Version May 2024
Travelers' diarrhea, treatment (alternative agent):
Note: Avoid use in patients with fever or bloody diarrhea. Antimicrobial treatment is not recommended for mild cases but may be considered for moderate cases and is recommended for severe cases (Ref).
Oral: 388 mg twice daily for 3 days; consider alternative therapy if symptoms persist or worsen after 48 hours of treatment.
The renal dosing recommendations are based upon the best available evidence and clinical expertise. Senior Editorial Team: Bruce Mueller, PharmD, FCCP, FASN, FNKF; Jason Roberts, PhD, BPharm (Hons), B App Sc, FSHP, FISAC; Michael Heung, MD, MS.
Altered kidney function: No dosage adjustment necessary for any degree of kidney dysfunction (systemic absorption limited) (Ref).
Hemodialysis, intermittent (thrice weekly): Unlikely to be dialyzed: No supplemental dose or dosage adjustment necessary (systemic absorption limited) (Ref).
Peritoneal dialysis: Unlikely to be dialyzed: No dosage adjustment necessary (systemic absorption limited) (Ref).
CRRT: No dosage adjustment necessary (systemic absorption limited) (Ref).
PIRRT (eg, sustained, low-efficiency diafiltration): No dosage adjustment necessary (systemic absorption limited) (Ref).
There are no dosage adjustments provided in the manufacturer's labeling (has not been studied). However, dosage adjustment unlikely due to low systemic absorption.
Refer to adult dosing.
The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified.
1% to 10%:
Central nervous system: Headache (3%)
Gastrointestinal: Constipation (4%), dyspepsia (<2%)
Frequency not defined:
Gastrointestinal: Abdominal pain
Miscellaneous: Fever
Hypersensitivity to rifamycin, other rifamycin class antimicrobial agents (eg, rifaximin), or any component of the formulation.
Concerns related to adverse effects:
• Superinfection: Prolonged use may result in bacterial superinfection, including C. difficile infection (CDI); CDI has been observed >2 months postantibiotic treatment.
Other warnings/precautions:
• Appropriate use: Not shown to be effective in patients with diarrhea complicated by fever and/or bloody stool; when these patients were treated with rifamycin, they had prolonged time to last unformed stool. Effectiveness has not been demonstrated in patients with travelers’ diarrhea caused by pathogens other than E. coli.
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Tablet Delayed Release, Oral:
Aemcolo: 194 mg
No
Tablet, EC (Aemcolo Oral)
194 mg (per each): $18.52
Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided when more than one manufacturer's AWP price is available and uses the low and high price reported by the manufacturers to determine the range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing data is updated monthly.
Oral: Administer each dose with a 6 to 8 ounce glass of liquid (not alcohol), with or without food. Swallow tablets whole; do not crush, break, or chew.
Bariatric surgery: Tablet, delayed release: Some institutions may have specific protocols that conflict with these recommendations; refer to institutional protocols as appropriate. No alternative formulation is available. If safety and efficacy can be effectively monitored, no change in formulation or administration is required after bariatric surgery.
Travelers' diarrhea, treatment: Treatment of travelers’ diarrhea (TD) caused by noninvasive strains of Escherichia coli in adults.
Limitations of use: Rifamycin is not indicated in patients with diarrhea complicated by fever or bloody stool or due to pathogens other than noninvasive strains of E. coli.
Substrate of P-glycoprotein/ABCB1 (minor); Note: Assignment of Major/Minor substrate status based on clinically relevant drug interaction potential
Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the Lexicomp drug interactions program by clicking on the “Launch drug interactions program” link above.
Bacillus clausii: Antibiotics may diminish the therapeutic effect of Bacillus clausii. Management: Bacillus clausii should be taken in between antibiotic doses during concomitant therapy. Risk D: Consider therapy modification
Cholera Vaccine: Antibiotics may diminish the therapeutic effect of Cholera Vaccine. Management: Avoid cholera vaccine in patients receiving systemic antibiotics, and within 14 days following the use of oral or parenteral antibiotics. Risk X: Avoid combination
Fecal Microbiota (Live) (Oral): May diminish the therapeutic effect of Antibiotics. Risk X: Avoid combination
Fecal Microbiota (Live) (Rectal): Antibiotics may diminish the therapeutic effect of Fecal Microbiota (Live) (Rectal). Risk X: Avoid combination
Immune Checkpoint Inhibitors (Anti-PD-1, -PD-L1, and -CTLA4 Therapies): Antibiotics may diminish the therapeutic effect of Immune Checkpoint Inhibitors (Anti-PD-1, -PD-L1, and -CTLA4 Therapies). Risk C: Monitor therapy
Sodium Picosulfate: Antibiotics may diminish the therapeutic effect of Sodium Picosulfate. Management: Consider using an alternative product for bowel cleansing prior to a colonoscopy in patients who have recently used or are concurrently using an antibiotic. Risk D: Consider therapy modification
Typhoid Vaccine: Antibiotics may diminish the therapeutic effect of Typhoid Vaccine. Only the live attenuated Ty21a strain is affected. Management: Avoid use of live attenuated typhoid vaccine (Ty21a) in patients being treated with systemic antibacterial agents. Postpone vaccination until 3 days after cessation of antibiotics and avoid starting antibiotics within 3 days of last vaccine dose. Risk D: Consider therapy modification
Voriconazole: Rifamycin may decrease the serum concentration of Voriconazole. Risk C: Monitor therapy
Maternal systemic absorption is limited following oral administration, therefore exposure to the fetus is not expected.
It is not known if rifamycin is present in breast milk. However, maternal systemic absorption is limited following oral administration and exposure to the infant via breast milk is expected to be negligible.
According to the manufacturer, the decision to breastfeed during therapy should consider the risk of infant exposure, the benefits of breastfeeding to the infant, and benefits of treatment to the mother.
Bloody stools, frequency of diarrhea
Rifamycin inhibits bacterial synthesis by inhibiting the beta-subunit of the bacterial DNA-dependent RNA polymerase.
Protein binding: ~80%
Bioavailability: <0.1%
Excretion: Feces: 86%
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