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rifampin

Generic Rifadin
Used for Skin Infection, Tuberculosis

Rifampin (Rifadin) is an antibiotic used to treat active and latent tuberculosis (TB). It also helps prevent the spread of meningococcal infections by people who carriers of the bacteria, but aren't showing symptoms. Rifampin (Rifadin) is taken by mouth once or twice daily, depending on your medical conditions. If you're taking it for TB, your provider might prescribe other medications as well, like isoniazid. One side effect of rifampin (Rifadin) is that it can temporarily change the color of your teeth, body fluids, and even urine as a side effect.

Reviewed by:
reviewerAileen Chu, PharmD, BCPS
reviewerAllison Gourley, PharmD
Last reviewed on June 14, 2023
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What is Rifampin (Rifadin)?

What is Rifampin (Rifadin) used for?

  • Tuberculosis (TB)
  • Meningococcal carriers (when there's bacteria living in the nose and/or throat, but not causing infection)

How Rifampin (Rifadin) works

Rifampin (Rifadin) is a rifamycin antibiotic. It blocks an enzyme (protein) the bacteria need to eventually make proteins, so the bacteria can't grow and spread.

Drug facts

Common BrandsRifadin
Drug ClassRifamycin antibiotic
Controlled Substance ClassificationNot a controlled medication
Generic StatusLower-cost generic available
AvailabilityPrescription only
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Side effects of Rifampin (Rifadin)

The following side effects may get better over time as your body gets used to the medication. Let your healthcare provider know immediately if you continue to experience these symptoms or if they worsen over time.

Common Side Effects

  • Temporary change in color (orange/yellow) of body fluids and teeth

Less Common Side Effects

  • Upset stomach
  • Diarrhea
  • Headache
  • Fever
  • Nervous system problems affecting energy, movement, thinking, or behavior
  • Nerve pain or numbness
  • Changes in vision
  • Changes in menstrual cycle
  • Fluid buildup (edema) in the face, arms, and/or legs

Rifampin (Rifadin) serious side effects

Contact your healthcare provider immediately if you experience any of the following.

  • Allergic reaction: fever, rash, swelling of your lips or tongue, trouble breathing
  • Serious bleeds: bruising easily, blood in the urine or stool, bleeding that's difficult to stop
  • Liver problems: loss of appetite, nausea or vomiting, dark urine, or yellowing of the eyes or skin

Source: DailyMed

The following Rifampin (Rifadin) side effects have also been reported

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor immediately if any of the following side effects occur:

Rare

Agitation

bleeding gums

blood in the urine or stools

bruising

confusion

cough

coughing or vomiting blood

dark urine

darkening of the skin

decreased frequency or amount of urine

difficulty in breathing and swallowing

dizziness

fainting

fast heartbeat

fever with or without chills

general feeling of tiredness or weakness

headache

hives

hoarseness

hostility

increased blood pressure

increased thirst

irritability

light-colored stools

loss of appetite

lower back or side pain

mental depression

nausea

painful or difficult urination

persistent bleeding or oozing from puncture sites, mouth, or nose

puffiness or swelling of the eyelids or around the eyes, face, lips, or tongue

skin itching, rash, or redness

sores, ulcers, or white spots on the lips or in the mouth

stomach pain

swelling of the face, ankles, fingers, hands, or lower legs

tightness in the chest

unusual bleeding or bruising

unusual drowsiness, dullness, tiredness, weakness, or feeling of sluggishness

vomiting

weight gain

yellow eyes or skin

Incidence not known

Bleeding under the skin

blistering, peeling, or loosening of the skin

bloating

bloody, severe, or watery diarrhea

bone pain

chest pain

chills

cold, clammy skin

difficulty with speaking

double vision

fast, weak pulse

inability to move the arms, legs, or facial muscles

inability to speak

increased menstrual flow or vaginal bleeding

joint or muscle pain

lightheadedness

nosebleeds

pale skin

paralysis

pinpoint red spots on the skin

prolonged bleeding from cuts

red or black, tarry stools

red or dark brown urine

red skin lesions, often with a purple center

red, irritated eyes

slow speech

sores, welts, blisters

sweating

swollen glands

unpleasant breath odor

unusual weight loss

Get emergency help immediately if any of the following symptoms of overdose occur:

Symptoms of overdose

Blurred vision

dizziness, faintness, or lightheadedness when getting up suddenly from a lying or sitting position

fast, pounding, or irregular heartbeat or pulse

feeling of fullness in the upper abdomen or stomach

low blood pressure or slow pulse

pain in the upper abdomen or stomach

reddish-orange to reddish-brown color of the urine, stool, saliva, sputum, sweat, and tears

seizures

swelling around the eyes or face

unconsciousness

yellow eyes or skin

Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

Rare

Feeling that others are watching you or controlling your behavior

feeling that others can hear your thoughts

feeling, seeing, or hearing things that are not there

muscle tenderness, wasting, or weakness

severe mood or mental changes

unusual behavior

Incidence not known

Belching

bloated or full feeling

drowsiness

excess air or gas in the stomach or bowels

indigestion

not able to concentrate

pain or discomfort in the chest, upper stomach, or throat

tooth discoloration

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

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Pros and cons of Rifampin (Rifadin)

Pros

  • One of the first-choice antibiotics for treating TB
  • Taken once daily for TB treatment
  • For people who carry the meningococcal bacteria, taking rifampin (Rifadin) for just 2 days helps prevent the spread of infection
  • Can be made into an oral suspension if you or your child has a hard time swallowing capsules
  • Available in an injectable form if you're in the hospital and can't take medications by mouth
  • Available as a lower-cost generic

Cons

  • Must be used in combination with other anti-TB antibiotics when treating active TB
  • Can change the color of your teeth and body fluids and stain your contact lenses
  • Skipping doses can quickly cause drug resistance, making it much harder to treat the infection.
  • Can cause liver injury, so it's recommended to avoid alcohol
  • Interacts with many medications, and can lower the medication levels in the body
  • Not recommended for the treatment of serious meningococcal infections
pharmacist-tips-icon

Pharmacist tips for Rifampin (Rifadin)

pharmacist
  • Take rifampin (Rifadin) 1 hour before or 2 hours after a meal with a full glass of water.
  • Before starting rifampin (Rifadin) for tuberculosis (TB), you'll need to get bloodwork done to check the health of your liver, kidneys, and blood cells. Make sure to follow up with your provider while you are taking rifampin (Rifadin) to make sure the medication is working correctly and not causing side effects.
  • For active TB infections, most people need to take rifampin (Rifadin) in combination with other anti-TB antibiotics such as isoniazid, pyrazinamide, and ethambutol (Myambutol). Some people have latent TB (when you have TB in your body, but you don't have symptoms), which can be treated with just rifampin (Rifadin) by itself. Talk to your provider if you're not sure if you have active or latent TB.
  • A common side effect is body fluids (e.g., urine, sweat, spit, tears) turning yellow, orange, red, or brown. This can lead to staining of clothing, teeth, soft contact lenses, which can be permanent.
  • Rifampin (Rifadin) can cause serious liver injury. It's best to avoid alcohol, herbal supplements, or other medications that can also affect your liver while you are taking rifampin (Rifadin).
  • It's very important not to miss any doses of rifampin (Rifadin) or other anti-TB medications. Skipping doses can make the bacteria resistant to the usual antibiotics, which then makes the infection much harder to treat.
  • Rifampin (Rifadin) interacts with many medications. Usually, it causes other medication levels to be lower making them less effective (not work as well). It's important to tell your provider and pharmacist about all the medications you are taking, including supplements and birth control as they might need to change your dose. Before starting any new medications, make sure your provider knows that you're on rifampin (Rifadin).
  • Since rifampin (Rifadin) can cause hormonal birth control to work less effectively, you should consider other methods of birth control while you are taking rifampin (Rifadin). Some options include condoms, spermicides, and a copper intrauterine device (IUD).
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Common questions about Rifampin (Rifadin)

If you have latent TB, which is when the TB in your body isn't causing an infection, you can expect to take rifampin (Rifadin) for 3 or 4 months. It's important to take rifampin (Rifadin) exactly as prescribed. Don't stop taking it unless instructed by your provider.

You're recommended to take rifampin (Rifadin) 1 hour before meals or 2 hours after eating. Taking rifampin (Rifadin) with food can lower the amount of medication absorbed, which can lead to lower medication levels and resistant bacteria.

Be careful about drinking alcohol while you are taking rifampin (Rifadin). Rifampin (Rifadin) can cause liver injury, and drinking alcohol at the same time can raise your risk. You should avoid alcohol during your months of treatment. If this is difficult, talk to your provider about your options for drinking responsibly.

Yes, rifampin (Rifadin) can turn urine red-orange. It can also do the same for other bodily fluids, like sweat and tears, as well as your teeth orange. This side effect is harmless and temporary. But the color might stain things like soft contact lenses or clothing permanently.

How long side effects of rifampin (Rifadin) last depends on what side effects you're experiencing. For example, some common side effects of rifampin (Rifadin) include changes in urine color and stomach upset. These side effects will typically start to fade once you stop rifampin (Rifadin) treatment. But this medication can also cause more serious side effects, such as liver damage, which might take longer to recover from. Studies show that people typically experience minor side effects from rifampin (Rifadin). Talk with your provider if you've concerned about the side effects of this medication.

Hair loss (alopecia) isn't a side effect reported by people who took rifampin (Rifadin) during clinical trials. There have been a few reports of other TB medications, such as isoniazid, causing hair loss. You might experience some hair loss if you take those other medications along with rifampin (Rifadin). If you're concerned about rifampin (Rifadin) and hair loss, talk with your provider.

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Risks and warnings for Rifampin (Rifadin)

Rifampin (Rifadin) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.

Liver injury

  • Risk factors: Drinking alcohol | Taking other medications that cause liver injury | Liver problems

Rifampin (Rifadin) can cause liver problems, which can be serious and life-threatening. You'll need regular blood tests to make sure that your liver is healthy, especially if you need to take rifampin (Rifadin) for a long time. While you're taking rifampin (Rifadin), avoid alcohol and other medications that might harm your liver. Before starting this medication, talk to your provider if you have a history of liver problems since taking rifampin (Rifadin) can make those problems worse. If you've a loss of appetite, nausea or vomiting, dark urine, or yellowing of the eyes or skin, talk to your provider right away because you might need to stop this medication.

Not for treating meningococcal infection

Rifampin (Rifadin) isn't meant to treat an active meningococcal infection. It's only meant to treat meningococcal bacteria if you're a carrier of the bacteria, but not showing any symptoms. Take this medication only for a short amount of time (usually recommended for 2 days) to prevent antibiotic resistance.

Allergic reactions

Rifampin (Rifadin) can cause various types of allergic reactions. You might experience allergy symptoms like rash, swelling, or difficulty breathing. Skin reactions can be severe or even life-threatening, especially if they affect large parts of the body or mucous membranes, like your eyes and mouth. Allergic reactions can also be less typical, such as abnormal blood counts, liver injury, or flu-like symptoms (weakness, vomiting, aches, and chills). If you feel unwell after starting rifampin (Rifadin), even if you don't see a rash, it's best to check with your provider to make sure you're not experiencing a severe allergic reaction. When taking rifampin (Rifadin) daily for tuberculosis, be careful not to miss doses, since stopping and starting the medication can cause kidney problems.

Higher risk for bleeding

  • Risk factors: Liver problems | Poor nutrition | Taking antibiotics or blood thinners for a long time

Rifampin (Rifadin) can cause bleeding problems, especially in people at risk for having low vitamin K. You might need regular blood tests to monitor your risk of bleeding. Your provider might prescribe vitamin K supplements which can help your clotting factors work better. If you notice abnormal bleeding or bruising while on rifampin (Rifadin), call your provider right away.

Caution in diabetes

Rifampin (Rifadin) can make it harder to control your blood sugar if you have diabetes. Before starting this medication, talk to your provider about your diabetes management plan.

More side effects if not taken once a day

For treatment of tuberculosis, it's best to take rifampin (Rifadin) once a day and no more than 600 mg per day. If you find that it's hard to take rifampin (Rifadin) every day, your provider may recommend a different dose strategy such as taking it twice a week. Taking higher doses less frequently can help some people stay on track with the medication, but also raises the risk of side effects such as flu-like symptoms, abnormal blood counts, upset stomach, liver or kidney injury, or allergic reaction including anaphylaxis.

Effects on hormones and vitamin D levels

Rifampin (Rifadin) raises the activity of some enzymes in the body. This can lead to faster breakdown of certain hormones (adrenal and thyroid) and vitamin D. Lower vitamin D in the body can lead to low calcium and phosphate, as well as high parathyroid hormone.

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Rifampin (Rifadin) dosage

The average cost for 60 capsules of 300mg of Rifampin (Rifadin) is $47.48 with a free GoodRx coupon. This is 62.91% off the average retail price of $128.00.
capsuleCapsule
DosageQuantityPrice as low asPrice per unit
300mg60 capsules$47.48$0.79
150mg60 capsules$40.21$0.67
vialVial
DosageQuantityPrice as low asPrice per unit
600mg24 vials$1,162.03$48.42

Typical dosage for Rifampin (Rifadin)

Tuberculosis

Your provider will calculate the dose of rifampin (Rifadin) based on your age and body weight. They'll also prescribe other tuberculosis medications to take along with rifampin (Rifadin). Your provider will let you know how long your treatment will last, but it'll usually take 4 months or longer.

  • Adults: The typical dose is 10 mg/kg (up to 600 mg) once a day.
  • Children: The typical dose is 10 mg/kg to 20 mg/kg (up to 600 mg) once a day.

Meningococcal bacteria in the nose and/or throat

  • Adults: The recommended dose is 600 mg by mouth twice daily for 2 days.
  • Children: The recommended dose ranges from 5 mg/kg to 10 mg/kg (up to 600 mg per dose), depending on your child's age. They'll take this medication by mouth every 12 hours for 2 days.

Rifampin (Rifadin) is also available as an infusion through the veins given by a healthcare provider in the hospital setting.

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Interactions between Rifampin (Rifadin) and other drugs

Rifampin (Rifadin) may interact with certain medications or supplements. Always let your doctor and pharmacist know about any other medications or supplements (including prescribed and over-the-counter medications, vitamins, and dietary or herbal supplements) that you are currently taking. The list below does not include all possible drug interactions with Rifampin (Rifadin). Please note that only the generic name of each medication is listed below.

Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking this medicine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Using this medicine with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.

Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

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Rifampin (Rifadin) contraindications

Contraindications are specific health conditions or situations in which a person should not take a medication due to safety concerns. If you have any of the following conditions or if any of the following apply to you, let your healthcare provider know because Rifampin (Rifadin) will not be safe for you to take.

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What are alternatives to Rifampin (Rifadin)?

There are a number of medications that your doctor can prescribe in place of Rifampin (Rifadin). Compare a few possible alternatives below.
Rifampin (Rifadin)
Used for:
  • Tuberculosis (TB)
  • Meningococcal carriers (when there's bacteria living in the nose and/or throat, but not causing infection)
$40.21Lowest GoodRx priceView prices
Used for:
  • Prevention of Mycobacterium avium complex (MAC) disease in people with severe HIV infection
$114.81Lowest GoodRx priceView prices
Used for:

As an add-on to other tuberculosis (TB) antibiotics for:

$125.92Lowest GoodRx priceView prices
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References

Best studies we found

Centers for Disease Control and Prevention. (2020). Latent TB infection and TB disease.

Centers for Disease Control and Prevention. (2020). Treatment regimens for latent TB infection.

Centers for Disease Control and Prevention. (2022). Causes and how it spreads.

GoodRx Health has strict sourcing policies and relies on primary sources such as medical organizations, governmental agencies, academic institutions, and peer-reviewed scientific journals. Learn more about how we ensure our content is accurate, thorough, and unbiased by reading our editorial guidelines.

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