rifabutin
Rifabutin (Mycobutin) is used to prevent Mycobacterium avium complex (MAC) infection in people with advanced human immunodeficiency virus (HIV). It's available as a capsule that's taken by mouth, typically once daily. The most common side effect of rifabutin (Mycobutin) include temporarily change the color of your teeth, body fluids, and even urine.
What is Rifabutin (Mycobutin)?
What is Rifabutin (Mycobutin) used for?
Prevention of Mycobacterium avium complex (MAC) disease in people with severe HIV infection
How Rifabutin (Mycobutin) works
Rifabutin (Mycobutin) kills certain bacteria by blocking an enzyme (protein) the bacteria need make copies of itself, so it can't grow and spread. It's not known if it does the same thing to the bacteria that causes Mycobacterium avium complex (MAC).
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What are the side effects of Rifabutin (Mycobutin)?
Common Side Effects
- Change in urine color (30%)
- Low blood cell count (up to 25%)
- Rash (11%)
- Higher liver enzymes (7-9%)
- Nausea (6%)
Other Side Effects
- Stomach pain
- Fever
- Headache
- Low appetite
- Diarrhea
- Upset stomach
- Excessive gas
- Vomiting
- Muscle pain
- Change in taste
Serious Side Effects
- Severe skin or allergic reaction: fever, body aches, rash, swelling of your lips or tongue, trouble breathing, blistering or peeling skin
- Infectious diarrhea: fever, tiredness, stomach pain, watery diarrhea, loose stools multiple times a day
Source: DailyMed
The following side effects have also been reported
Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor immediately if any of the following side effects occur:
Less common
Black, tarry stools
chills
indigestion
itching or skin rash
loss of appetite
loss of strength or energy
painful or difficult urination
ulcers, sores, or white spots in the mouth
unusual bleeding or bruising
unusual tiredness or weakness
Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:
Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.
Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.
Pros and cons of Rifabutin (Mycobutin)
Pros
Helps prevent MAC, a very serious infection, if you have severe HIV
Is an option for people who can't take azithromycin or clarithromycin to prevent MAC
Can take with or without food
Cons
Isn't a first-choice medication for prevention of MAC in people with HIV
Interacts with many medications, including some HIV medications
Can change the color of your skin and body fluids, and stain your contact lenses
Pharmacist tips for Rifabutin (Mycobutin)
It's normal to have upset stomach, including diarrhea, while you're on antibiotics. If you're having trouble taking rifabutin (Mycobutin) 300 mg once daily, talk to your provider about trying 150 mg twice a day with food.
Rifabutin (Mycobutin) interacts with many medications. It's important to tell your provider and pharmacist about all the medications you're taking. Before starting any new medications, make sure your provider knows that you're on rifabutin (Mycobutin). Also let them know when you stop taking rifabutin (Mycobutin) so they can make the appropriate adjustments.
Since rifabutin (Mycobutin) can cause hormonal birth control to work less well and raise your risk for pregnancy. You should consider other methods of birth control, such as condoms, while you're taking rifabutin (Mycobutin). Talk with your provider if you're not sure about your options for birth control.
Rifabutin (Mycobutin) can turn your skin and body fluids (urine, sweat, spit, tears) to turn brown-orange. This can permanently stain soft contact lenses, clothing, and fabric.
Before starting rifabutin (Mycobutin) for MAC prevention, your provider will make sure that you don't have an active MAC or TB infection. Let your provider know right away if you notice new symptoms such as coughing that doesn't go away, fatigue, unexplained weight loss, fever, chills, or night sweats. These can be signs of an active MAC or TB infection that require treatment with a combination of antibiotics.
Frequently asked questions about Rifabutin (Mycobutin)
Rifabutin (Mycobutin) is only FDA-approved to prevent MAC in people with HIV. On its own, it's not approved to treat H.pylori stomach infections. But studies suggest rifabutin (Mycobutin) might be a second-choice option (in combination with other antibiotics) for H.pylori infections for people whose infections didn't go away after taking recommended medications. In fact, you can find rifabutin (Mycobutin) as a combination medication called Talicia for H. pylori. Talk with your provider if you've questions about rifabutin (Mycobutin) and H.pylori.
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What are the risks and warnings for Rifabutin (Mycobutin)?
Rifabutin (Mycobutin) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Not for treatment of tuberculosis (TB)
Don't take rifabutin (Mycobutin) to prevent MAC if you have active tuberculosis. Doing so can lead to serious antibiotic resistance problems. You must take a combination of different anti-TB antibiotics if you have a TB infection. Your provider will evaluate you to make sure you don't have TB before starting rifabutin (Mycobutin), and will regularly check to make sure you don't get a TB infection while taking this medication for MAC.
Interactions with other medications
Rifabutin (Mycobutin) interacts with a lot of medications, including clarithromycin, which is also used for MAC treatment, and protease inhibitors, a class of HIV ARVs. It's very important that all your providers and pharmacists have a full list of your medications. This way they can check for medication interactions and adjust the doses to make sure you are getting the right amount of medication.
Serious allergic and skin reactions
Rifabutin (Mycobutin) can cause serious allergic and skin reactions, including anaphylaxis. If you develop dizziness, rash or hives, swelling in your face or tongue, difficulty breathing, or flu-like symptoms, get medical help right away.
Eye inflammation
Risk factors: Also taking clarithromycin, azithromycin, or fluconazole
It's rare, but some people who take rifabutin (Mycobutin) get uveitis, inflammation of an important part of the eye. It's more common in people who are also taking other anti-infective medications like clarithromycin, azithromycin, and fluconazole. If you notice eye redness, pain, blurry vision, or light sensitivity, let your provider know right away. They might tell you to stop taking the medication and will refer you to an eye specialist.
Infectious diarrhea
Risk factors: Taking rifabutin (Mycobutin) for a long time | Taking other antibiotics recently
All antibiotics, including rifabutin (Mycobutin), can raise your risk of getting a serious gut bacterial infection that causes severe diarrhea. This can happen even after you've finished treatment with rifabutin (Mycobutin). If you develop severe diarrhea with watery stools after you finish the medication, talk to your provider.
Low blood cell counts
Rifabutin (Mycobutin) can cause low numbers of white blood cells and platelets in the blood. Your provider will order regular lab tests to monitor your cell counts while you're on this antibiotic.
Rifabutin (Mycobutin) dosage forms
| Dosage | Quantity | Price as low as | Price per unit |
|---|---|---|---|
| 150mg | 28 capsules | $114.81 | $4.10 |
Typical dosing for Rifabutin (Mycobutin)
The typical dose is 300 mg by mouth once daily. People who have stomach upset with medications can take 150 mg twice daily with food.
Your dose might differ if you have kidney problems or if you're also taking certain medications.
Interactions between Rifabutin (Mycobutin) and other drugs
Using this medicine with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.
- Artemether
- Delamanid
- Lumefantrine
- Lurasidone
- Ranolazine
- Voriconazole
Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
- Abametapir
- Alfentanil
- Amiodarone
- Amprenavir
- Apremilast
- Atazanavir
- Atovaquone
- Avapritinib
- Bedaquiline
- Benzhydrocodone
- Bictegravir
- Boceprevir
- Brigatinib
- Buprenorphine
- Capmatinib
- Ceritinib
- Cholera Vaccine, Live
- Clarithromycin
- Cobicistat
- Codeine
- Conivaptan
- Crizotinib
- Cyclosporine
- Daclatasvir
- Darunavir
- Delavirdine
- Desogestrel
- Dienogest
- Dihydrocodeine
- Doravirine
- Doxorubicin
- Doxorubicin Hydrochloride Liposome
- Dronedarone
- Drospirenone
- Efavirenz
- Elvitegravir
- Encorafenib
- Entrectinib
- Enzalutamide
- Erdafitinib
- Erlotinib
- Estradiol
- Ethinyl Estradiol
- Ethynodiol
- Etonogestrel
- Etravirine
- Exemestane
- Fedratinib
- Fentanyl
- Fluconazole
- Fosamprenavir
- Fosnetupitant
- Gestodene
- Glasdegib
- Hemin
- Hydrocodone
- Idelalisib
- Ifosfamide
- Indinavir
- Irinotecan
- Irinotecan Liposome
- Itraconazole
- Ixabepilone
- Ketoconazole
- Lapatinib
- Ledipasvir
- Lefamulin
- Lemborexant
- Levonorgestrel
- Linagliptin
- Lopinavir
- Lorlatinib
- Lumateperone
- Lurbinectedin
- Medroxyprogesterone
- Meperidine
- Mestranol
- Methadone
- Mifepristone
- Naloxegol
- Nelfinavir
- Netupitant
- Nifedipine
- Nilotinib
- Nomegestrol
- Norelgestromin
- Norethindrone
- Norgestimate
- Norgestrel
- Oxycodone
- Panobinostat
- Pazopanib
- Pemigatinib
- Pentazocine
- Piperaquine
- Posaconazole
- Pretomanid
- Rilpivirine
- Rimegepant
- Ritonavir
- Saquinavir
- Segesterone
- Selpercatinib
- Selumetinib
- Sonidegib
- Sorafenib
- Sufentanil
- Sunitinib
- Tacrolimus
- Tazemetostat
- Telaprevir
- Tenofovir Alafenamide
- Tipranavir
- Tolvaptan
- Tramadol
- Ubrogepant
- Ulipristal
- Vandetanib
- Velpatasvir
- Vilazodone
- Vincristine
- Vincristine Sulfate Liposome
- Voclosporin
- Vortioxetine
- Voxelotor
- Voxilaprevir
- Zanubrutinib
Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
- Azithromycin
- Dapsone
- Didanosine
- Nevirapine
- Ospemifene
- Sirolimus
- Sulfamethoxazole
- Trimetrexate
- Warfarin
- Zidovudine
How much does Rifabutin (Mycobutin) cost?
Rifabutin (Mycobutin) contraindications
Allergy to rifamycins
What are alternatives to Rifabutin (Mycobutin)?
Prevention of Mycobacterium avium complex (MAC) disease in people with severe HIV infection
Sudden worsening of chronic obstructive pulmonary disease (COPD) from a bacterial infection
Skin infections (e.g., cellulitis)
Urethra or cervix infections
Ear infections (ages 6 months and older)
Pneumonia (ages 6 months and older)
Strep throat (ages 2 years and older)
Tonsil infections (ages 2 years and older)
Tuberculosis (TB)
Meningococcal carriers (when there's bacteria living in the nose and/or throat, but not causing infection)
What is the latest news about Rifabutin (Mycobutin)?
Rifabutin (Mycobutin) images
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References
Best studies we foundAkram, S. M., et al. (2023). Mycobacterium avium complex. StatPearls.
American Lung Association. (n.d.). MAC lung disease.
Centers for Disease Control and Prevention. (2013). Managing drug interactions in the treatment of HIV-related tuberculosis.
Chey, W. D., et al. (2017). ACG Clinical Guideline: Treatment of Helicobacter pylori infection. American Journal of Gastroenterology.
Clinical Info HIV.gov. (2023). Disseminated mycobacterium avium complex disease.
Gisbert, J. P., et al. (2021). Rifabutin for the Treatment of Helicobacter pylori Infection: A Review. Pathogens.
Greenstone LLC. (2023). Rifabutin capsule [package insert]. DailyMed.
U.S. Department of Health and Human Services. (2001). Recommendations on prophylaxis and therapy for disseminated Mycobacterium avium complex for adults and adolescents infected with human immunodeficiency virus. Morbidity and Mortality Weekly Report.
Wang, J., et al. (2023). Drug-induced tooth discoloration: An analysis of the US food and drug administration adverse event reporting system. Frontiers in Pharmacology.
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