513; 6.8 %) compared to 20/526 (3.8%) in the rifapentine combination arm. The types of other adverse events were similar between the treatment arms.
Hyperuricemia was not reported as an adverse reaction in this study of continuation phase therapy. In the previous study which evaluated initial therapy containing pyrazinamide, hyperuricemia was reported in 32% of rifapentine and 23% of rifampin combination treated patients (see Table 1). [1]
DRUG INTERACTIONS
Protease Inhibitors and Reverse Transcriptase Inhibitors
Rifapentine is an inducer of CYP450 enzymes. Concomitant use of PRIFTIN with other drugs metabolized by these enzymes, such as protease inhibitors and reverse transcriptase inhibitors, may cause a significant decrease in plasma concentrations and loss of therapeutic effect of the protease inhibitor or reverse transcriptase inhibitor. [see Warnings and Precautions and Clinical Pharmacology ]
Hormonal Contraceptives
PRIFTIN may reduce the effectiveness of hormonal contraceptives. Therefore, patients using oral, transdermal patch, or other systemic hormonal contraceptives should be advised to change to non-hormonal methods of birth control.
Cytochrome P450 3A4 and 2C8/9
Rifapentine is an inducer of cytochromes P4503A4 and P4502C8/9. Therefore, rifapentine may increase the metabolism of other coadministered drugs that are metabolized by these enzymes. Induction of enzyme activities by rifapentine occurred within 4 days after the first dose. Enzyme activities returned to baseline levels 14 days after discontinuing rifapentine. In addition, the magnitude of enzyme induction by rifapentine was dose and dosing frequency dependent; less enzyme induction occurred when 600 mg oral doses of rifapentine were given once every 72 hours versus daily.
In vitro and in vivo enzyme induction studies have suggested rifapentine induction potential may be less than rifampin but more potent than rifabutin.
Rifampin has been reported to accelerate the metabolism and may reduce the activity of the following drugs; hence, rifapentine may also increase the metabolism and decrease the activity of these drugs. Dosage adjustments of the drugs in Table 2 or of other drugs metabolized by cytochrome P4503A4 or P4502C8/9 may be necessary if they are given concurrently with rifapentine.
References
Adapted from the FDA Package Insert.