Rimactazid
Generic Name
Rifampicin 300 mg + Isoniazid 150 mg
Manufacturer
Square Pharmaceuticals Ltd.
Country
Bangladesh
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Price Details
Current market pricing information
| Variant | Unit Price | Strip Price |
|---|---|---|
| rimactazid 300 mg tablet | ৳ 8.40 | ৳ 84.00 |
Description
Overview of the medicine
Rimactazid 300 mg tablet is a fixed-dose combination of Rifampicin and Isoniazid, used in the treatment of all forms of tuberculosis.
Uses & Indications
Dosage
Adults
Standard dosage for adults typically involves 450-600 mg Rifampicin and 300 mg Isoniazid daily, often weight-based. This specific tablet (Rifampicin 300 mg + Isoniazid 150 mg) might require two tablets for a full adult dose depending on body weight.
Elderly
Similar to adult dosage, but caution with liver function. Lower doses may be considered if hepatic impairment is present.
Renal_impairment
Rifampicin is primarily excreted via bile, so no significant dose adjustment needed. Isoniazid is excreted renally, but dose adjustment is generally not necessary in mild to moderate renal impairment; however, caution is advised in severe cases.
How to Take
Take orally, preferably on an empty stomach (1 hour before or 2 hours after a meal) to maximize absorption. Take with water.
Mechanism of Action
Rifampicin inhibits bacterial RNA synthesis by binding to DNA-dependent RNA polymerase. Isoniazid inhibits mycolic acid synthesis, essential for the mycobacterial cell wall.
Pharmacokinetics
Onset
Rapid onset of action, typically within hours.
Excretion
Rifampicin is mainly excreted via bile and feces, with some renal excretion. Isoniazid is primarily excreted in urine (75-95%) as metabolites.
Half life
Rifampicin: 2-5 hours (can decrease with repeated dosing due to autoinduction). Isoniazid: 1-4 hours (variable depending on genetic acetylator status).
Absorption
Both Rifampicin and Isoniazid are well absorbed orally. Food may reduce absorption of Rifampicin.
Metabolism
Both are primarily metabolized in the liver. Rifampicin undergoes deacetylation. Isoniazid undergoes acetylation via N-acetyltransferase 2 (NAT2).
Side Effects
Contraindications
- Hypersensitivity to Rifampicin, Isoniazid, or any component of the formulation
- Acute liver disease or a history of drug-induced hepatitis
- Concomitant use with certain antiretrovirals (e.g., protease inhibitors) due to significant drug interactions
Drug Interactions
Alcohol
Increases risk of hepatotoxicity.
Corticosteroids
Rifampicin can reduce the effects of corticosteroids.
Oral Contraceptives
Rifampicin is a potent enzyme inducer and can significantly reduce the efficacy of oral contraceptives. Patients should use alternative non-hormonal birth control methods.
Phenytoin, Carbamazepine
Isoniazid can inhibit the metabolism of these drugs, leading to increased plasma levels and potential toxicity.
Anticoagulants (e.g., Warfarin)
Rifampicin can decrease the effect of warfarin, requiring dose adjustment and close monitoring of INR.
Antiretrovirals (e.g., Protease Inhibitors, NNRTIs)
Significant interactions, potentially leading to treatment failure. Co-administration often contraindicated or requires careful management.
Storage
Store below 30°C in a dry place, away from light and moisture. Keep out of reach of children.
Overdose
Symptoms of overdose include nausea, vomiting, abdominal pain, hepatotoxicity, central nervous system effects (seizures, psychosis), and reddish-orange discoloration of skin and fluids. Management involves gastric lavage, activated charcoal, supportive care, and administration of pyridoxine (Vitamin B6) for Isoniazid toxicity.
Pregnancy & Lactation
Not recommended during pregnancy unless the benefits outweigh the risks. Rifampicin can cause postnatal hemorrhage in mothers and neonates; Vitamin K supplementation may be considered. Isoniazid passes into breast milk; monitor infants for potential side effects. Consult a doctor.
Side Effects
Contraindications
- Hypersensitivity to Rifampicin, Isoniazid, or any component of the formulation
- Acute liver disease or a history of drug-induced hepatitis
- Concomitant use with certain antiretrovirals (e.g., protease inhibitors) due to significant drug interactions
Drug Interactions
Alcohol
Increases risk of hepatotoxicity.
Corticosteroids
Rifampicin can reduce the effects of corticosteroids.
Oral Contraceptives
Rifampicin is a potent enzyme inducer and can significantly reduce the efficacy of oral contraceptives. Patients should use alternative non-hormonal birth control methods.
Phenytoin, Carbamazepine
Isoniazid can inhibit the metabolism of these drugs, leading to increased plasma levels and potential toxicity.
Anticoagulants (e.g., Warfarin)
Rifampicin can decrease the effect of warfarin, requiring dose adjustment and close monitoring of INR.
Antiretrovirals (e.g., Protease Inhibitors, NNRTIs)
Significant interactions, potentially leading to treatment failure. Co-administration often contraindicated or requires careful management.
Storage
Store below 30°C in a dry place, away from light and moisture. Keep out of reach of children.
Overdose
Symptoms of overdose include nausea, vomiting, abdominal pain, hepatotoxicity, central nervous system effects (seizures, psychosis), and reddish-orange discoloration of skin and fluids. Management involves gastric lavage, activated charcoal, supportive care, and administration of pyridoxine (Vitamin B6) for Isoniazid toxicity.
Pregnancy & Lactation
Not recommended during pregnancy unless the benefits outweigh the risks. Rifampicin can cause postnatal hemorrhage in mothers and neonates; Vitamin K supplementation may be considered. Isoniazid passes into breast milk; monitor infants for potential side effects. Consult a doctor.
Frequently Asked Questions
Common questions about this medicine
Pack Sizes
Shelf Life
2-3 years from manufacturing date
Availability
Available in pharmacies and hospitals
Approval Status
Approved for Tuberculosis treatment
Patent Status
Off-patent (generic versions available)
WHO Essential Medicine
YesClinical Trials
Extensive clinical trials have established the efficacy and safety of Rifampicin and Isoniazid fixed-dose combinations for the treatment of tuberculosis globally.
Lab Monitoring
- Liver function tests (ALT, AST, bilirubin) at baseline and periodically during treatment
- Complete blood count (CBC)
- Renal function tests (BUN, creatinine)
- Ophthalmic examination if visual disturbances occur (for Isoniazid-induced optic neuritis)
Doctor Notes
- Emphasize strict adherence to the full course of treatment to prevent drug resistance.
- Monitor liver function tests (LFTs) regularly, especially in patients with pre-existing liver conditions or alcohol abuse.
- Consider pyridoxine (Vitamin B6) supplementation to prevent Isoniazid-induced peripheral neuropathy, particularly in high-risk patients (e.g., diabetics, alcoholics, malnourished, elderly, pregnant).
Patient Guidelines
- Take the medicine exactly as prescribed, without missing any doses, for the entire duration of treatment.
- Report any unusual symptoms, especially yellowing of skin/eyes, dark urine, severe fatigue, or numbness/tingling in hands/feet, to your doctor immediately.
- Avoid alcohol consumption during treatment.
- Pyridoxine (Vitamin B6) supplementation may be recommended to prevent Isoniazid-induced peripheral neuropathy.
Missed Dose Advice
If you miss a dose, take it as soon as you remember. If it is almost time for your next dose, skip the missed dose and continue your regular dosing schedule. Do not double the dose to catch up.
Driving Precautions
Rimactazid may cause dizziness, lightheadedness, or visual disturbances in some patients. Patients should exercise caution when driving or operating machinery until they know how the medication affects them.
Lifestyle Advice
- Maintain a balanced diet.
- Avoid activities requiring mental alertness if experiencing dizziness or visual disturbances.
- Inform your doctor about all other medications, herbal products, and supplements you are taking.
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