Rifampin is a powerful antibiotic used mainly for tuberculosis and certain serious infections. It kills bacteria by blocking RNA synthesis. You’ll often see it paired with other drugs because resistance builds quickly when it’s used alone. It’s fast-acting, but it changes how many other medicines work and can stress the liver.
Rifampin is a core drug for active tuberculosis. In TB regimens it’s usually given daily during the intensive and continuation phases. Doctors also use it for latent TB in some short-course options. Outside TB, rifampin treats infections caused by susceptible staph, helps clear meningococcal carriers, and is used in some bone and prosthetic joint infections because it penetrates biofilms when combined with another antibiotic.
Expect orange-red urine, sweat, saliva, and tears — harmless but alarming. Common side effects include stomach upset, headache, and fever. More serious is liver injury; patients need baseline liver tests and periodic monitoring, especially if they drink alcohol or take other hepatotoxic drugs. Rifampin is a strong inducer of liver enzymes (CYP450). That means it can lower levels of many drugs: oral contraceptives, warfarin, certain statins, some anticonvulsants, and many HIV antiretrovirals. If you take any of these, talk to your provider before starting rifampin.
Take rifampin on an empty stomach for best absorption — usually 30 minutes before a meal or two hours after. Swallow capsules whole. If you wear soft contact lenses, expect staining; use glasses while on treatment to avoid permanent discoloration. Avoid alcohol to reduce liver risk. Always tell every provider and pharmacist you’re taking rifampin so they can check drug interactions.
Dosing and what to expect: For adults with active TB the usual dose is 600 mg once daily (often written as 10 mg/kg with a 600 mg cap for adults). Rifampin is almost always given with other TB drugs like isoniazid, pyrazinamide, and ethambutol to prevent resistance. For short-term prevention of meningococcal disease, adults commonly get rifampin 600 mg every 12 hours for two days. If you miss a dose, take it as soon as you remember that day but don’t double up the next day. Never stop rifampin suddenly without checking with your provider.
Before treatment, doctors usually check liver enzymes and may screen for other meds that interact. During treatment, pay attention to yellowing skin or eyes, dark urine beyond the expected orange tint, severe fatigue, persistent nausea, or abdominal pain — those can be signs of liver trouble. For women on hormonal birth control, use a backup method because rifampin can make pills less effective.
People with severe liver disease, uncontrolled alcoholism, or known allergy to rifamycins should avoid it. Pregnant people can sometimes use rifampin for TB under close monitoring, but it may affect other drugs and requires specialist care.
Rifampin is effective and often essential for treating TB and certain other infections. It works well when paired with other antibiotics, but it brings a long list of drug interactions and a risk to the liver. Stay in touch with your healthcare team, get the right lab checks, and report any worrying symptoms quickly.
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