Rifampicin pregnancy hormonal contraception menopause and senescence

Rifampicin (usually 600 mg per day with ethambutol 1 gm or isoniazide) was given to 106 patients with tuberculosis: 6 during pregnancy 4 of whom were taking estrogen and progestagens for hormonal imbalance 14 women taking oral contraceptives or steroids 25 women with increased estrogen levels and 5 elderly women taking testosterone. Particular attention was paid to liver function considering reports of jaundice in pregnancy oral contraception and use of rifampicin with isoniazide. The 6 pregnancies resulted in 5 normal infants (1 with meconium staining) and 1 fetal death at 6 months. During pregnancy there were 3 incidents of elevated serum glutamic-pyruvate transaminase (SGPT) 30-150 units and 1 of liver toxicity. The authors concluded that there was no proof that rifampicin caused the hormonal imbalance or fetal death and it can be prescribed safely especially after the first 3 months. In 12 progestagen and estrogen users there were 1 jaundice treated by stopping rifampicin but not the pill and 4 incidents of elevated SGPT of 35-90 units. The authors recommended following those taking pills and rifampicin with regular SGPT tests. 5 patients received cyclofenil 400 or 800 mg per day in addition to rifampicin to induce ovulation or treat menopausal symptoms: this resulted in 1 case of hepatic toxicity. Cyclofenil is preferred over estrogen for treating menopausal symstoms in patients on rifampicin. 5 postmenopausal women received methyl-testosterone and ethinyl estradiol without any change in SGPT.