rifampicin at a glance
Medicine class
Rifamycin antibiotic with bactericidal activity.
Combination treatment
Usually combined with other active antibiotics to limit resistance when treating infection.
Food
Oral rifampicin is usually taken on an empty stomach because food reduces absorption.
Body-fluid colour
Urine, tears, sweat, saliva and sputum may turn orange-red; soft contact lenses can stain permanently.
Interactions
It can substantially alter the effects of many medicines.
What is rifampicin used for?
Licensed uses represented by the selected UK products include:
Tuberculosis, with other active tuberculosis medicines.
Leprosy, with other active treatment.
Brucellosis, Legionnaires’ disease and serious staphylococcal infections, with an appropriate companion antibiotic.
Eliminating meningococcal carriage in specified contacts or asymptomatic carriers.
Eliminating Haemophilus influenzae carriage and prophylaxis in specified exposed contacts.
Intravenous treatment of serious bacterial infections when oral treatment cannot be used or absorption is impaired.
Specialist non-licensed use for severe itch associated with chronic cholestatic liver disease.
How does rifampicin work?
Rifampicin binds to bacterial DNA-dependent RNA polymerase and blocks production of bacterial RNA. This kills susceptible bacteria, including actively growing and some slow-growing tuberculosis organisms. It does not inhibit the equivalent human enzyme.
rifampicin preparations and strengths
Capsule
Route: Oral
Strengths: 150 mg, 300 mg
Oral suspension
Route: Oral
Strengths: 100 mg/5 mL
How to take rifampicin
Follow the product instructions and plan from the treating team. Interruptions can promote resistance and may increase the risk of immune reactions when treatment restarts.
Take oral rifampicin on an empty stomach, usually at least 30 minutes before food or two hours afterwards.
Swallow capsules whole with water.
Measure oral suspension with the device supplied; do not dilute it.
The infusion is prepared and given into a vein by healthcare professionals.
Tell the prescriber or pharmacist about every prescribed, over-the-counter and herbal product before starting or stopping rifampicin.
rifampicin side effects
Common or expected effects
- Nausea or vomiting
- Headache or dizziness
- Fever or chills
- Raised bilirubin or liver-enzyme results
- Orange-red discolouration of body fluids
Get urgent medical advice
- Severe allergic reaction or anaphylaxis
- Severe blistering, peeling or widespread skin reaction
- Drug-induced liver injury or hepatitis
- Unusual bleeding, purpura or a serious blood-cell disorder
- Acute kidney injury
- New pneumonitis or interstitial lung disease symptoms
rifampicin in pregnancy
Rifampicin can be used during pregnancy when a doctor considers it necessary. Human information is limited but does not currently suggest a major fetal risk. Exposure late in pregnancy may increase bleeding risk in the mother or newborn, so maternity and specialist teams may consider vitamin K management.
rifampicin while breastfeeding
Rifampicin passes into breast milk. UK clinical sources generally regard it as compatible with breastfeeding when needed, while product information recommends an individual benefit-risk assessment. Discuss breastfeeding with the treating team, especially if the infant was premature or jaundiced; milk may become orange-red.
rifampicin interactions
Rifampicin induces multiple metabolic enzymes and transporters. Check interactions both when it is started and when it is stopped.
Systemic hormonal contraceptives
Exposure and contraceptive reliability can fall; arrange a method unaffected by enzyme induction.
Coumarin anticoagulants such as warfarin
Anticoagulant effect can change substantially, requiring close coagulation monitoring and review.
Certain HIV and hepatitis C antivirals
Rifampicin can markedly reduce antiviral exposure; several combinations are contraindicated.
Common questions about rifampicin
Answers are fully visible for fast scanning and source review.
Why does rifampicin turn urine and tears orange?
Rifampicin and its coloured breakdown products enter body fluids. Orange-red urine, tears, saliva, sweat and sputum are expected and usually harmless, but soft contact lenses may stain permanently.
Does rifampicin affect contraception?
Yes. It can make systemic hormonal contraception less reliable by increasing hormone metabolism. Ask for a contraceptive method unaffected by enzyme induction.
Sources
These sources were used to prepare and review this medicine page.
Prepared and reviewed by the iatroX editorial team.