Rifater/Akt FD is an oral, fixed-dose combination of isoniazid, pyrazinamide, rifampin, and ethambutol, used as part of an overall treatment program for tuberculosis as well as infections of other parts of the body. Technically Rifater contains only three active ingredients, minus the ethambutol, while Akt FD contains all four; however, treatments are the same.

Patients often buy Rifater/Akt FD to treat:

• Tuberculosis
• Bacterial infection of membranes covering the brain
• Bacterial infection of membranes covering the spinal cord
• Contagious disease of mucous membranes
• Contagious disease of nerves
• Contagious disease of skin

There may, additionally, be other conditions not listed here that the medications may be prescribed to treat.

Treatment Overview

The medication only comes in tablet form. Rifater should be taken by patients 15 years and older, with a glass of water, as a single daily dose either one hour before or two hours following a meal. Avoid foods containing tyramine, such as cheese and red wine, and foods containing histamine should be avoided; skipjack, tuna, and other tropical fish may cause side effects such as headache, sweating, palpitations, flushing, or hypotension.

Rifater is recommended in the initial 2 month phase of short-course therapy. It is here that the difference between the three-medication Rifater and the four-medication Akt FD is apparent; it is recommended that ethambutol be added as a fourth drug in a regimen containing isoniazid (INH), rifampin and pyrazinamide for initial treatment of tuberculosis unless the likelihood of INH or rifampin resistance is very low.

The need for a fourth drug should be reassessed when the results of susceptibility testing are known; if community rates of INH resistance are currently less than 4%, an initial treatment regimen with less than four drugs may be considered. It is, however, becoming decreasingly likely to find such low community rates given the risks associated with ethambutol, which are virtually nil.

Following the initial phase, treatment should be continued with rifampin and isoniazid for at least 4 months. Treatment should be continued for longer if the patient is still sputum or culture positive, if resistant organisms are present, or if the patient is HIV positive.

Potential Complications

Rifater/Akt FD can produce side effects, though these are rare and usually not nearly as severe as the condition being treated:

• Itching
• Painful urination
• Worsening of stomach or intestinal ulcers
• Enlarged liver
• Abnormal liver function tests
• General feeling of discomfort

Simultaneous administration of pyridoxine (B6) is recommended in the malnourished, in those predisposed to neuropathy (e.g., alcoholics and diabetics), and in adolescents.

Patients using oral contraceptives should change to non-hormonal methods of birth control during Rifater therapy. Also diabetes may become more difficult to control.

Rifater/Akt FD are known to interact with a wide range of other medications, increasing or decreasing the effectiveness of one or more involved. Always check with a doctor or pharmacist before mixing medications, particularly one taken as long as this one.