{"id":60454,"date":"2024-02-28T06:49:25","date_gmt":"2024-02-28T06:49:25","guid":{"rendered":"https:\/\/medsname.com\/r-cin\/"},"modified":"2026-05-01T10:49:16","modified_gmt":"2026-05-01T10:49:16","slug":"r-cin","status":"publish","type":"product","link":"https:\/\/medsbase.com\/nl\/r-cin\/","title":{"rendered":"R-Cin"},"content":{"rendered":"

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⚡ Quick Answer — What is R-Cin?<\/h3>\n

R-Cin<\/strong> bevat rifampicin (300 mg \/ 450 mg \/ 600 mg capsules)<\/strong> from a WHO-GMP certified manufacturer (made by Cipla) — a bactericidal anti-tuberculous antibiotic that inhibits bacterial DNA-dependent RNA polymerase. Standard adult dose for active TB:<\/strong> 10 mg\/kg once daily (typically 450 mg for 38–55 kg, 600 mg for > 55 kg) op een lege maag<\/strong> — one hour before food or two hours after. Rifampicin is never used alone for active TB<\/strong>; it is always combined with isoniazid, pyrazinamide, and ethambutol (the 4-drug RIPE regimen) for the first two months, then continued with isoniazid for four more months. Single-agent rifampicin has defined uses in latent TB infection (4-month monotherapy), leprosy, meningococcal contact prophylaxis, MRSA bone\/joint infections, and brucellosis<\/strong>. Expect orange-red discolouration of urine, sweat, tears and saliva<\/strong> (harmless but permanently stains soft contact lenses). Rifampicin is a very potent CYP3A4\/2C9\/2C19 inducer<\/strong> and reduces the effectiveness of dozens of medications including oral contraceptives, warfarin, DOACs, statins, methadone, immunosuppressants, antiretrovirals, and many others.<\/p>\n<\/div>\n

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Waarom bestellen bij MedsBase<\/h3>\n

Onze generieke medicijnen zijn afkomstig van WHO-GMP gecertificeerde fabrikanten en worden wereldwijd verzonden in discrete, eenvoudige verpakkingen \u2014 geen medicijnnaam op de buitenkant van het pakket. Betalingen met kaart worden verwerkt via een gereguleerde processor (betalingsoverzichten vermelden een gereguleerde kaartbetalingprocessor \u2014 nooit \u201cMedsBase\u201d of een medicijnnaam). Crypto en SEPA bankoverschrijvingen worden ook geaccepteerd. Elke bestelling wordt ondersteund door ons Reshipment Assurance Policy.<\/p>\n

Critical safety notice — rifampicin alone is not a treatment for active tuberculosis.<\/strong> Active pulmonary or extrapulmonary TB requires combination therapy. The standard WHO-recommended regimen is 2 months of intensive-phase RIPE<\/strong> (rifampicin + isoniazid + pyrazinamide + ethambutol) followed by 4 months of continuation-phase RH<\/strong> (rifampicin + isoniazid). Using rifampicin as a single agent for active TB causes rapid emergence of rifampicin resistance<\/strong>, treatment failure, prolonged infectivity, and the development of multidrug-resistant TB (MDR-TB). Single-agent R-Cin is appropriate alleen<\/strong> when prescribed for: (a) continuation of an ongoing supervised combination regimen, (b) latent TB infection (4-month rifampicin monotherapy — the 4R regimen), (c) one of the defined non-TB indications listed below. If you have suspected or confirmed active TB, you need full combination therapy under specialist supervision — do not treat with rifampicin alone.<\/div>\n

What R-Cin (Rifampicin) Is<\/h2>\n

R-Cin is the Cipla brand of rifampicin<\/strong>, a semi-synthetic rifamycin antibiotic introduced in the late 1960s and on the WHO Model List of Essential Medicines. Each opaque red-and-maroon capsule contains 300 mg, 450 mg, or 600 mg of rifampicin. Rifampicin is bactericide<\/strong> against Mycobacterium tuberculosis<\/em>, M. leprae<\/em>, and a range of staphylococci, neisseria, and other intracellular pathogens. It is the most important sterilising drug in modern short-course TB therapy — the single agent that allowed treatment duration to drop from 18–24 months to 6 months in the 1970s.<\/p>\n

How R-Cin Works (Mechanism)<\/h2>\n

Rifampicin binds to the β-subunit of bacterial DNA-dependent RNA polymerase, blocking the initiation of RNA transcription. Mammalian RNA polymerases are not affected because their structure differs at the rifampicin-binding pocket. The drug penetrates host cells, granulomas, abscess cavities, and cerebrospinal fluid in inflamed meninges — which is why it is so important against intracellular and partition-resistant infections. Resistance arises through point mutations in the rpoB<\/em> gene encoding the polymerase β-subunit; this is why rifampicin must always be combined with at least one other active agent<\/strong> when treating organisms with high bacillary load (such as active TB).<\/p>\n

Indications — What R-Cin Treats<\/h2>\n

1. Active tuberculosis (combination therapy only)<\/h3>\n

Rifampicin is the cornerstone of the WHO 6-month short-course regimen for drug-susceptible pulmonary and extrapulmonary TB:<\/p>\n\n\n\n\n\n\n
Fase<\/th>\nDuur<\/th>\nGeneesmiddelen<\/th>\n<\/tr>\n<\/thead>\n
Intensieve<\/td>\n2 maanden<\/td>\nRifampicin + Isoniazid + Pyrazinamide + Ethambutol (RIPE)<\/td>\n<\/tr>\n
Vervolg<\/td>\n4 maanden<\/td>\nRifampicin + Isoniazid (RH)<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

Total minimum duration is 6 months. Longer regimens (9–12 months) are used for TB meningitis, bone\/joint TB, and disseminated disease. Treatment must be supervised — directly observed therapy (DOT) is recommended in most national programmes to ensure adherence and prevent the emergence of MDR-TB.<\/p>\n

2. Latent tuberculosis infection (LTBI)<\/h3>\n

For patients with positive TB skin test or interferon-gamma release assay but no active disease, four months of rifampicin monotherapy<\/strong> at 10 mg\/kg\/day (the 4R regimen) is one of the WHO-preferred options. The 2017 NEJM trial by Menzies et al. showed 4R was non-inferior to 9 months of isoniazid and had significantly fewer hepatotoxicity events, lower discontinuation, and better completion rates. This is the only standard situation where rifampicin is correctly used as a single agent for tuberculous infection.<\/p>\n

3. Leprosy (multibacillary multi-drug therapy)<\/h3>\n

The WHO multidrug therapy regimen for multibacillary leprosy is monthly rifampicin 600 mg + monthly clofazimine 300 mg + daily clofazimine 50 mg + daily dapsone 100 mg, for 12 months. Rifampicin is the most rapidly bactericidal agent against M. leprae<\/em> — a single 600 mg dose kills more than 99% of viable organisms.<\/p>\n

4. Meningococcal disease prophylaxis<\/h3>\n

Close contacts of a confirmed meningococcal disease case can take rifampicin 600 mg twice daily for 2 days (adults; weight-adjusted in children) to eradicate nasopharyngeal carriage. Ciprofloxacin 500 mg single dose or ceftriaxone 250 mg IM single dose are equally acceptable alternatives, particularly when rifampicin would interact with ongoing medication.<\/p>\n

5. Staphylococcal bone, joint, and prosthetic-device infections<\/h3>\n

Rifampicin is added to vancomycin, daptomycin, or beta-lactams for serious staphylococcal infections involving biofilm — particularly prosthetic joint infections and infective endocarditis on prosthetic valves. Rifampicin penetrates biofilm where most antibiotics cannot. It must always be combined to prevent rapid resistance.<\/p>\n

6. Brucellosis<\/h3>\n

Rifampicin 600–900 mg\/day combined with doxycycline 100 mg twice daily for 6 weeks is one of the standard WHO regimens for non-complicated brucellosis. An aminoglycoside (streptomycin or gentamicin) is added for spondylitis or endocarditis.<\/p>\n

Dosering<\/h2>\n\n\n\n\n\n\n\n\n\n\n
Indicatie<\/th>\nVolwassen dosis<\/th>\nPaediatric dose<\/th>\n<\/tr>\n<\/thead>\n
Active TB (in combination)<\/td>\n10 mg\/kg once daily, max 600 mg
 • 38–55 kg → 450 mg
 • > 55 kg → 600 mg<\/td>\n		15 mg\/kg once daily, max 600 mg<\/td>\n<\/tr>\n
Latent TB (4R)<\/td>\n10 mg\/kg once daily for 4 months<\/td>\n15 mg\/kg once daily for 4 months<\/td>\n<\/tr>\n
Leprosy (multibacillary)<\/td>\n600 mg once monthly × 12 months<\/td>\n10 mg\/kg once monthly<\/td>\n<\/tr>\n
Meningococcal prophylaxis<\/td>\n600 mg twice daily for 2 days<\/td>\n10 mg\/kg twice daily × 2 days (max 600 mg\/dose)<\/td>\n<\/tr>\n
Bone\/joint\/prosthetic-device infection<\/td>\n300–600 mg twice daily, in combination<\/td>\nSpecialist-led<\/td>\n<\/tr>\n
Brucellosis (with doxycycline)<\/td>\n600–900 mg once daily for 6 weeks<\/td>\n15–20 mg\/kg\/day<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

Take on an empty stomach —<\/strong> one hour before food or two hours after. Food (especially fatty meals) reduces absorption by ~30%. Swallow capsules whole with water; do not break or open them.<\/p>\n

Verplichte monitoring<\/h2>\n
Liver-function monitoring is required.<\/strong> Baseline ALT, AST, bilirubin and alkaline phosphatase before starting; repeat at 2 weeks, then monthly through treatment. Stop rifampicin and the companion drugs (especially isoniazid and pyrazinamide) and seek medical review if you develop: nausea or vomiting that does not settle, loss of appetite, jaundice (yellowing of skin or whites of the eyes), dark urine, pale stools, or right-upper-quadrant abdominal pain. Stop if ALT > 3× ULN with symptoms or > 5× ULN without symptoms.<\/div>\n

Additional monitoring depending on regimen: full blood count (rifampicin can cause thrombocytopenia and rare haemolytic anaemia), urea\/creatinine, sputum smear\/culture (for active TB — conversion at 2 months is the main efficacy marker), HIV status (TB-HIV co-infection alters the regimen).<\/p>\n

Bijwerkingen<\/h2>\n

Common (expected and usually harmless):<\/strong><\/p>\n

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  • Orange-red discolouration of urine, sweat, tears, saliva (always — confirms absorption; permanently stains soft contact lenses)<\/li>\n
  • Nausea, loss of appetite, abdominal discomfort — ease over the first 1–2 weeks<\/li>\n
  • Mild rash, particularly in the first month<\/li>\n<\/ul>\n

    Zeldzaam maar belangrijk:<\/strong><\/p>\n

      \n
    • Drug-induced hepatitis (5–10% have asymptomatic transaminase rise; ~1% develop clinical hepatitis — risk higher in older patients, alcohol users, hepatitis B\/C carriers, and when combined with isoniazid + pyrazinamide)<\/li>\n
    • Flu-like syndrome — fever, chills, headache, myalgia — particularly with intermittent (twice- or thrice-weekly) dosing or after restarting<\/li>\n
    • Thrombocytopenia, haemolytic anaemia, eosinophilia (rare; immune-mediated; stop drug)<\/li>\n
    • Acute kidney injury (rare; usually with intermittent dosing)<\/li>\n
    • Hypersensitivity rash, urticaria, angioedema, anaphylaxis (rare; permanent contraindication)<\/li>\n
    • Stevens-Johnson syndrome \/ toxic epidermal necrolysis (very rare; permanent contraindication)<\/li>\n<\/ul>\n

      Geneesmiddelinteracties<\/h2>\n
      Drug-interaction warning — rifampicin is one of the strongest CYP enzyme inducers in clinical use.<\/strong> It induces CYP3A4, CYP2C9, CYP2C19, CYP1A2, CYP2B6, P-glycoprotein, and many phase-II conjugation enzymes. Plasma concentrations of co-administered medicines can drop by 50–90%, with onset within 1–2 weeks and persisting 2–4 weeks after rifampicin is stopped. Tell your prescriber every medicine, supplement, and herbal preparation you take before starting rifampicin.<\/strong> The interactions table below covers the main classes; consult a pharmacist for any drug not listed.<\/div>\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n
      Drug class \/ examples<\/th>\nInteraction with rifampicin<\/th>\nWat te doen<\/th>\n<\/tr>\n<\/thead>\n
      Combined \/ progestogen-only oral contraceptives, patch, ring, implant<\/td>\nSubstantial loss of efficacy<\/td>\nUse barrier contraception (condoms) or copper IUD throughout and 4 weeks after<\/td>\n<\/tr>\n
      Warfarine<\/td>\nINR drops sharply; risk of thrombosis<\/td>\nMonitor INR weekly; expect to need a 2–3-fold dose increase; recheck weekly for 4 weeks after stopping rifampicin<\/td>\n<\/tr>\n
      DOACs (apixaban, rivaroxaban, dabigatran, edoxaban)<\/td>\nAll DOAC levels drop substantially<\/td>\nSwitch to warfarin (or LMWH) for the duration of rifampicin treatment<\/td>\n<\/tr>\n
      Statines (simvastatine, atorvastatine, lovastatine)<\/td>\nPlasma levels reduced > 50%<\/td>\nSwitch to fluvastatin, rosuvastatin, or pravastatin (less affected); discuss with prescriber<\/td>\n<\/tr>\n
      HIV protease inhibitors (lopinavir, atazanavir, darunavir)<\/td>\nPI levels collapse; ART failure<\/td>\nSwitch rifampicin to rifabutin<\/strong> or change ART regimen — specialist input mandatory<\/td>\n<\/tr>\n
      HIV NNRTIs (efavirenz OK; nevirapine reduced)<\/td>\nVariable<\/td>\nEfavirenz-based ART is generally compatible with rifampicin<\/td>\n<\/tr>\n
      Dolutegravir, raltegravir<\/td>\nLevels reduced<\/td>\nDolutegravir 50 mg twee keer per dag<\/strong> with rifampicin; raltegravir 800 mg twice daily<\/td>\n<\/tr>\n
      Methadon<\/td>\nWithdrawal within days<\/td>\nIncrease methadone dose 50–100% with monitoring; warn the patient before starting rifampicin<\/td>\n<\/tr>\n
      Tacrolimus, ciclosporin, sirolimus, everolimus<\/td>\nTrough levels collapse; transplant rejection risk<\/td>\nSpecialist transplant team input before rifampicin is started<\/td>\n<\/tr>\n
      Phenytoin, carbamazepine<\/td>\nAnticonvulsant levels drop; seizure risk<\/td>\nMonitor levels; dose increase often needed<\/td>\n<\/tr>\n
      Corticosteroids (prednisolone, dexamethasone)<\/td>\nSteroid clearance roughly doubles<\/td>\nIncrease steroid dose if treating Addison’s disease, asthma, or autoimmune flare<\/td>\n<\/tr>\n
      Itraconazole, ketoconazole, voriconazole<\/td>\nAntifungal levels drop dramatically<\/td>\nAvoid combination — consider fluconazole (less affected) or amphotericin<\/td>\n<\/tr>\n
      Sulfonylureas (gliclazide, glimepiride, glipizide)<\/td>\nGlycaemic control deteriorates<\/td>\nMonitor blood glucose; dose-adjust as needed<\/td>\n<\/tr>\n
      Levothyroxine<\/td>\nIncreased clearance; TSH rises<\/td>\nRecheck TSH at 6 weeks; expect to increase levothyroxine dose<\/td>\n<\/tr>\n
      Theophylline, beta-blockers (metabolised), opioids (codeine, oxycodone)<\/td>\nVerminderd effect<\/td>\nClinical monitoring; titrate to effect<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

      This list is not exhaustive. Always have a pharmacist or physician review every concurrent medication and supplement — including over-the-counter analgesics, herbal preparations, and complementary medicines.<\/p>\n

      Contra-indicaties en voorzorgsmaatregelen<\/h2>\n