Rifampin can also be used in people infected with a bacteria called Neisseria meningitides in the nose or throat, but have no symptoms of meningitis. Meningitis is an infection that causes inflammation of the brain and spinal cord and can be life-threatening. Rifampin does not treat meningitis but helps prevent people from spreading the infection to others.
Rifampin is available as a capsule or a liquid suspension that is taken by mouth (oral). There is also an injectable form of rifampin; however, this article will focus on oral rifampin.
Rifampin is in a drug class called antimycobacterials (or rifamycins). It works by killing bacteria.
What Is Rifampin Used For?
The Food and Drug Administration (FDA) approved rifampin to:
Brand Name(s): Rifadin, Rimactane
Drug Availability: Prescription
Therapeutic Classification: Antimycobacterial
Available Generically: Yes
Controlled Substance: N/A
Administration Route: Oral
Active Ingredient: Rifampin
Dosage Form(s): Capsule, Suspension
Treat tuberculosis in combination with other prescription drugsPrevent the spread of meningitis from people who carry the bacteria (Neisseria meningitides) that cause meningitis but do not have symptoms. Rifampin does NOT treat meningitis.
Rifampin does not treat viral infections, such as the common cold, flu, or COVID-19.
How to Take Rifampin
If you are prescribed rifampin, read the prescription label and the information leaflet that comes with your prescription. Consult your healthcare provider if you have any questions.
Use rifampin exactly as directed by your healthcare provider, and do not skip doses or stop taking rifampin early. Take it for the full prescribed length of time, even if you start to feel better. Stopping rifampin suddenly and then starting again later can cause harm to the kidneys.
Consider the following when taking rifampin:
Take it on an empty stomach with a full glass of water. This means at least one hour before a meal or at least two hours after a meal. Avoid alcohol while taking rifampin. Alcohol can increase the risk of liver damage. Rifampin may temporarily discolor teeth, sweat, tears, urine, and saliva to a yellow/orange/red/brown color. Rifampin can also cause staining of contact lenses, so avoid wearing them while on the medication. Dark urine can signal liver problems. If your urine is dark, and you also have other symptoms, such as stomach pain, appetite loss, and yellowing of the skin or whites of the eyes, call your healthcare provider immediately. Your healthcare provider will order lab tests while you are being treated with rifampin. Keep all lab appointments. Rifampin can affect drug screening tests.
Storage
Store rifampin at room temperature, away from direct light, heat, and moisture. Do not store it in the bathroom. Keep the bottle tightly closed and out of sight and reach of children and pets.
Off-Label Uses
Sometimes rifampin is used off-label for indications that are not FDA approved.
For example, healthcare providers may prescribe rifampin in combination with other drugs for:
Staphylococcus aureus prosthetic valve endocarditis Hansen’s disease, or leprosy Systemic anthrax Brucellosis Prevention of tuberculosis Prevention of meningitis after exposure
What Are the Side Effects of Rifampin?
This is not a complete list of side effects, and others may occur. A healthcare provider can advise you on side effects. If you experience other effects, contact your pharmacist or a healthcare provider. You may report side effects to the FDA at fda.gov/medwatch or 1-800-FDA-1088.
Like other medications, rifampin can cause side effects. Tell your healthcare provider about any side effects you experience while taking this medication.
Common Side Effects
The most common side effects of rifampin are:
Allergic reaction Appetite loss Discoloration of body fluids and teeth to red/orange color Dizziness Drowsiness/tiredness Flu-like symptoms Headache Impaired coordination Increased liver function tests Shortness of breath Staining of contact lenses Stomach problems, such as nausea, vomiting, diarrhea, or stomach pain Vision changes
Severe Side Effects
Call your healthcare provider immediately if you have serious side effects. Call 911 if your symptoms feel life-threatening or if you think you’re having a medical emergency. Serious side effects and their symptoms can include the following:
Hypersensitivity reaction or anaphylaxis: Symptoms can include rash, hives, swelling around the lips, tongue, and face, or difficulty breathing and require emergency medical attention. Serious or life-threatening skin/body reactions: Be alert to symptoms such as a red or purple rash, blistering or peeling skin, red skin with pus-filled bumps, bullseye-shaped lesions on the body, burning eyes, sore throat, fever, swollen glands, muscle aches, and weakness. These symptoms require emergency medical attention. Clostridioides difficile (C. difficile)-associated diarrhea: This is a type of diarrhea that can occur up to several months after antibiotic treatment. It can range from mild to life-threatening or cause death if not treated. Be alert to severe, watery, or bloody diarrhea and stomach cramps. Call your healthcare provider immediately if symptoms occur. Liver problems: Be alert to dark urine, clay-colored stools, fatigue, stomach pain, and yellowing of the skin and whites of the eyes. Low platelet levels or disseminated intravascular coagulation can increase the risk of bleeding, including severe or life-threatening bleeding. Contact your healthcare provider if you have easy bruising or signs of bleeding, such as nosebleeds or bleeding gums. Low white blood cells can interfere with the body’s ability to fight infections. Symptoms may include body aches, fever/chills, or headaches. Hemolytic anemia is a condition where red blood cells are destroyed faster than they are being made. Symptoms may include pale skin, fever, weakness, dizziness, and confusion. Kidney problems or kidney failure: Symptoms may include urinating less, shortness of breath, and swelling in the legs, ankles, and feet. Shock: Symptoms may include low blood pressure, cold skin, confusion, fast breathing, and weak pulse. Exacerbation of porphyria: Porphyria is a condition that can affect the skin and/or nervous system. If you have porphyria, consult your healthcare provider regarding rifampin use. Lung disease or toxicity: Be alert to chest pain, dry cough, and shortness of breath.
Long-Term Side Effects
While many people tolerate rifampin, long-term or delayed side effects are possible. Some long-term side effects can be mild, such as:
Appetite loss Cough Discolored contact lenses Irregular menstrual cycle Low levels of vitamin B6 Purpura (purple spots on the skin due to blood vessels leaking) Tooth discoloration
Moderate long-term side effects can include:
Blood in the urine (hematuria) Bone and muscle pain C. difficile-associated diarrhea Impaired coordination Increased liver function tests, liver problems, and jaundice (yellowing of the skin and whites of the eyes) Low platelet levels Low red and white blood cells Low vitamin D levels Lung disease Pink eye (conjunctivitis) Superinfection (a second infection, such as a yeast infection) Swelling of the arms or legs Swollen lymph nodes
Severe long-term side effects may include:
Bleeding inside the skull, which can cause brain damage or death C. difficile-associated diarrhea Kidney problems or kidney failure Liver problems or liver failure Serious or life-threatening skin or body reactions Thrombotic thrombocytopenic purpura, a condition where small clots can form in blood vessels, possibly causing damage to the heart, brain, and kidneys.
Dosage: How Much Rifampin Should I Take?
Modifications
You may need to use caution when taking rifampin if you are 65 years or older, especially if you have other medical conditions.
The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.
For oral dosage form (capsules): For the treatment of meningitis bacteria in the nose or throat: Adults—600 milligrams (mg) 2 times a day for 2 days. Children 1 month of age and older—Dose is based on body weight and must be determined by your doctor. The dose is 10 mg per kilogram (kg) of body weight every 12 hours for 2 days. Children younger than 1 month of age—Dose is based on body weight and must be determined by your doctor. The dose is 5 mg per kg of body weight every 12 hours for 2 days. For the treatment of tuberculosis: Adults—Dose is based on body weight and must be determined by your doctor. The dose is 10 milligrams (mg) per kilogram (kg) of body weight once a day. Your doctor may increase your dose as needed. However, the dose is usually not more than 600 mg per day. Children—Dose is based on body weight and must be determined by your doctor. The dose is 10 to 20 mg per kg of body weight once a day. Your doctor may increase your dose as needed. However, the dose is usually not more than 600 mg per day.
Rifampin interacts with many drugs, so drug interactions will be a consideration.
People with liver problems will generally not be prescribed rifampin. However, if there are no other alternatives, rifampin may be prescribed with caution and close monitoring. People with kidney problems will usually require a lower dose.
The healthcare provider will carefully weigh the risks and benefits for individuals who are pregnant or trying to become pregnant. Rifampin should only be used in pregnancy if the benefits to the pregnant individual outweigh the possible risks to the fetus. There is very little data on rifampin use during pregnancy.
People who are breastfeeding should consult their healthcare provider regarding rifampin use.
An oral liquid suspension form of rifampin is available for people who have trouble swallowing pills or need lower doses. Ask your healthcare provider how to properly prepare the suspension before using it.
Missed Dose
If you miss a dose of rifampin, take it as soon as you remember. If it is almost time for the next dose, skip the missed dose. Do not take two doses to try to make up for a missed dose. If you are unsure what to do, consult your healthcare provider.
Overdose: What Happens If I Take Too Much Rifampin?
Taking too much rifampin can cause any of the following symptoms:
Discolored skin, saliva, tears, urine, or stoolsHeadacheItchingLack of energy (which can lead to unconsciousness)Nausea, vomiting, or stomach pain
Precautions
What Are Reasons I Shouldn’t Take Rifampin?
Rifampin is not appropriate for everyone. You should not take this medication if you are allergic to rifampin, any rifamycin drug such as Mycobutin (rifabutin) or Priftin (rifapentine), or any of the inactive ingredients in rifampin.
If someone collapses or isn’t breathing after taking rifampin, call 911 immediately.
Do not use this medicine if you or your child are also receiving certain medicines to treat HIV infection (eg, atazanavir, darunavir, fosamprenavir, ritonavir, saquinavir, tipranavir, Aptivus®, Fortovase®, Invirase®, Lexiva®, Norvir®, Prezista®, or Reyataz®).
Do not use this medicine together with praziquantel. If you or your child need to take praziquantel, you should stop using rifampin 4 weeks before starting praziquantel. You may restart rifampin one day after the last dose of praziquantel.
Liver problems may be more likely to occur if you drink alcoholic beverages regularly while you are using this medicine. Also, the regular use of alcohol may keep this medicine from working properly. Therefore, you should strictly limit the amount of alcoholic beverages you drink while you are using this medicine.
Check with your doctor right away if you or your child have fever, chills, cough, sore throat, swollen, painful, or tender lymph glands in the neck, armpit, or groin, or yellow skin or eyes while using this medicine. These could be symptoms of a serious condition called drug reaction with eosinophilia and systemic symptoms (DRESS).
Check with your doctor right away if you or your child have pain or tenderness in the upper stomach, pale stools, dark urine, loss of appetite, nausea, unusual tiredness or weakness, or yellow eyes or skin. These could be symptoms of a serious liver problem.
Serious skin reactions (eg, Stevens-Johnson syndrome, toxic epidermal necrolysis, and acute generalized exanthematous pustulosis) can occur with this medicine. Check with your doctor right away if you or your child have blistering, peeling, or loosening of the skin, red skin lesions, severe acne or a skin rash, sores or ulcers on the skin, or fever or chills with this medicine.
Tell your doctor right away if you have chest pain, cough, coughing or spitting up blood, difficulty in breathing, sore throat, muscle aches, night sweats, sudden high fever, or unusual tiredness. These could be symptoms of a paradoxical drug reaction to this medicine. If your symptoms do not improve within a few days or if they become worse, check with your doctor.
This medicine may cause blood clotting problems, which may lead to bleeding. Check with your doctor right away if you or your child cough up blood, have bleeding gums, difficulty in breathing or swallowing, dizziness, headache, increased menstrual flow or vaginal bleeding, nosebleeds, prolonged bleeding from cuts, red or dark brown urine, or red or black, tarry stools after using this medicine.
This medicine may cause lung or breathing problems (eg, interstitial lung disease, pneumonitis, pneumonia, respiratory failure, pulmonary fibrosis, acute respiratory distress syndrome), which can be life-threatening and require immediate medical attention. Check with your doctor right away if you have chest pain, chills, dry cough, fever, general feeling of discomfort or illness, thickening of bronchial secretions, or trouble breathing.
Rifampin will cause urine, saliva, sputum, sweat, teeth, and tears to turn a reddish-orange to reddish-brown color. This is to be expected while you are using this medicine. This effect may also cause soft contact lenses to become permanently discolored. Standard cleaning solutions may not take out all the discoloration. Therefore, it is best not to wear soft contact lenses while using this medicine. Hard contact lenses are not discolored by this medicine. This condition will return to normal once you stop using this medicine. If you have any questions about this, check with your doctor.
If you or your child develop a skin rash, hives, or any allergic reaction to this medicine, check with your doctor right away.
Birth control pills may not work properly while you are using this medicine. To keep from getting pregnant, use another form of birth control together with your birth control pills. Other forms include condoms, diaphragms, or contraceptive foams or jellies.
Before you have any medical tests, tell the doctor in charge that you or your child are using this medicine. The results of some tests may be affected by this medicine.
Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal or vitamin supplements.
Do not take rifampin if you also take:
Ritonavir-boosted saquinavir Antiviral drugs used to treat HIV such as atazanavir, Prezista (darunavir), Lexiva (fosamprenavir), or Aptivus (tipranavir) Biltricide (praziquantel)
Rifampin may be prescribed with caution in some people only if the healthcare provider determines it is safe. This includes:
People who are taking other medicines that can harm the liver People who drink alcohol People with liver problems People with diabetes People with porphyria People with vitamin K deficiency People who have recently had C. difficile-associated diarrhea
What Other Medications May Interact With Rifampin?
Tell your healthcare provider about all your medications, including prescription and over-the-counter (OTC) medicines and vitamins or supplements. Rifampin is well-known for interacting with many medications. While taking rifampin, do not start any new medications without approval from your healthcare provider.
Rifampin can affect hormonal birth control. If you take birth control pills, you should talk to your healthcare provider about using another form of effective birth control to prevent pregnancy, such as a condom, diaphragm, cervical cap, or contraceptive sponge.
Examples of medications that interact with rifampin include:
Ambien (zolpidem) Angiotensin receptor blockers such as Cozaar (losartan), Diovan (valsartan), and Avapro (irbesartan) Antacids Antiarrhythmic/heart medications such as Lanoxin (digoxin) or Norpace (disopyramide) Antifungals such as Diflucan (fluconazole) or Nizoral (ketoconazole) Antiretrovirals such as atazanavir, darunavir, fosamprenavir, or tipranavir Benzodiazepines (anti-anxiety medicines) such as Klonopin (clonazepam), Valium (diazepam), and Xanax (alprazolam) Beta-blockers such as Inderal (propranolol) or Toprol XL (metoprolol) Biltricide (praziquantel) Blood thinners and antiplatelet drugs like Plavix (clopidogrel), Brilinta (ticagrelor), Jantoven (warfarin), Xarelto (rivaroxaban), and Eliquis (apixaban) Calcium channel blockers such as Cardizem (diltiazem), Procardia (nifedipine), Norvasc (amlodipine), and Verelan (verapamil) Diabetes oral medicines such as Actos (pioglitazone), Amaryl (glimepiride), Glucotrol (glipizide), and Micronase (glyburide) Haldol (haloperidol) Immunosuppressants such as cyclosporine, Prograf (tacrolimus), Rapamune (sirolimus) Macrolide antibiotics such as Biaxin XL (clarithromycin) and erythromycin Narcotic pain medications such as methadone, oxycodone, and morphine Nolvadex (tamoxifen) Probenecid Quinolone antibiotics such as Cipro (ciprofloxacin) or Levaquin (levofloxacin) Seizure medications such as phenobarbital and Dilantin (phenytoin) Statins such as Crestor (rosuvastatin), Lipitor (atorvastatin), or Zocor (simvastatin) Steroids such as prednisone, Decadron (dexamethasone), and Medrol (methylprednisolone) Sulfa antibiotics such as Bactrim (trimethoprim and sulfamethoxazole) Synthroid (levothyroxine) Theophylline Tricyclic antidepressants like Elavil (amitriptyline) or Pamelor (nortriptyline) Vasotec (enalapril) Vibramycin (doxycycline) Zofran ODT (ondansetron)
This list does not contain every possible drug interaction with rifampin. Other drug interactions may occur. Consult your healthcare provider for a complete list of drug interactions.
What Medications Are Similar?
Other drugs close to rifampin are Mycobutin (rifabutin) or Priftin (rifapentine).
Rifampin is used along with other medications for tuberculosis (TB). Your healthcare provider will determine the best course of treatment using established guidelines.
New guidelines from the Centers for Disease Control and Prevention (CDC) recommend one of three treatments for TB. The drugs work in combination to treat the infection. A four-month treatment plan uses the drugs rifapentine, moxifloxacin, isoniazid, and pyrazinamide. A six- to nine-month treatment plan uses rifampin, isoniazid, pyrazinamide, and ethambutol.
How Can I Stay Healthy While Taking Rifampin?
Take your prescribed treatment regimen exactly as directed and do not skip doses. It is important to report side effects to your healthcare provider. Consider using a weekly pill organizer to keep your different medications organized.
Rifampin can also cause discoloration of body fluids and teeth, and staining of contact lenses (avoid wearing contact lenses while taking rifampin).
Serious reactions can also occur. Before taking rifampin, discuss potential side effects with your healthcare provider. Avoid alcohol while on this medication, as alcohol can increase the risk of liver problems.
Ask your healthcare provider about Directly Observed Therapy (DOT), where a healthcare professional makes sure you take your medications, either in person or virtually. This helps ensure you stay on track with your medications and do not miss any doses. Refill your prescriptions several days early to ensure there is no interruption in your treatment for any reason.
Here are some tips on what to do while you have active TB:
If you have active TB, you will need to take your medication for several weeks until you are no longer contagious. Do not return to school or work until your healthcare provider tells you to do so. Avoid coming in close contact with others. Sleep alone in your bedroom. Air out your room by opening the windows as often as you can to help get rid of germs. Cover your mouth with a tissue when coughing or sneezing, then place the tissue in a closed bag and discard it.
Avoid drinking alcohol while you are on rifampin therapy. Alcohol can increase the risk of liver problems while taking this medication. Avoid wearing contact lenses, as they can become stained from rifampin.
