A tablet for multidrug-resistant tuberculosis (TB)
Bedaquiline
A specialist tablet used, alongside other medicines, to treat multidrug-resistant tuberculosis (TB).
What is Bedaquiline?
Bedaquiline is a specialist medicine used to treat multidrug-resistant tuberculosis (TB), a form of TB that does not respond to the usual treatments. It is always used as part of a combination of TB medicines, never on its own, because using it alone would let the bacteria become resistant. Two important safety points are that it can affect the heart's electrical rhythm (the QT interval), needing regular heart tracings (ECGs), and that it can affect the liver. It is taken by mouth under close specialist supervision, and treatment lasts many months.
Education and reference only. This is a plain-language guide to Bedaquiline — it deliberately contains no doses. Doses depend on the person, the brand and the reason for treatment, and belong with your prescriber. Always check the BNF, the product labelling (SmPC) and follow medical advice.
What it is
Bedaquiline is a specialist antibiotic used against tuberculosis, an infection that usually affects the lungs. It is reserved for multidrug-resistant TB, where the bacteria no longer respond to the standard first-choice TB medicines. A key principle is that it is always given together with other TB medicines as part of a carefully chosen combination, because no single drug should be used alone against TB. It is taken by mouth and is managed by a specialist TB team over a long course of treatment, with close monitoring.
How it works
Bedaquiline works against the TB bacterium by blocking an enzyme the bacterium needs to make its energy, so the bacteria cannot survive and multiply. Because TB bacteria can quickly learn to resist a single medicine, bedaquiline is combined with other TB drugs that attack the infection in different ways, which together give the best chance of clearing it and reduce the risk of further resistance. It works gradually over a long course, which is why treatment continues for many months and why taking every dose matters.
Company & origin
Originated / developed by: Specialist manufacturer.
A specialist medicine used in the UK to treat multidrug-resistant tuberculosis (TB), always as part of a combination of medicines.
Practical use
How to take Bedaquiline
General, dose-free guidance — always follow your prescriber's and the leaflet's specific instructions.
- Take it by mouth exactly as your TB specialist directs, usually with food to help it be absorbed.
- Always take it together with the other TB medicines you are given, never on its own.
- Keep taking it for the full course, which lasts many months, even when you feel better.
- Attend your heart tracings (ECGs) and blood tests, as it can affect the heart rhythm and the liver.
- Avoid alcohol and tell your team about all your other medicines, as some can add to the heart-rhythm effect.
Weighing it up
Advantages & disadvantages of Bedaquiline
Advantages
- An effective option against multidrug-resistant TB, where standard medicines no longer work.
- Taken by mouth as part of a combination, rather than needing an injection.
- Helps make up an effective regimen for an otherwise very hard-to-treat infection.
Disadvantages
- Can affect the heart's rhythm (the QT interval) and needs regular heart tracings.
- Can affect the liver, so blood tests are needed and alcohol should be avoided.
- Must always be used in combination, and treatment lasts many months.
Practical use
Good to know
The first thing to understand is that bedaquiline is only ever used as part of a combination of TB medicines, never alone, because TB bacteria can become resistant to a lone drug. Two safety points dominate. First, it can affect the heart's electrical rhythm by lengthening the QT interval, so heart tracings (ECGs) are done before and during treatment, and other medicines that do the same are reviewed carefully. Second, it can affect the liver, so liver blood tests are checked and alcohol is best avoided. Treatment lasts many months, and taking every dose consistently is vital both to clear the infection and to prevent resistance. It is managed by a specialist TB team who watch closely for side effects and check that the whole combination is working.
Who should not take it / use with caution
- People who have had a serious allergic reaction to bedaquiline should not take it.
- It is used with great caution, or avoided, in people with certain heart-rhythm problems or a long QT interval.
- It is used with care in people with liver problems, and only under specialist TB supervision.
Monitoring
- Heart tracings (ECGs) before and during treatment to watch the QT interval.
- Regular liver blood tests during treatment.
- Reviewing how the TB is responding and that the whole combination is being taken.
Side effects
- Nausea, headache or joint pains.
- Changes in the heart's electrical rhythm (a longer QT interval), which is why ECGs are done.
- Changes in liver blood tests; rarely, more serious liver problems, which need urgent attention.
Key interactions
- Other medicines that lengthen the QT interval can add to the heart-rhythm effect and need careful review.
- Some medicines change the level of bedaquiline in the body, so a full medicines list is important.
- Alcohol and other liver-affecting medicines can add to the strain on the liver.
Available as: Tablets taken by mouth.
Answers
Bedaquiline: frequently asked questions
What is bedaquiline used for?
It is a specialist medicine used to treat multidrug-resistant tuberculosis, a form of TB that does not respond to the usual treatments, and it is always used with other TB medicines.
Why is it never used on its own?
TB bacteria can quickly become resistant to a single medicine, so bedaquiline is always combined with other TB drugs to clear the infection and prevent resistance.
Why do I need heart tracings?
Bedaquiline can affect the heart's electrical rhythm by lengthening the QT interval, so ECGs are done before and during treatment to keep this safe.
Does it affect the liver?
Yes, it can affect the liver, so liver blood tests are checked during treatment and it is best to avoid alcohol.
How long does treatment last?
Treatment for multidrug-resistant TB lasts many months, and taking every dose consistently is vital to clear the infection and prevent resistance.
Authoritative sources
- BNF
- NICE CKS
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