Can rifampin (Rifampicin) cause dyspepsia?

From the Guidelines

Yes, rifampin can cause dyspepsia.

Adverse Effects of Rifampin

The most common adverse reaction to rifampin is gastrointestinal upset 1, which includes symptoms such as nausea, anorexia, and abdominal pain. According to the American Thoracic Society, the incidence of gastrointestinal reactions is variable, but symptoms are rarely severe enough to necessitate discontinuation of the drug 1.

• Gastrointestinal reactions, including dyspepsia, can occur in patients taking rifampin, although the exact frequency is not specified in the provided evidence.
• Other adverse effects of rifampin include cutaneous reactions, hepatotoxicity, and severe immunologic reactions, but these are less common than gastrointestinal upset 1.
• It is essential to note that rifampin can interact with various drugs, including oral contraceptives, methadone, and warfarin, due to its induction of hepatic microsomal enzymes 1.

From the FDA Drug Label

Gastrointestinal Heartburn, epigastric distress, anorexia, nausea, vomiting, jaundice, flatulence, cramps, and diarrhea have been noted in some patients. The answer is yes, rifampin can cause dyspepsia, as evidenced by reports of epigastric distress and heartburn, which are symptoms of dyspepsia, in patients taking the drug 2.

From the Research

Rifampin and Dyspepsia

• Dyspepsia is a term that refers to indigestion or an upset stomach, and it can be caused by various factors, including certain medications.
• Rifampin, an antibiotic used to treat tuberculosis, has been reported to cause gastrointestinal disturbances, including anorexia, nausea, vomiting, abdominal discomfort, and diarrhea 3, 4, 5.
• While dyspepsia is not explicitly mentioned in these studies, the gastrointestinal symptoms associated with rifampin use suggest that it could contribute to dyspepsia in some patients.
• Additionally, a case report of pill-induced esophagitis caused by oral rifampin noted that the patient experienced dysphagia, which can be related to dyspepsia 6.

Gastrointestinal Effects of Rifampin

• The gastrointestinal effects of rifampin are well-documented and can include:
  • Anorexia
  • Nausea
  • Vomiting
  • Abdominal discomfort
  • Diarrhea
  • Hepatitis
  • Thrombocytopenic purpura
  • "Flu" syndrome
  • Shock
  • Shortness of breath
  • Haemolytic anaemia
  • Renal failure 3, 4, 5
• These effects can be minor or major and may be associated with intermittent or prolonged therapy.

Clinical Relevance

• The clinical relevance of rifampin's gastrointestinal effects is significant, as they can impact patient compliance and treatment outcomes.
• Healthcare providers should be aware of the potential for rifampin to cause gastrointestinal disturbances, including dyspepsia, and monitor patients accordingly 3, 4, 5, 6.