Rifapentine

INTRODUCTION

Indications

Treatment of pulmonary tuberculosis: Must be used in combination with other agents.

Action

Inhibits DNA-dependent RNA polymerase. Therapeutic Effects: Bactericidal action against intracellular and extracellular susceptible strains of Mycobacterium tuberculosis.

Adverse Reactions/Side Effects

CNS: dizziness, headache. Resp: hemoptysis. CV: hypertension. GI: PSEUDOMEMBRANOUS COLITIS, anorexia, diarrhea, dyspepsia, increased liver enzymes, nausea, vomiting. GU: hematuria, proteinuria, pyuria, urinary casts. Derm: acne, pruritus, rash. Hemat: anemia, leukopenia, lymphopenia, neutropenia, thrombocytosis. MS: arthralgia. Misc: pain.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Monitor signs of pseudomembranous colitis, including diarrhea, abdominal pain, fever, pus or mucus in stools, and other severe or prolonged GI problems (nausea, vomiting, heartburn). Notify physician or nursing staff immediately of these signs.

• Monitor any chest pain or breathing problems, and instruct patient to immediately report coughing up blood (hemoptysis).

• Assess any joint or muscle pain to rule out musculoskeletal pathology; that is, try to determine if pain is drug induced rather than caused by anatomic or biomechanical problems.

• Assess dizziness that might affect gait, balance, and other functional activities (See Appendix C). Report balance problems and functional limitations to the physician and nursing staff, and caution the patient and family/caregivers to guard against falls and trauma.

• Monitor signs of leukopenia or neutropenia (fever, sore throat, signs of infection), thrombocytosis (headache, chest pain, dizziness, fainting, vision problems, numbness/tingling in the hands and feet), or unusual weakness and fatigue that might be due to anemia. Report these signs to the physician.

• Assess blood pressure periodically and report a sustained increase in BP (hypertension) (See Appendix F).

Interventions

• Always wash hands thoroughly and disinfect equipment (whirlpools, electrotherapeutic devices, treatment tables, and so forth) to help prevent the spread of infection. Use universal precautions or isolation procedures as indicated for specific patients.

Patient/Client-Related Instruction

• Advise patient about the likelihood of GI reactions such as diarrhea, nausea, vomiting, loss of appetite, abdominal pain, and indigestion. Instruct patient to report severe or prolonged GI problems.

• Instruct patient to report other troublesome side effects such as severe or prolonged headache, skin problems (acne, rash, itching), or blood in the urine.

Pharmacokinetics

Absorption: 70% absorbed following oral administration.

Distribution: Widely distributed in body tissues and fluids.

Protein Binding: Rifapentine—97.7%; desacetyl rifapentine—93.2%.

Metabolism and Excretion: Mostly metabolized by the liver; 17% excreted by the kidneys; some conversion to another active compound (25-desacetyl rifapentine).

Half-life: 13 hr (rifapentine and desacetyl rifapentine).