An anti-tuberculosis (TB) antibiotic
Rifampicin
A core antibiotic used as part of tuberculosis (TB) treatment, and sometimes for other serious bacterial infections.
What is Rifampicin?
Rifampicin is a key antibiotic used as part of standard tuberculosis (TB) treatment, usually combined with other TB medicines, and it is also used for some other serious infections. It commonly turns urine, tears and other body fluids a harmless orange-red colour and can permanently stain soft contact lenses. Importantly, it interacts with many medicines — including making hormonal contraception less reliable — and can affect the liver, so monitoring is needed.
Education and reference only. This is a plain-language guide to Rifampicin — 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
Rifampicin is one of the main antibiotics used in the UK to treat tuberculosis (TB), almost always combined with other TB medicines as part of a course lasting several months. It is also used for some other serious bacterial infections and sometimes to prevent the spread of certain infections to close contacts. TB treatment is long and must be completed in full, even though symptoms often improve early on.
How it works
Rifampicin works by blocking an enzyme (RNA polymerase) that bacteria need to read their genetic instructions and make essential proteins. Without this, the bacteria cannot grow or multiply, which helps clear the infection. In TB it is combined with other medicines so the bacteria are attacked in different ways at once, which improves cure rates and reduces the risk of resistance. It also speeds up the liver's processing of many other drugs, which is why it has so many interactions.
Company & origin
Originated / developed by: A core anti-tuberculosis medicine.
A key antibiotic used in the UK as part of standard tuberculosis (TB) treatment, and for some other serious infections.
Practical use
How to take Rifampicin
General, dose-free guidance — always follow your prescriber's and the leaflet's specific instructions.
- Take it exactly as prescribed and complete the whole course, even after you feel better.
- It is usually taken on an empty stomach, often before food, unless your team advises otherwise.
- Expect a harmless orange-red colour to urine, tears and sweat, and avoid soft contact lenses, which it can stain.
- Use extra or alternative contraception if you rely on hormonal methods, as rifampicin can make them fail.
- If you miss a dose, take it as soon as you remember unless it is nearly time for the next; do not double up, and tell your team about missed doses.
Weighing it up
Advantages & disadvantages of Rifampicin
Advantages
- A highly effective, central part of curing tuberculosis when taken correctly.
- Also useful for some other serious infections and to protect close contacts.
- Works in a different way from many antibiotics, helping prevent resistance when combined with others.
Disadvantages
- Interacts with many medicines, including making hormonal contraception unreliable.
- Can affect the liver and requires monitoring with blood tests.
- Turns body fluids orange-red and can permanently stain soft contact lenses.
Practical use
Good to know
Rifampicin commonly turns urine, sweat, tears and other body fluids a reddish-orange colour — this is harmless, but it can permanently stain soft contact lenses, so glasses may be preferable during treatment. A very important point is that it interacts with a wide range of medicines and can make them less effective; in particular it makes hormonal contraception (the pill, patch, implant and others) unreliable, so additional or alternative contraception is needed. It can affect the liver, so liver blood tests are checked and you should report yellowing of the skin or eyes, dark urine, nausea or tummy pain. The full TB course must be completed exactly as prescribed, even after you feel well, to cure the infection and prevent resistance.
Who should not take it / use with caution
- People who have had a serious allergic reaction to rifampicin or related (rifamycin) antibiotics should not take it.
- It should not be used in people who currently have jaundice, and is used with great caution in other significant liver disease.
- Used carefully in pregnancy and breastfeeding and where many interacting medicines are involved, with close review.
Monitoring
- Liver function blood tests before and during treatment.
- Symptoms of liver problems, such as jaundice, dark urine or persistent nausea.
- Response of the infection and adherence to the full course.
Side effects
- Harmless orange-red discolouration of urine, tears, sweat and other fluids.
- Nausea, tummy upset and reduced appetite, especially early on.
- Liver problems (reported as yellowing skin or eyes, dark urine or tummy pain) and, rarely, flu-like reactions or allergic reactions.
Key interactions
- It makes hormonal contraception (pill, patch, implant and similar) less reliable, so extra or alternative methods are needed.
- It speeds up the breakdown of many medicines — including some heart, blood-thinning, HIV, epilepsy and steroid medicines — making them less effective.
- Always check with a pharmacist or doctor before starting or stopping any medicine while on rifampicin.
Available as: Capsules and an oral liquid; also combined with other TB medicines in single tablets, and an injection used in hospital.
Answers
Rifampicin: frequently asked questions
Why has my urine turned orange-red on rifampicin?
This is a well-known and harmless effect of rifampicin, which colours urine, tears, sweat and other fluids reddish-orange. It is not a sign of harm, but it can permanently stain soft contact lenses, so glasses may be better during treatment.
Does rifampicin stop my contraceptive pill working?
Yes — rifampicin can make hormonal contraception, including the pill, patch and implant, much less reliable. You will usually need to use extra or alternative contraception; your team or pharmacist can advise what is suitable while you are on it and for a period afterwards.
Why are liver tests checked during treatment?
Rifampicin can occasionally affect the liver, so blood tests are used to keep an eye on it. Report yellowing of the skin or eyes, dark urine, severe nausea or tummy pain promptly, as these can be signs of a liver problem.
Why does TB treatment last so long?
TB bacteria are slow to clear, so several medicines, including rifampicin, are taken together for months to cure the infection fully and prevent resistance. It is vital to complete the whole course even after you feel well.
Can I take other medicines while on rifampicin?
Sometimes, but rifampicin interacts with many medicines and can make them less effective, so always check first. Tell every prescriber and pharmacist that you are taking rifampicin so they can adjust treatment safely.
The wider class
About Anti-tuberculosis medicines
Rifampicin belongs to the anti-tuberculosis medicines class. For how the class as a whole works, its shared safety principles and monitoring, see the full guide.
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Authoritative sources
- BNF
- NICE CKS
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