Rifampicin for Itch in chronic liver disease

Introduction

You have been started on a medicine called rifampicin for itch.

Rifampicin is an antibiotic that is used to treat various conditions. It is not licensed by drug companies to treat itch; however, it is used commonly by liver doctors for this reason with good effect.

How to take

Rifampicin comes in capsule or liquid form.

Rifampicin works best if you take it on an empty stomach (i.e. at least 30 minutes before a meal or two hours after a meal). If you are taking rifampicin capsules, swallow them whole with a glass of water.

Side-effects

Rifampicin can discolour (yellow, brown, orange or red colour) urine, tears, saliva, sweat or phlegm (sputum). This is quite common and you need not worry; however, the colour may permanently stain soft contact lenses. The colour in tears may also last for some time after stopping rifampicin.

For a full list of side-effects, please see the manufacturer leaflet included in your box of rifampicin (however, note this leaflet will contain information relating to rifampicin use for various infections).

Blood tests

Rifampicin can affect your liver function tests so you will need to have these checked every week for the first two weeks of treatment, then every two weeks for the next 10 weeks. If you remain on rifampicin after these first three months, you will need blood tests less often – usually every three months or as recommended by your liver team.

Effects on other medicines

Rifampicin affects the way your body processes certain medicines so can affect the levels of other medicines that you take. Please check with your doctor or pharmacist that rifampicin is ok with your other medicines.

Examples include oral contraceptives and immunosuppression / anti-rejection medicine (tacrolimus, ciclosporin, sirolimus, azathioprine, mycophenolate).

Due to issues with other medicines, if you have had a transplant in the past, make sure that your transplant team are aware that you are on rifampicin and there is a plan for managing your immunosuppression with rifampicin before you start taking it.

Rifampicin may make the oral contraceptive ‘pill’ work less well. This means you should change to a different type of contraception that will be effective. Instead, you must use a non-hormonal barrier method of contraception such as condoms, or get an intra-uterine device / system such as ‘the coil’ while taking rifampicin. If you have any questions or are unsure about this, talk to your doctor or pharmacist.

Pregnancy and breastfeeding

Due to potential risks in pregnancy, talk to your doctor before taking rifampicin if you are pregnant, plan to get pregnant or think you are pregnant.

Rifampicin can also be found in breast milk. If you are breastfeeding or planning to breast-feed, talk to your doctor or pharmacist before taking rifampicin.