posted
i took 1200 mg day rifampicin as pulse treatment . but 1800 mg day(2x900mg) very high. hepatic function should follow very often
Posts: 182 | From turkey | Registered: Jan 2008
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posted
Hubby eventually worked his way up to 900 mg daily in one dose. But he started with 75 mg per day and added an extra 75 mg every 4 or 6 weeks to get to that dose.
He actaully did not want to stop the med, but after ending up in the hospital he was put on a seizure med which would have interacted with that drug.
But now he has been told to stop the seizure med and there is some discussion about putting him back on Rifampin.
Definitely need to monitor liver enzymes on this med. And be sure to read about all the potential drug interactions.
Bea Seibert
Posts: 7306 | From Martinsville,VA,USA | Registered: Oct 2004
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janet thomas
Frequent Contributor (1K+ posts)
Member # 7122
There are two antibiotics that have been found to be most useful for treating Bartonella/BLO. My choice of these two antibiotics depends on two issues: (1) the extent to which the central nervous system (CNS) is affected and (2) the presence of co-infections other than Bartonella/BLO.
Levofloxacin (Levaquin)
This antibiotic is generally considered to be the antibiotic of choice for the treatment of Bartonella/BLO. Levaquin is a member of the family of antibiotics known as fluoroquinolones, which also includes ciprofloxacin (Cipro). All the fluoroquinolones seem to have activity against Bartonella/BLO, but Levaquin seems to be the most effective. The dosage is 250-500 mg once a day. It is best to take Levaquin on an empty stomach (or with minimal food if you need to eat something due to gastrointestinal side effects). Also, it is important not to take minerals like calcium, zinc, iron, and magnesium within several hours of the dose of Levaquin, because these minerals will bind Levaquin and render it less effective. I advise that patients take levofloxacin early in the morning, or it can be taken late in the evening, but not at bedtime. Except for the tetracycline antibiotic group, the fluoroquinolones are not generally used in combination with other antibiotics. Usually the course of treatment for Bartonella/BLO is one to three months, but occasionally it may take much longer.
Precautions: Levaquin is usually very well tolerated. The major adverse reaction that may occur with use of this medication is tendonitis (inflammation of the tendons). This complication is not common, but when it occurs, the medication must be stopped for a few days to allow symptoms to resolve.
It can then be restarted in a few days at a lower dose, but if the tendonitis recurs, the medication should be stopped. The mechanism for tendonitis is not clearly known, but magnesium deficiency may The play a role in some patients. For this reason, I recommend that Bartonella/BLO patients ideally take 600-1,000 mg of magnesium for two weeks before beginning Levaquin therapy. Once Levaquin is begun, the patient should continue the magnesium, being careful to take it three (or more) hours before or after the dose of Levaquin.
Rifampin
Rifampin is a very old antibiotic that for many years has been used for the treatment of chronic infections such as tuberculosis. It is very effective against Bartonella/BLO.
In particular, it is very useful for the neurological and psychiatric manifestations of Bartonella/BLO--severe anxiety and mood swings, panic, seizure-like episodes, memory loss, ``spaciness,'' confusion, disorientation episodes, and many other symptoms. Expect a herx-like reaction during the first week or so; then significant progress often occurs during the second or third week on rifampin.
It is best used in combination with certain other antibiotics. Frequently, those combinations include rifampin with doxycycline or rifampin with clarithromycin. The combination of rifampin with doxycycline is especially helpful when a patient with Bartonella/BLO is also infected with either Ehrlichia or Lyme.
The dosage of rifampin is 300 mg per day for the first week; increase to 600 mg once a day after the first week. It is advisable to use rifampin in the evening (not at bedtime) on an empty stomach, three hours or more after a meal. It may be used in the morning an hour before breakfast also.
Rifabutin is a medication in the same family as rifampin and is reportedly very effective against Bartonella also. Apparently, it can be combined effectively with azithromycin. I do not have enough experience with its use to recommend it at this time.
Precautions: Rifampin is usually very well tolerated. It will always turn a patient's urine orange. It may cause headaches and sleepiness. Liver function and blood counts should be monitored at regular intervals while using rifampin.
The greatest concern about rifampin is the potential for interactions with other medications. Rifampin speeds the metabolism of certain medications, resulting in an increased breakdown of the other medications. Clinically, this drug-interaction issue often becomes a problem when certain pain medications are being used, and often a patient will require higher doses of pain medications while on rifampin.
-------------------- I am not a doctor and this is not medical advice but only my personal experience and opinion. Posts: 2001 | From NJ | Registered: Mar 2005
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Haley
Frequent Contributor (1K+ posts)
Member # 22008
posted
Wow. 600mg kicked my butt but I did not ramp up. I am going to do what Bea's hubby did. Ramp up slowly.
Does anyone know if this comes in pills lower than 300 mg? I only have 300 mg capsules.
Posts: 2232 | From USA | Registered: Aug 2009
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posted
Haley -- Can get 150 mg capsules. I just got some empty gelatin capsules at the health food store and split the capsules. Have known people who had the drug compounded at a compounding pharmacy but that can be expensive.
For hubby rifampin was helpful and so was factive -- but neither one by itself made much headway with his BLO -- the combo was what seemed to really work. He was also on Mino at the same time.
We think hubby also had ehrlichia -- one questionable test for that. His WBC went low when he got to 600 mg on the Rifampin. But within a couple of weeks both red and white cells counts went to normal -- red count had been low (also hemoglobin and hematocrit) for about a year prior to this.
Bea Seibert
Posts: 7306 | From Martinsville,VA,USA | Registered: Oct 2004
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posted
I take 600mg also 1x/day. Doc says to take on an empty stomach if you can tolerate it. I haven't seen any issues other than peeing red in the morning. Do not take while on diflucan though, the med facts indicate there can be reactions between the two.
-------------------- If you play at the beach, expect to get some sand in your shorts Posts: 223 | From central pa | Registered: May 2010
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posted
Rifampin on empty stomach. I had no stomach issues from it. 600mg in one dose.
Posts: 819 | From East Coast | Registered: Apr 2009
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posted
I started Rifampicin a week ago, 300mg twice a day. Flat on my back with fatigue for 2 days, so that must have been a Herx.
Today i took the morning dose of 300mg on an empty stomach. I certainly felt as if it hit my bloodstream at a higher level. 3 hours later, I am feeling hot and sweaty. Another part of a herx, i think.
This stuff really acts fast !!
Posts: 250 | From canada | Registered: Oct 2007
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