Adult: As treatment for active cases: Initial phase: 600 mg twice weekly (with an interval of ≥72 hours between doses) for 2 months as directly observed therapy, given in combination with other antituberculosis agents. Continuation phase: 600 mg once weekly for 4 months as directly observed therapy, given in combination with isoniazid or another appropriate antituberculosis agent. Child: As treatment for active cases: ≥12 years Same as adult dose.
Oral Latent tuberculosis infection
Adult: In patients at high risk of progression to TB disease (including those in close contact with active tuberculosis patients, recent conversion to a positive tuberculin skin test, those with pulmonary fibrosis on radiograph, or HIV-infected patients): For patients weighing 25.1-32 kg: 600 mg; 32.1-50 kg: 750 mg; >50 kg: 900 mg. Max: 900 mg. All doses are given once weekly for 12 weeks, in combination with isoniazid. Child: In patients at high risk of progression to TB disease (including those in close contact with active tuberculosis patients, recent conversion to a positive tuberculin skin test, those with pulmonary fibrosis on radiograph, or HIV-infected patients): ≥2 years weighing 10-14 kg: 300 mg; 14.1-25 kg: 450 mg; 25.1-32 kg: 600 mg; 32.1-50 kg: 750 mg; >50 kg: 900 mg. Max: 900 mg. All doses are given once weekly for 12 weeks, in combination with isoniazid.
Administration
Rifapentine film-coated tab: Should be taken with food. Patients who are unable to swallow may crush the tab and add it to a small amount of semi-solid food, then consume the mixture immediately.
Contraindications
Hypersensitivity to rifapentine or other rifamycins (e.g. rifampicin, rifabutin).
Special Precautions
Patient with bilateral pulmonary disease, cavitary pulmonary lesions and/or positive sputum cultures after initial phase of active tuberculosis treatment. Avoid use in patients with porphyria. Should not be used as a once-weekly continuation phase regimen in combination with isoniazid in HIV-infected patients with active pulmonary tuberculosis due to a higher rate of failure and/or relapse with rifampicin-resistant organisms. Hepatic impairment. Children. Pregnancy and lactation.
Adverse Reactions
Significant: Hypersensitivity reactions including anaphylaxis; severe cutaneous adverse reactions (e.g. Stevens-Johnson syndrome, drug reaction with eosinophilia and systemic symptoms syndrome); elevations of liver transaminases; red/orange discolouration of body tissues and/or fluids (e.g. tears, teeth, tongue, saliva, sputum, skin, sweat, urine, faeces, CSF); may permanently stain dentures and contact lenses. Blood and lymphatic system disorders: Anaemia, neutropenia, lymphocytopenia, thrombocytopenia, leucocytosis, thrombocythaemia, lymphadenopathy. Eye disorders: Conjunctivitis. Gastrointestinal disorders: Abdominal pain, dyspepsia, nausea, vomiting, diarrhoea. General disorders and administration site conditions: Fever. Metabolism and nutrition disorders: Anorexia. Musculoskeletal and connective tissue disorders: Arthralgia, back pain. Nervous system disorders: Headache, dizziness. Renal and urinary disorders: Uraemia. Respiratory, thoracic and mediastinal disorders: Cough, haemoptysis. Skin and subcutaneous tissue disorders: Diaphoresis, pruritus, maculopapular rash, skin rash. Potentially Fatal: Fungal or bacterial superinfection, including pseudomembranous colitis and Clostridioides difficile-associated diarrhoea (CDAD).
This drug may cause red/orange discolouration of tears, teeth, tongue, saliva, urine, faeces, saliva, sweat, skin, and sputum; this is harmless, do not be alarmed. It may also cause permanent staining of dentures or contact lenses; remove dentures or contact lenses during therapy.
Monitoring Parameters
Perform culture and susceptibility tests; consult local institutional recommendations before treatment initiation due to antibiotic resistance risks. Monitor LFTs before treatment initiation and every 2-4 weeks during therapy in patients with preexisting hepatic impairment. Assess for signs and symptoms of liver injury, severe or bloody diarrhoea, hypersensitivity and severe cutaneous adverse reactions.
Drug Interactions
May significantly decrease the plasma levels of protease inhibitors and certain reverse transcriptase inhibitors, leading to reduced therapeutic efficacy. May decrease the efficacy of hormonal contraceptives. May increase the metabolism and reduce the activity of antiarrhythmics (e.g. disopyramide, mexiletine, quinidine), antibiotics (e.g. clarithromycin, dapsone, doxycycline), oral anticoagulants (e.g. warfarin), anticonvulsants (e.g. phenytoin), azole antifungals (e.g. fluconazole, ketoconazole), β-blockers (e.g. propranolol), barbiturates (e.g. phenobarbital), benzodiazepines (e.g. diazepam), cardiac glycosides (e.g. digoxin), calcium channel blockers (e.g. diltiazem, verapamil, nifedipine), corticosteroids (e.g. prednisone), immunosuppressants (e.g. ciclosporin, tacrolimus), narcotic analgesics (e.g. methadone), TCAs (e.g. amitriptyline, nortriptyline), sulfonylureas (e.g. glyburide, glipizide), quinine, haloperidol, sildenafil, levothyroxine, and theophylline.
Food Interaction
Increased absorption with food.
Lab Interference
May interfere with standard microbiological assays for serum folate and vitamin B12.
Action
Description: Overview: Rifapentine is a long-acting, semisynthetic cyclopentyl rifamycin antimycobacterial agent. It exhibits bactericidal activity against both intracellular and extracellular Mycobacterium tuberculosis. Mechanism of Action: Rifapentine inhibits DNA-dependent RNA polymerase in susceptible strains of Mycobacterium tuberculosis. It prevents RNA transcription by inhibiting the initiation of RNA chain formation and forms a stable complex with the bacterial DNA-dependent RNA polymerase, resulting in suppression of RNA synthesis and cell death. Pharmacodynamics: Resistance to rifapentine occurs due to a single-step mutation in the rpoβ gene, resulting in alteration of the β subunit of the DNA-dependent RNA polymerase. Resistance is also associated with monotherapy; hence, rifapentine should always be used in combination with other antituberculosis drugs. A high level of cross-resistance between rifapentine and other rifamycins has been demonstrated in Mycobacterium tuberculosis strains, but cross-resistance between rifapentine and non-rifamycin antimycobacterial agents has not been detected in clinical isolates. Pharmacokinetics: Absorption: Food increases absorption. Bioavailability: 70%. Time to peak plasma concentration: 5-6 hours. Distribution: Volume of distribution: Approx 70 L. Plasma protein binding: Approx 98%, primarily to albumin (rifapentine); approx 93% (25-desacetyl rifapentine). Metabolism: Metabolised in the liver by an esterase enzyme to form 25-desacetyl rifapentine, the active metabolite. Excretion: Mainly via faeces (70%); urine (17%; primarily as metabolites). Elimination half-life: Approx 17 hours (rifapentine); approx 24 hours (25-desacetyl rifapentine).
Chemical Structure
Rifapentine Source: National Center for Biotechnology Information. PubChem Compound Summary for CID 135403821, Rifapentine. https://pubchem.ncbi.nlm.nih.gov/compound/Rifapentine. Accessed Jan. 28, 2026.
Storage
Store at 25°C. Protect from excessive heat and humidity.
J04AB05 - rifapentine ; Belongs to the class of antibiotics. Used in the systemic treatment of tuberculosis.
References
Brayfield A, Cadart C (eds). Rifapentine. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 20/11/2025.Priftin Tablet, Film Coated (Sanofi-Aventis U.S. LLC). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed. Accessed 20/11/2025.Priftin Tablets (Sanofi-Aventis U.S. LLC). U.S. FDA. https://www.fda.gov. Accessed 20/11/2025.Rifapentine. Gold Standard Drug Database in ClinicalKey [online]. Elsevier Inc. https://www.clinicalkey.com. Accessed 19/12/2025.Rifapentine. UpToDate Lexidrug, AHFS DI (Adult and Pediatric) Online. American Society of Health-System Pharmacists, Inc. Waltham, MA. UpToDate, Inc. https://online.lexi.com. Accessed 20/11/2025.Rifapentine. UpToDate Lexidrug, Lexi-Drugs Multinational Online. Waltham, MA. UpToDate, Inc. https://online.lexi.com. Accessed 20/11/2025.
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