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Rifampin dosage

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Posted 9/25/2019 2:27 PM (GMT -5)
The typical prescription for Rifampin is 300mg twice per day. Just curious if anyone has had success or adjusted their dosing to improve tolerance? I am going to start with one per day and hopefully progress to alternating 300 / 600 days before getting to the full dose. Is there a minimum dosage needed that anyone is aware of? (For instance with Doxy, the standard is 200mg but for LLMDs they want 400mg daily). Last time I tried Rif I had to quit within a week due to side effects, but when i initially tried it I tolerated it for nearly 8 weeks and it cleared up most of my Bart. Basically I’m wondering if once per day would still be enough to have some therapeutic benefits if that’s all I can tolerate.
Posted 9/25/2019 3:06 PM (GMT -5)
My llnd (several years ago...had me starting at lower dose - just for a week if I'm remembering correctly.

I wanted to go slow, so I opened up the 300 mg capsule and took approximately 1/2 of it in the morning, and then the rest in the evening. (I bought empty capsules to fill)
Had no reaction after several days so then jumped to the 300 mg twice a day.

I believe the half -life is short - something like 3 hours

Edited: to correct my dosage.
Posted 9/26/2019 2:10 AM (GMT -5)
Bump
Posted 9/26/2019 4:24 AM (GMT -5)
It’s Rifampin so thr capsules are 300mg, maybe you’re thinking of rifabutin?

Anyone had experience with lower dosages of Rif?
Posted 9/26/2019 10:44 AM (GMT -5)

Solaris719 said...
It’s Rifampin so thr capsules are 300mg, maybe you’re thinking of rifabutin?

Anyone had experience with lower dosages of Rif?

No it was Rifampin with my previous lyme doc - just made a mistake with the dosage of each capsule.

I think it’s fine to do the half dose for awhile
Posted 9/29/2019 1:39 PM (GMT -5)
So today is my 4th day of taking Rif at 300mg, I take it in the afternoon 2-3 hours after lunch to make sure my stomach is mostly empty. It definitely knocks me on my butt - feels like it drains a lot of the strength out of my body for a few hours after taking it. It doesn’t crash my blood pressure or other vital like Bactrim did and I do notice some improvements with POTS already. Does anyone know (Either from their LLMD, or studies) if it can still be effective at the lower dosage? I know most people take it twice per day due to the short 2-3 hr half life - but surely it must be killing bart during that time when it’s at its peak concentration.

Has anyone had success with this method? I anticipate trying to increase to 2x a day after the first week or two but my ultimate goal is to last as long as I can on it - I did 8 weeks last year at the 2x/day which eradicated the bart Henselae, just dealing with Vinsonii now. I had to quit after 8 weeks even with a reduced dosing schedule due to feeling like I was going to pass out, but it did the job and got me to transition to Bicillin and remission for 6 months.

On a side note, It’s being paired with Doxy (Which I don’t feel is helpful with my Bart but I can tolerate it at 100mg twice a day And it should at least help prevent Abx resistance with the Rif. At some point I’ll probably try to swap in Minocycline again.
Posted 9/29/2019 2:18 PM (GMT -5)
Hi I’d definitely try to go to the higher dose. It’s great you seem to be tolerating it ok right now though. How long do you plan to e in it? In had a bad Herx the first week but after that felt pretty good! Best of luck
Posted 9/29/2019 3:20 PM (GMT -5)
You should go to the higher dose of Rifampin

Taking it twice a day isn’t because of short half life - it’s because 300 mg daily isn’t the recommended dose.
There are some llmd’s who prescribe it once daily (but taking the full dose once daily of 600)
Posted 9/29/2019 5:54 PM (GMT -5)
My reasons for starting with the lower dose are because 1) last time I had to quit it after 8 weeks due to the toxic side effects, and even the lower dose at the end was too much and 2) I wanted to see if and how I tolerate it while not affecting my ability to go to work. It’s made me tired and weak-feeling the first 4 days for about 3-4 hours after taking it (I take it about 2pm or so) but I hope to bump up sometime this week. Or at least go to alternating 600/300 days then 600 daily. My goal is to try to make it 2 months, 3 at most.

Last time I tried it was after 7 months of various antibiotic combos so it could be that my body just couldn’t take antibiotics anymore after 9 straight months (last 2 with Rif and Mino) of treatment. But out of any drug, Rifampin is what helped me the most. 8 weeks on it torched the Bartonella Hensellae that had been making me so sick and was resistant to all the other antibiotics. I think it’s the final key to finishing off Bart Vinsonii so that’s why I decided to give it another go to get back to remission again.
Posted 9/30/2019 9:27 AM (GMT -5)
Took the second dose of Rifampin last night before bed, ended up in ER this morning due to a syncopal episode as soon as I got out of bed. I think it’s time for herbals. Will make another thread looking for advice.
Posted 9/30/2019 6:28 PM (GMT -5)
I’m not suggesting you just “push through” but I believe it could be a herx from the rifampin. A lot of Lyme patients suffer from POTs and dysfunction of the nervous system. It makes sense to me, that if your nervous system is affected, then your herxes would make those symptoms worse. And maybe it happened as you got out of bed because you got up too quickly? It can really take time for those symptoms to improve or resolve.

http://whatislyme.com/potsdysautonomia/
Posted 9/30/2019 8:15 PM (GMT -5)
I agree with Upatnite - could be a herx.
Posted 9/30/2019 8:38 PM (GMT -5)
about 30 minutes after taking the 2nd dose last night, I began experiencing a near psychosis-like episode while trying to sleep - I was tossing and turning pretty aggressively, having intrusive thoughts and almost felt like I was hallucinating. It went on for about 40 mins until I thankfully fell asleep but it scared the crap out of me. Even if it was a herx, it’s not worth it.

I’m familiar with ortho static hypotension being a physical therapist, so I did get up slow. But after 5-10 seconds of standing the episode started, drenching sweat, racing heart, and vision going black (pretty typical for a vaso-vagal episode).

I’m still struggling as I lay in bed typing this. The Rifampin, or the toxins, or whatever caused this, did some damage to my nervous system. I am going to see a naturopath on wed and posted another thread trying to catalog all the available antibiotics and herb options available to see what’s out there that won’t send me to the hospital.
Posted 9/30/2019 8:40 PM (GMT -5)
The other option is taking it once a day for a month or so... maybe that would help
Posted 9/30/2019 11:23 PM (GMT -5)

Solaris719 said...
Took the second dose of Rifampin last night before bed, ended up in ER this morning due to a syncopal episode as soon as I got out of bed. I think it’s time for herbals. Will make another thread looking for advice.

Lower the dosage and detox more. But I hear you, herxing and ending up in the ER is scary. May be worth giving herbs a try.

Or even a more tolerable antibiotic like mino or doxy with a herb like houttuynia, sida acuta, or a-bart.

Bartonella flares in the beginning can be tough to get past that hump, start off with lower dosage, maybe even once a day, then ramp up as you would with herbs.
Posted 10/1/2019 6:26 AM (GMT -5)

Charlie55 said...

Solaris719 said...
Took the second dose of Rifampin last night before bed, ended up in ER this morning due to a syncopal episode as soon as I got out of bed. I think it’s time for herbals. Will make another thread looking for advice.

Lower the dosage and detox more. But I hear you, herxing and ending up in the ER is scary. May be worth giving herbs a try.

Or even a more tolerable antibiotic like mino or doxy with a herb like houttuynia, sida acuta, or a-bart.

Bartonella flares in the beginning can be tough to get past that hump, start off with lower dosage, maybe even once a day, then ramp up as you would with herbs.

Any recommendations for detoxing? I take NAC, glutathione, methyl b12, alka seltzer gold, milk thistle, circumin.
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