Rimactan (Rifampicin)
Rifamycin antibiotic for the treatment of tuberculosis and other serious bacterial infections
Quick Facts About Rimactan
Key Takeaways About Rimactan
- First-line TB treatment: Rimactan is one of the four cornerstone drugs in the WHO-recommended tuberculosis treatment regimen and should always be used in combination with other anti-TB drugs
- Potent drug interactions: Rifampicin is one of the strongest enzyme inducers known and can dramatically reduce the effectiveness of many other medications, including oral contraceptives, anticoagulants, and HIV medications
- Body fluid discoloration: Rimactan causes a harmless red-brown discoloration of urine, tears, saliva, sweat, and sputum; soft contact lenses may be permanently stained
- Liver monitoring required: Regular liver function tests are essential during treatment, as rifampicin can cause hepatotoxicity, especially in patients with pre-existing liver disease
- Never stop early: Completing the full course of treatment is critical to prevent TB relapse and the development of drug-resistant tuberculosis
What Is Rimactan and What Is It Used For?
Rimactan (rifampicin) is a semisynthetic antibiotic of the rifamycin class that works by inhibiting bacterial DNA-dependent RNA polymerase. It is primarily used in multi-drug combination regimens to treat tuberculosis (TB), one of the world's most deadly infectious diseases affecting approximately 10.6 million people annually worldwide.
Rifampicin was first introduced in clinical practice in 1968 and quickly became one of the most important antibiotics in the fight against tuberculosis. It revolutionized TB treatment by significantly shortening the required treatment duration from 18 months to just 6 months when used in combination therapy. Today, rifampicin remains a cornerstone of TB treatment and is included on the World Health Organization (WHO) Model List of Essential Medicines, underscoring its critical importance in global public health.
The drug exerts its antibacterial effect by binding to the beta-subunit of DNA-dependent RNA polymerase in susceptible bacteria. This binding inhibits the enzyme's ability to initiate RNA synthesis, effectively shutting down protein production and leading to bacterial cell death. Rifampicin has potent bactericidal activity, meaning it actively kills bacteria rather than merely stopping their growth. This makes it particularly effective in the intensive phase of TB treatment.
Rimactan is manufactured by Sandoz GmbH (part of the Novartis group) and is available as hard capsules in two strengths: 150 mg and 300 mg. The capsules are taken orally, typically once daily on an empty stomach to ensure optimal absorption. Rimactan should always be used as part of a multi-drug regimen for tuberculosis, never as monotherapy, to prevent the emergence of rifampicin-resistant TB strains.
Rifampicin must never be used alone for tuberculosis treatment. Monotherapy rapidly leads to the selection of resistant mutants. The standard WHO-recommended regimen for drug-susceptible TB includes rifampicin, isoniazid, pyrazinamide, and ethambutol for the first 2 months (intensive phase), followed by rifampicin and isoniazid for 4 months (continuation phase).
Beyond tuberculosis, rifampicin has also been used in certain other clinical contexts, although these uses are less common and may vary by country. The active substance rifampicin may be approved for additional indications not covered in this article. Always follow your prescribing physician's instructions and consult your healthcare provider for guidance specific to your situation.
What Should You Know Before Taking Rimactan?
Before starting Rimactan, it is essential to inform your doctor about all medical conditions, particularly liver disease, kidney problems, porphyria, and all other medications you are taking. Rifampicin has numerous contraindications and drug interactions that must be carefully evaluated by a healthcare professional before treatment begins.
Contraindications
Rimactan must not be taken in certain medical situations. Your doctor will assess whether Rimactan is safe for you. The following conditions are absolute contraindications to Rimactan use:
- Allergy to rifampicin or rifamycins: If you have had an allergic reaction to rifampicin or any other rifamycin antibiotic (such as rifabutin or rifapentine), you must not take Rimactan. Allergic reactions can range from skin rashes to severe anaphylaxis.
- Acute liver disease: Patients with any acute liver disease, drug-induced hepatitis, or jaundice should not take rifampicin, as it can cause further liver damage and potentially fatal hepatotoxicity.
- Porphyria: Rifampicin is contraindicated in patients with porphyria, a rare group of metabolic disorders affecting the production of heme. Rifampicin can trigger acute porphyric attacks.
- Severe renal impairment: Patients with severe kidney failure should not take Rimactan without careful medical supervision and dosage adjustment.
- Concurrent use of voriconazole: Rifampicin dramatically reduces blood levels of the antifungal voriconazole, rendering it ineffective. These two drugs must never be used together.
- Concurrent use of HIV protease inhibitors: Rifampicin is contraindicated with HIV protease inhibitors including fosamprenavir, saquinavir, indinavir, ritonavir, nelfinavir, lopinavir, atazanavir, tipranavir, and darunavir, as rifampicin reduces their blood levels to subtherapeutic concentrations.
- Concurrent use of hepatitis C antivirals: Medications such as daclatasvir, simeprevir, telaprevir, and sofosbuvir must not be combined with rifampicin.
- Concurrent use of artemether-lumefantrin: This antimalarial combination is contraindicated with rifampicin due to significant interaction.
- Concurrent use of nifedipine: The calcium channel blocker nifedipine must not be used together with rifampicin.
Warnings and Precautions
Even when Rimactan is not contraindicated, certain conditions require extra caution and close medical monitoring. Talk to your doctor before taking Rimactan if you have any of the following:
- Impaired liver function or chronic liver disease: Rifampicin is metabolized in the liver and can cause hepatotoxicity. Regular liver function tests (LFTs) are essential, particularly during the first 2-3 months of treatment. Patients should be instructed to report symptoms such as fatigue, weakness, nausea, vomiting, dark urine, or yellowing of the skin or eyes immediately.
- Increased bleeding risk: If you take anticoagulant medications (blood thinners) or have a bleeding disorder, inform your doctor. Rifampicin can affect coagulation factors and may cause vitamin K deficiency, leading to increased bleeding risk.
Rimactan has an intense red-brown color that will discolor your body fluids, particularly during the first weeks of treatment. This affects urine, tears, saliva, sweat, sputum, and feces. This discoloration is harmless and expected, but patients should be aware that:
- Soft contact lenses may become permanently stained - switch to glasses or daily disposable lenses during treatment
- Tooth discoloration can occur and may be permanent in some cases
- Clothing and bedding may be stained
Pregnancy and Breastfeeding
If you are pregnant, think you may be pregnant, are planning to have a baby, or are breastfeeding, consult your doctor before taking Rimactan. Rifampicin crosses the placental barrier and there is a risk of harm to the developing fetus. However, in cases where the mother has active TB, the benefits of treatment generally outweigh the risks, as untreated TB poses a severe threat to both mother and child.
Rifampicin passes into breast milk. The decision to continue or discontinue breastfeeding during treatment should be made by your doctor, weighing the benefits of breastfeeding against the potential risks to the nursing infant. The American Academy of Pediatrics considers rifampicin to be usually compatible with breastfeeding, but close monitoring of the infant is recommended.
Rifampicin significantly reduces the effectiveness of hormonal contraceptives (birth control pills, patches, rings, and implants) by accelerating their metabolism through potent liver enzyme induction. Women of childbearing age must use additional non-hormonal contraceptive methods (such as condoms, copper IUD, or barrier methods) throughout the entire duration of Rimactan treatment and for at least one menstrual cycle after completing treatment.
Driving and Using Machines
Rimactan may have a minor to moderate effect on your ability to drive or operate machinery. Some patients experience drowsiness, dizziness, or visual disturbances during treatment. If you experience any of these effects, do not drive or operate heavy machinery until the symptoms have resolved. You are personally responsible for assessing whether you are fit to drive or perform activities requiring alertness.
Lactose Content
Rimactan capsules contain lactose monohydrate as an excipient. Patients with rare hereditary problems of galactose intolerance, total lactase deficiency, or glucose-galactose malabsorption should consult their doctor before taking this medicine.
How Does Rimactan Interact with Other Drugs?
Rifampicin is one of the most potent inducers of hepatic cytochrome P450 enzymes (particularly CYP3A4, CYP2C8, CYP2C9, and CYP2C19) and the P-glycoprotein transporter. This means it can dramatically accelerate the metabolism and reduce the blood levels of a very large number of co-administered drugs, potentially rendering them ineffective. Always inform your doctor about every medication you take.
The scope of rifampicin's drug interactions is exceptionally broad and clinically significant. When rifampicin is started, it typically takes 1-2 weeks for maximal enzyme induction to occur. Conversely, when rifampicin is stopped, it takes approximately 2 weeks for enzyme activity to return to baseline. During these transitional periods, dose adjustments of co-administered medications may be necessary.
It is critically important to review all medications with your doctor before starting Rimactan. Even over-the-counter medications, herbal supplements (particularly St. John's Wort, which also induces CYP enzymes), and dietary supplements may interact with rifampicin.
Major Interactions (Contraindicated or Avoid)
| Drug / Drug Class | Therapeutic Area | Interaction Effect |
|---|---|---|
| Voriconazole | Antifungal | Rifampicin reduces voriconazole levels by up to 96%, rendering it ineffective |
| HIV Protease Inhibitors (saquinavir, ritonavir, lopinavir, atazanavir, etc.) | HIV/AIDS | Dramatically reduced protease inhibitor levels, risk of HIV treatment failure and resistance |
| Hepatitis C Antivirals (sofosbuvir, daclatasvir, simeprevir, telaprevir) | Hepatitis C | Significantly reduced antiviral levels, treatment failure |
| Nifedipine | Cardiovascular (calcium channel blocker) | Reduced nifedipine levels, loss of blood pressure control |
| Artemether-Lumefantrin | Antimalarial | Reduced antimalarial levels, risk of treatment failure |
Significant Interactions (Require Monitoring or Dose Adjustment)
| Drug / Drug Class | Therapeutic Area | Clinical Significance |
|---|---|---|
| Warfarin | Anticoagulation | Reduced anticoagulant effect; frequent INR monitoring and dose increases required |
| Oral contraceptives | Contraception | Reduced effectiveness; use additional non-hormonal methods |
| Cyclosporine, Tacrolimus, Everolimus, Sirolimus | Immunosuppression (transplant) | Dramatically reduced levels; risk of organ rejection |
| Phenytoin, Carbamazepine, Lamotrigine, Valproic acid | Epilepsy | Reduced antiepileptic levels; risk of seizure breakthrough |
| Nevirapine, Efavirenz, Raltegravir, Maraviroc | HIV/AIDS (NNRTIs and others) | Reduced antiretroviral levels; requires dose adjustment or alternative regimens |
| Methadone | Opioid dependence / Pain | Reduced methadone levels; may precipitate withdrawal symptoms |
| Digoxin | Cardiovascular | Reduced digoxin levels; monitor serum concentrations |
| Ketoconazole, Itraconazole, Fluconazole | Antifungal | Reduced antifungal levels; some combinations may reduce rifampicin levels too |
| Corticosteroids (e.g., prednisolone) | Anti-inflammatory | Reduced steroid levels; dose increase may be necessary |
| Levothyroxine | Thyroid | Reduced thyroid hormone levels; TSH monitoring and dose adjustment needed |
| Simvastatin, Fluvastatin | Cholesterol (statins) | Reduced statin levels; monitor lipid levels |
| Glibenclamide | Diabetes | Reduced hypoglycemic effect; blood glucose monitoring required |
| Morphine, Codeine, Paracetamol | Pain management | Altered metabolism; reduced analgesic effect possible |
| Diazepam, Zolpidem | Sedatives / Sleep | Reduced sedative effect due to increased metabolism |
| Imatinib, Tamoxifen, Erlotinib | Cancer therapy | Reduced anticancer drug levels; potential treatment failure |
Antacids (medications for heartburn and acid reflux) can reduce the absorption of Rimactan. If you need to take antacids, take Rimactan at least 1 hour before the antacid to ensure adequate absorption of the antibiotic.
What Is the Correct Dosage of Rimactan?
The recommended adult dose of Rimactan is 450-600 mg (approximately 10 mg/kg body weight) once daily, taken on an empty stomach 30-60 minutes before breakfast. Children receive 10-20 mg/kg once daily, up to a maximum of 600 mg per day. Always follow your doctor's specific dosing instructions.
Rimactan capsules should be swallowed whole with a full glass of water. Do not crush, chew, or open the capsules. Taking Rimactan on an empty stomach is important because food can significantly reduce the absorption of rifampicin, leading to lower blood levels and potentially reduced efficacy.
Adults
Standard Adult Dosage
The recommended dose for adults is 450-600 mg or 10 mg/kg body weight once per day. In practice:
- Adults weighing less than 50 kg: 450 mg once daily (three 150 mg capsules or one-and-a-half 300 mg capsules)
- Adults weighing 50 kg or more: 600 mg once daily (two 300 mg capsules or four 150 mg capsules)
The dose is taken as a single daily dose, not divided throughout the day. Treatment duration for tuberculosis follows WHO guidelines and typically lasts 6 months in the standard regimen.
Children
Pediatric Dosage
Children are dosed based on body weight: 10-20 mg/kg once daily, up to a maximum of 600 mg per day for tuberculosis treatment. Important considerations for pediatric use:
- Alternative pharmaceutical forms (such as liquid suspensions) are preferred for children, particularly for accurate dose measurement
- Children under 6 years should not be given capsules due to the risk of choking or the capsule becoming lodged in the throat
- Rifampicin should not be given to infants under 3 months of age
Consult your pediatrician or infectious disease specialist for the appropriate dose for your child.
Elderly Patients
Dosage in Elderly Patients
No specific dose adjustment is routinely required for elderly patients based on age alone. However, elderly patients often have reduced liver and kidney function, and they may be taking multiple other medications that interact with rifampicin. Close monitoring of liver function and potential drug interactions is particularly important in this population. Your doctor may start with a lower dose and adjust based on your response and tolerance.
Missed Dose
If you forget to take a dose of Rimactan, take it as soon as you remember on the same day. If it is almost time for your next scheduled dose, skip the missed dose and continue with your regular schedule. Do not take a double dose to make up for a forgotten dose. Consistent daily dosing is important for maintaining therapeutic drug levels and preventing the development of drug-resistant TB.
Overdose
If you have taken more Rimactan than prescribed, or if a child has accidentally ingested the medication, seek emergency medical attention immediately. Contact your local poison control center or emergency department. Symptoms of rifampicin overdose may include nausea, vomiting, abdominal pain, facial or periorbital edema, itching, headache, and increasing lethargy. In severe cases, liver involvement may occur. The characteristic red-brown discoloration of skin, urine, sweat, and tears becomes intensified after overdose, and the skin may take on an orange-red appearance (sometimes called "red man syndrome").
Never discontinue Rimactan without first consulting your doctor. Stopping treatment prematurely is one of the most significant factors contributing to tuberculosis relapse and the development of multidrug-resistant TB (MDR-TB), which is much more difficult and expensive to treat. Even if you feel better, the full course of treatment must be completed to eliminate all TB bacteria from your body.
What Are the Side Effects of Rimactan?
Like all medicines, Rimactan can cause side effects, although not everyone experiences them. The most common side effects are gastrointestinal symptoms (nausea, abdominal pain, loss of appetite), skin reactions (redness, itching), and the characteristic harmless red-brown discoloration of body fluids. Serious but rare side effects include severe liver damage, severe skin reactions, and blood disorders.
If you experience any of the following serious side effects, stop taking Rimactan and seek immediate medical attention:
- Allergic reactions with symptoms such as difficulty breathing, itchy rash with redness, fever, and chills
- Fever, onset of vomiting, or yellowing of the skin and whites of the eyes (jaundice) - these may indicate impaired liver function
- Fever, chills, and possibly headache, dizziness, and musculoskeletal pain (flu-like syndrome) - these can be warning signs of serious complications
- Severe skin reactions: red patches on the trunk that may be target-shaped or circular, often with blisters in the center; scaling skin; sores in the mouth, throat, nose, genitals, and eyes
- Signs of infection such as fever with severely impaired general condition, sore throat, or urinary difficulties (due to reduced white blood cell count)
Common Side Effects
May affect up to 1 in 10 people
- Elevated liver enzymes (detected in blood tests)
- Fatigue, drowsiness, headache, mental confusion, dizziness
- Eye redness; permanent discoloration of soft contact lenses
- Abdominal pain, nausea, loss of appetite, bloating
- Skin redness, itching with or without rash, hives (urticaria)
- Red-brown discoloration of body fluids and secretions (urine, sputum, tears, feces, saliva, sweat)
Rare Side Effects
May affect up to 1 in 1,000 people
- Porphyria (disorders in red blood cell production causing intensely pigmented skin)
- Difficulty coordinating muscle movements (ataxia)
- Coagulation disorders with blood clots
- Visual disturbances, conjunctivitis
- Diarrhea, vomiting, gastritis, inflammation of the colon, pancreatitis
- Increased blood urea nitrogen and uric acid levels, kidney failure, nephritis
- Muscle weakness, myopathy
- Menstrual irregularities (including amenorrhea)
- Adrenal crisis (in patients with Addison's disease)
- Confusion, psychosis
- Cardiovascular collapse
Frequency Not Known
Reported but frequency cannot be estimated from available data
- Tooth discoloration (may be permanent)
- Bleeding due to prolonged blood clotting time (caused by vitamin K deficiency)
A flu-like syndrome (fever, chills, headache, dizziness, bone and muscle pain) can occur particularly with intermittent or irregular dosing of rifampicin. This syndrome may serve as a warning of more serious complications including hemolytic anemia, kidney failure, and thrombocytopenia. If you develop flu-like symptoms during treatment, contact your doctor immediately. Regular, uninterrupted daily dosing helps prevent this syndrome.
If any side effect becomes severe, or if you notice any side effects not listed in this article, please consult your doctor or pharmacist. Reporting suspected adverse reactions after the medicine has been authorized is important, as it allows continued monitoring of the medicine's benefit-risk balance.
How Should You Store Rimactan?
Store Rimactan at or below 30°C (86°F) in its original packaging. Keep out of the sight and reach of children. Do not use after the expiry date printed on the carton.
Proper storage of Rimactan is essential to maintain the drug's efficacy and safety. Follow these storage guidelines carefully:
- Temperature: Store at a temperature not exceeding 30°C (86°F). Avoid exposure to excessive heat or direct sunlight.
- Moisture: Keep the capsules in their original blister pack or container to protect them from moisture. Do not store in the bathroom or other humid environments.
- Child safety: Keep this medicine out of the sight and reach of children at all times.
- Expiry date: Do not use Rimactan after the expiry date stated on the carton and label after "EXP." The expiry date refers to the last day of that month.
- Disposal: Do not dispose of medicines via wastewater or household waste. Ask your pharmacist how to properly dispose of medicines you no longer use. This helps protect the environment.
What Does Rimactan Contain?
Each Rimactan capsule contains either 150 mg or 300 mg of the active substance rifampicin, along with inactive excipients including lactose monohydrate and calcium stearate. The capsules are available in blister packs or plastic containers of 100 capsules.
Active Substance
The active substance is rifampicin. Each capsule contains either 150 mg or 300 mg of rifampicin.
Inactive Ingredients (Excipients)
- Capsule contents: Lactose monohydrate, calcium stearate
- 150 mg capsule shell: Gelatin, titanium dioxide (E171), red iron oxide (E172)
- 300 mg capsule shell: Gelatin, titanium dioxide (E171), red iron oxide (E172), yellow iron oxide (E172), black iron oxide (E172)
- Printing ink: Shellac, black iron oxide (E172), propylene glycol
Appearance and Pack Sizes
The 150 mg capsules are red and marked with "150" and "NG" (size: 6.35 x 18.0 mm). The 300 mg capsules are also red and marked with "300" and "NG" (size: 6.9 x 19.4 mm). Rimactan is available in blister packs of 100 capsules or plastic containers of 100 capsules. Not all pack sizes may be marketed in all countries.
Marketing Authorization Holder and Manufacturer: Sandoz GmbH, Biochemiestrasse 10, A-6250 Kundl, Austria.
Frequently Asked Questions About Rimactan
Rimactan (rifampicin) is an antibiotic primarily used in combination with other drugs to treat tuberculosis (TB). It belongs to the rifamycin class of antibiotics and works by inhibiting bacterial RNA polymerase, which stops bacteria from producing the proteins they need to survive. It is one of the four first-line drugs in the WHO-recommended TB treatment regimen and is considered an essential medicine worldwide. Rifampicin may also be used in certain other bacterial infections as determined by your doctor.
Rifampicin, the active ingredient in Rimactan, has an inherent intense red-brown color. As the drug is metabolized and excreted from your body, it colors various body fluids including urine, tears, saliva, sweat, sputum, and feces. This is a completely harmless and expected effect - it is not a sign of blood in the urine or any other problem. The discoloration is typically most noticeable at the start of treatment and may decrease slightly over time. However, be aware that soft contact lenses can become permanently stained, and tooth discoloration may occur.
Rimactan (rifampicin) significantly reduces the effectiveness of hormonal contraceptives, including birth control pills, patches, rings, and implants. This is because rifampicin is a potent inducer of liver enzymes that metabolize the hormones in contraceptives, causing them to be broken down much faster than normal. Women taking Rimactan must use additional non-hormonal contraceptive methods (such as condoms, copper IUD, or diaphragm) throughout the entire course of treatment and for at least one full menstrual cycle after stopping Rimactan. Discuss your contraceptive options with your doctor.
The standard WHO-recommended treatment regimen for drug-susceptible pulmonary TB lasts 6 months. During the first 2 months (intensive phase), rifampicin is taken alongside isoniazid, pyrazinamide, and ethambutol. During the following 4 months (continuation phase), rifampicin is taken with isoniazid only. It is absolutely critical to complete the full 6-month course even if you feel better, as stopping early is one of the main causes of TB relapse and the development of drug-resistant TB. Your doctor may prescribe a different duration depending on the type and severity of your TB infection.
Mild side effects such as mild nausea or the expected red-brown discoloration of body fluids are generally not a reason to stop treatment. However, you should seek immediate medical attention if you experience: yellowing of the skin or eyes (jaundice), persistent vomiting, severe abdominal pain, unexplained fever or flu-like symptoms, severe skin rash or blistering, unusual bleeding or bruising, or signs of an allergic reaction (difficulty breathing, facial swelling). Never stop taking Rimactan on your own without consulting your doctor first, as abruptly stopping TB treatment can have serious consequences.
Yes, rifampicin is one of the most potent enzyme inducers known in clinical pharmacology. It can dramatically reduce the blood levels and effectiveness of a very wide range of other medications, including blood thinners (warfarin), anti-rejection drugs (cyclosporine, tacrolimus), HIV medications, antifungals, diabetes drugs, blood pressure medications, anti-seizure drugs, corticosteroids, thyroid hormones, pain medications (including methadone), cancer drugs, and many others. Before starting Rimactan, it is essential to provide your doctor with a complete list of all medications, supplements, and herbal products you are taking.
References
- World Health Organization. WHO consolidated guidelines on tuberculosis. Module 4: treatment - drug-susceptible tuberculosis treatment. Geneva: WHO; 2022. Available at: who.int
- World Health Organization. WHO Model List of Essential Medicines - 23rd List. Geneva: WHO; 2023.
- European Medicines Agency. Rifampicin - Summary of Product Characteristics (SmPC). EMA; 2023. Available at: ema.europa.eu
- Joint Formulary Committee. British National Formulary (BNF) - Rifampicin monograph. London: BMJ Group and Pharmaceutical Press; 2024.
- Nahid P, Dorman SE, Alipanah N, et al. Official American Thoracic Society/Centers for Disease Control and Prevention/Infectious Diseases Society of America Clinical Practice Guidelines: Treatment of Drug-Susceptible Tuberculosis. Clin Infect Dis. 2016;63(7):e147-e195. doi:10.1093/cid/ciw376
- Niemi M, Backman JT, Fromm MF, Neuvonen PJ, Kivisto KT. Pharmacokinetic interactions with rifampicin: clinical relevance. Clin Pharmacokinet. 2003;42(9):819-850. doi:10.2165/00003088-200342090-00003
- National Institute for Health and Care Excellence (NICE). Tuberculosis: NICE guideline [NG33]. Updated 2019. Available at: nice.org.uk
- U.S. Food and Drug Administration. Rifadin (rifampin) prescribing information. FDA; 2023.
- Global Tuberculosis Report 2023. World Health Organization. Geneva: WHO; 2023.
- Mitchison DA. The action of antituberculosis drugs in short-course chemotherapy. Tubercle. 1985;66(3):219-225.
Medical Editorial Team
This article has been written and reviewed by the iMedic Medical Editorial Team, consisting of licensed physicians and pharmacists specializing in infectious disease, clinical pharmacology, and internal medicine. Our team follows international treatment guidelines from the WHO, EMA, FDA, NICE, and BNF to ensure all information is evidence-based and clinically accurate.
All content is reviewed according to the GRADE evidence framework and updated regularly to reflect the latest medical research and guideline changes. iMedic receives no commercial funding and maintains complete editorial independence.
Learn more about our medical team | Read our editorial standards