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Question
A 7 year-old Spanish speaking female presents to the emergency room after ingestion of 2 – 3 tablets of her sister’s medication. She complains of nausea/vomiting with diarrhea, periorbital/facial swelling, and flushing of her skin. Her urine is reddish but there is no blood is shown in urinalysis/urine microscopic analysis. The patient's sister is taking the medication for a respiratory condition.
Which medication did she take?
Answer
Rifampin
Rifampin is often used to treat tuberculosis as part of a combination therapy. It inhibits RNA chain polymerization in mycobacteria. Rifampin also has significant drug-drug interaction issue due to induction of CYP3A4, 1A2, 2C9 and 2C19.
Isolated rifampin ingestion infrequently leads to serious toxicity.
Common symptoms of acute toxicity include:
- GI: nausea/vomiting and diarrhea
- Skin: facial/periorbital swelling in children, and angioedema
- Neurologic: numbness, extremity pain, ataxia, muscle weakness
- Red-orange discoloration of bodily fluids
Chronic toxicity
- Hepatitis when co-administered with INH
- Hypersensitivity reaction:
- Viral syndrome like condition: fever, chills, myalgia
- Hemolytic anemia, thrombocytopenia, eosinophilia
- Interstitial nephritis and acute kidney injury
Management of acute toxicity is mainly supportive.