Rifampicin

Key facts

• Rifampicin is an antibiotic used mainly to treat tuberculosis and leprosy, usually combined with other antibiotics, and sometimes given to prevent meningococcal or Haemophilus influenzae disease in close contacts of a case.
• Take it on an empty stomach at the same time each day, and complete the full course exactly as prescribed, which for tuberculosis often runs 6 months or longer.
• Rifampicin is a potent liver enzyme inducer. It speeds up the breakdown of many other drugs, including hormonal contraceptives, making them less reliable, so use an additional non-hormonal method of contraception during treatment and for a time after stopping.
• It harmlessly turns urine, tears, sweat and saliva orange-red, and can permanently stain soft contact lenses, so wear glasses instead while taking it.
• Seek urgent care for yellowing of the skin or eyes, or unexplained bruising or bleeding.

What rifampicin treats

Rifampicin treats tuberculosis, always combined with other anti-tuberculosis drugs to prevent resistance, and leprosy. It is also given as a short preventive course to people in close contact with someone who has meningococcal disease or Haemophilus influenzae type b infection.

How rifampicin works

Rifampicin blocks a bacterial enzyme called RNA polymerase, which bacteria need to copy their genetic instructions into the templates used to build proteins. Without this enzyme working, bacteria cannot make the proteins they need to survive, and they die.

Before you take it

• Tell your prescriber about every other medicine you take. Rifampicin induces liver enzymes and can reduce the effectiveness of hormonal contraceptives, warfarin, corticosteroids, some HIV medicines, and many others.
• Tell your prescriber about any liver disease, heavy alcohol use, or previous liver problems on treatment. Rifampicin can be hepatotoxic, and this risk is higher when combined with other tuberculosis drugs such as isoniazid.
• Discuss pregnancy and breastfeeding with your prescriber, since your regimen may need adjusting.

Side effects

Common effects include harmless orange-red discolouration of urine, sweat, tears and saliva, nausea, and loss of appetite.

Stop and seek urgent medical care for any of these:

• Yellowing of the skin or eyes, dark urine, or persistent vomiting or abdominal pain.
• Unusual bruising or bleeding.
• Fever with flu-like symptoms, especially if a dose was missed and then resumed.
• Signs of a severe allergic reaction.

Safety essentials

• Liver function is checked before and during treatment because of rifampicin's hepatotoxicity risk, particularly when combined with other tuberculosis drugs.
• Because rifampicin is a potent enzyme inducer, use an additional, non-hormonal method of contraception rather than relying on hormonal methods alone, and review any other regular medicines with your prescriber, since doses may need changing.
• Never stop or skip doses on your own. Incomplete tuberculosis treatment risks the infection returning in a drug-resistant form.

This page is educational and does not replace advice from a doctor or pharmacist who knows your health history.