Rifampin - ok to take breaks?

I am supposed to be starting Rifampin for my bart coupled with doxy in a few weeks.

My ALT liver enzymes have been elevated the past few months. I am taking Milk Thistle, along with ALA, and L-Cysteine (last two recently added - recommended by my LLND) I also drink lots of water, with lemon.

If I go on Rifampin, and the liver enzymes continue to climb, is it alright to take a couple weeks off to allow them to normalize - every couple months?
I have read about Rifampin - the bacteria becoming resistant. So, would that happen if I took periodic breaks...not every week, but after a couple months? I wouldn't be pulsing it - but taking it daily.

Anyone do this? take breaks while on Rifampin?

Also, I wanted to start slow. My LLND usually has me jump right in on full dose of everything..but I just ignore that, and start off on half dose for the first week.

I'm thinking this is the missing link to my wellness. I have unaddressed bart. I am using Buhner herbs for bart...and it maybe helping somewhat - as my rib pain is gone, and my foot pain is much better.

Unfortunately, I'm feeling like I should have done this a few months ago...before my liver enzymes had elevated from the lyme antibiotics. If I only had a crystal ball.

I'm also reading that bart can affect the liver...so my raised enzymes may in fact be from an unaddressed infection...and the longer I go without effectively treating it, the worse it may get...

But LP - what do I do if my liver enzymes continue to climb while on Rifampin?

Should I take a break prior to going on Rifampin then? Let them normalize...and then it would take Rifampin a month or two to raise them?

My liver enzymes took 4-5 months to elevate from lyme antibiotics...so If I take a break before starting rifampin, maybe that would work?
But, to go on it when they're already raised...doesn't give me much wiggle room.

Is your doctor concerned about the liver enzymes? Why or why not?

IHL - I will be on Rifampin with Doxy, and i don't plan on pulsing. I will take it every day and if my enzymes are elevated after a month...then I'll take a two -three week break and then hopefully they will go down.
My Dr. doesn't want me to take breaks ever, but I always tell him after the fact when I stopped due to herxing. He doesn't ever scold me...he's not that kind of Dr.

Sarah - Yes my Dr. is concerned. My GP is concerned - and she asked me how long I was going to be on the antibiotics...and i told her until I'm symptom free. She also informed me that Tinidazole could be the culprit in them elevating. My LLND - told me after the 73 in March to take extra milk thistle, add ALA and L-Cysteine and make sure I was 24 hours between Tinidazole and the test. I did that and then retested and got 92 - the highest yet. I haven't talked to my LLND since the 92, but he had said in the prior phone call that if they stayed high, we would have to 'change something'. I'm thinking he will stop my tinidazole. I am seeing him end of March.

Prior to Tini- my ALT levels were: Sept: 29 (in range), Oct: 76 (high), Nov: 45 (in range), Dec: 62(high), Jan: 55 (slightly raised), Started Tini end of Jan and my ALT levels were: Feb: 87 (high), March: 73 (high), March #2: 92(highest) - the second one in March was after increasing my detoxing, adding extra milk thistle, ALA, and L-Cysteine.

I'm not concerned about the ones in the 50's or 60's - mainly concerned what happened from February onward. I started tinidazole end of January...so maybe I don't need to be worried - as it could be the tinidazole...and i will most likely be off it when I go on Rifampin.

Or...do I need it when I'm on Rifampin....oh goodness...it's too complicated.

Fronton - are you noticing anything since you started Rifampin? How long have you been on Tinidazole? And Rifampin - for three months?

So, Fronton, you're not concerned about the ones in the 70's? So, maybe most of mine aren't so bad...just two of them the 87 and 92.
Maybe all I need to do is stop Tini for a few weeks. I only take the Tini two days per week.

Thanks Fronton - I think all the supplements are hard on the liver, too. They have fillers, and also the herbs themselves are in a potent form...more potent than you would get from eating food. So, in reality, it's not natural to take these high doses of milk thistle, and ashwaganda, rhodiola, B vitamins, Vit. D, etc.
Even though we may need them...the liver has to process each and every one of them...on top of our food, and the tinctures i take with alcohol....etc.

So, I may try the 12 hour fast, and not take my supplements or antibiotics the night before or morning of the test...see what happens.

I have been taking Tinidazole two days/per week, but two in a row. I see you're taking it two days, but a day apart. Is that just a random choice of yours...or is their a reason for the day in between?
Are you just taking those two together...or do you also have another lyme drug in there, too with the rifampin and tini?

okay, thanks Fronton. I was thinking of doing mino, but my Dr. preferes doxy for some reason. I thought I read somewhere that doxy was harder on the body than mino.

I know that I can't take doxy when the sun starts shining...I tried it last July...and was wearing long sleeves, etc. but it was too much, my hands got affected just driving into town. And I had sunscreen on.
So, if I start rifampin and doxy end of March....I probably won't be off the doxy by end of May.

Revive - what are your herxing symptoms when you're on full dose rifampin?
So, is that how rifampin works? You take full dose once daily? rather than twice daily -half dose?

LymePickle said...
I wouldn't take a break with it. I have heard the stories of bartonella becoming resistant to rifampin and they aren't good stories. One woman I read about almost had it beat and went off and then it stopped working completely for her.

LP I would be one of those stories ( but not a chick. Lol. ) I have been on rifampin for a while. I had to drop down cause of massive herxing. I had no choice. It was awful. My LLMD bumped it back up and it just hasn't been working at all. He believes I developed rifampin antibiotic resistance. When I stop rifampin I get much worse, so rifampin is suppressing bugs, but not killing them.

Everyone has to judge herxing. Massive herxing can do just as bad terrible damage as chronic Bart. I don't believe you kill yourself to get better either with herxing or liver issues ( if you have them ). No LLMD would say that either. I don't second guess myself. It's just how it goes. A lot of it is not under my control. That is really frustrating.

I will admit I am very concerned, but I am still going to try other Bart meds and Bart herbals. Their always is something else to try.

Girlie said...
So Jackie - you developed resistance by just lowering your dose of Rifampin for awhile? You didn't even stop it?

Yikes! i think if i go on Rifampin, I will start low for awhile and then go to full dose...hopefully I won't have to back down from herxes.

Probably a good idea.

Frankly I don't know how any doctor can say 100% for sure the bacteria is "resistant" to a certain medication?
It is speculation.

I have stopped meds. I get much worse with all Bart symptoms. Rifampin is DEFINITELY suppressing the bugs for me. But on meds I am also not getting "better." So Rifampin is not killing the bugs anymore. I did have a big die off for the first 3 months of Rifampin. All Bart symptoms with Bart rash and everything. No more die offs anymore.

Sigh... Stuck in limbo.

I found Dr. Burrascano from ILADS talks a lot about this happening. Tick born Bartonella is different than regular Bartonella. That is why he calls it a BLO ( Bartonella-LIKE Organism ). He recommends trying a couple other drug combinations if rifampin isn't working and possibly herbals.

At least I know I still have options