Rifampin

Prescription ·Exploratory record · not publication-reviewed ·Updated July 13, 2026

Rifampin is a bactericidal rifamycin antibiotic used most often as a cornerstone of multidrug tuberculosis therapy and for eradicating meningococcal carriage. It is also one of the most potent inducers of hepatic and intestinal drug-metabolizing enzymes and transporters, which is why it dramatically lowers the blood levels of many co-administered drugs. Through enzyme induction it can also accelerate the catabolism of vitamin D and reduce circulating 25-hydroxyvitamin D, contributing to disturbances in calcium and bone metabolism with prolonged use.

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Publication status

Exploratory record, not a reviewed medical publication.

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This generated database record has not completed a claim-level review by a qualified human medical reviewer. Bibliography links and evidence labels are not approval. The page remains available for reference and is excluded from search indexing.

In short

What the research says.

A quick, data-only summary. The full evidence, dosing, and sources are below.

Rifampin is a bactericidal rifamycin antibiotic used most often as a cornerstone of multidrug tuberculosis therapy and for eradicating meningococcal carriage. NutriStack rates the supporting evidence as strong. Common adult dosing is Tuberculosis: 10 mg/kg/day (up to 600 mg) orally once daily on an empty stomach. Meningococcal prophylaxis: 600 mg orally every 12 hours for 2 days in adults., though a prescriber sets the actual dose. With long-term use it can deplete vitamin d, vitamin k, calcium. This profile indexes 3 sources.

What it's good for

Treatment of active and latent Mycobacterium tuberculosis infection as part of combination therapy
Eradication of Neisseria meningitidis nasopharyngeal carriage (meningococcal prophylaxis)
Treatment of leprosy in combination regimens
Adjunctive therapy for serious staphylococcal infections including prosthetic device and biofilm-associated infections

What to watch for

Orange-red discoloration of urine, sweat, tears, and other body fluids (can permanently stain soft contact lenses)
Hepatotoxicity with elevated liver enzymes
Nausea, vomiting, abdominal discomfort, and anorexia
Hypersensitivity to rifampin or other rifamycins^1,2
Concurrent use with certain HIV protease inhibitors and other contraindicated drugs due to severe enzyme-induction interactions

The bottom line

Evidence rating strong. Most-documented uses: treatment of active and latent mycobacterium tuberculosis infection as part of combination therapy, eradication of neisseria meningitidis nasopharyngeal carriage (meningococcal prophylaxis), treatment of leprosy in combination regimens. 3 sources indexed (1980–2018), with 0 interaction records on file.

The science

How it works, mechanistically.

Core mechanism

Rifampin inhibits bacterial DNA-dependent RNA polymerase by binding to its beta subunit, blocking the initiation of RNA transcription and thereby halting protein synthesis in susceptible organisms, which produces bactericidal activity against Mycobacterium tuberculosis and many gram-positive and selected gram-negative bacteria. In the human host it is a powerful agonist of the pregnane X receptor (PXR), which upregulates cytochrome P450 enzymes (notably CYP3A4, CYP2C9, and CYP2C19), phase II conjugating enzymes (UGTs), and efflux transporters such as P-glycoprotein. This broad induction accelerates the metabolism and elimination of numerous substrates, including vitamin D (via increased 25-hydroxyvitamin D catabolism), oral contraceptives, warfarin, many antiretrovirals, and immunosuppressants, accounting for its extensive drug-interaction profile.^2,1

Class

Rifamycin Antibiotic

Absorption

Best on an empty stomach

Dosing

Dosing & protocol.

Common range

Tuberculosis: 10 mg/kg/day (up to 600 mg) orally once daily on an empty stomach. Meningococcal prophylaxis: 600 mg orally every 12 hours for 2 days in adults.

Recommended form

Oral capsule (also available as oral suspension and intravenous formulation)

Best absorbed on an empty stomach, taken 1 hour before or 2 hours after a meal, because food (especially high-fat meals) delays and modestly reduces absorption. It is well absorbed orally and widely distributed, including into CSF when meninges are inflamed.

Depletions

What it depletes.

Nutrients this medication can lower over time, and what to replace.

Vitamin D

Moderate

Rifampin induces hepatic enzymes that accelerate vitamin D catabolism during prolonged therapy.

Replace Vitamin D3Monitor 25-hydroxyvitamin DOnset Weeks to months

Vitamin K

Mild

Rifampin labeling describes vitamin K-dependent coagulation disorders and bleeding, especially in patients already at risk for vitamin K deficiency, on prolonged antibacterial therapy, or taking anticoagulants. This is best treated as a clinically relevant vitamin K-dependent coagulopathy risk rather than a predictable nutrient depletion in well-nourished patients.

Replace Vitamin K1 (phylloquinone)Monitor Prothrombin time / INROnset Several days to weeks of continued therapy

Calcium

Mild

Rifampin lowers active vitamin D metabolites through PXR-mediated CYP induction, which secondarily reduces intestinal calcium absorption. Chronic therapy has been associated with disturbed calcium and phosphate homeostasis and, in susceptible patients, drug-induced osteomalacia.

Replace Calcium citrateMonitor Serum calcium and serum 25-hydroxyvitamin DOnset Weeks to months of chronic therapy, secondary to vitamin D depletion

Full Rifampin depletion and interaction guide →

Safety

Full safety detail.

Side effects

Orange-red discoloration of urine, sweat, tears, and other body fluids (can permanently stain soft contact lenses)
Hepatotoxicity with elevated liver enzymes
Nausea, vomiting, abdominal discomfort, and anorexia
Flu-like syndrome (fever, chills, myalgia), more common with intermittent dosing
Rash and hypersensitivity reactions
Thrombocytopenia and hemolytic anemia
Reduced 25-hydroxyvitamin D and secondary disturbances of calcium and bone metabolism with prolonged use

Contraindications

Hypersensitivity to rifampin or other rifamycins^1,2
Concurrent use with certain HIV protease inhibitors and other contraindicated drugs due to severe enzyme-induction interactions
Active or severe liver disease (use with extreme caution)
Concomitant use with saquinavir/ritonavir owing to risk of severe hepatocellular toxicity

Sources

Sources, by evidence tier.

Numbered references. Citations throughout the page link here.

Reviews & position papers

1The role of rifampin as a drug interaction perpetrator: clinical pharmacology of enzyme and transporter inductionNiemi M, et al. · Clinical Pharmacokinetics · 2003
Rifampin induces CYP3A4, CYP2C9, CYP2C19, UGTs, and P-glycoprotein, reducing plasma concentrations of numerous substrate drugs.

Reference material

2Rifadin (rifampin) US Prescribing InformationSanofi-Aventis · FDA Label · 2018
Documents the mechanism of action against RNA polymerase, the empty-stomach dosing recommendation, hepatotoxicity, and extensive enzyme-induction drug interactions.
3Effect of rifampin on serum 25-hydroxyvitamin D and vitamin D metabolismBrodie MJ, et al. · Clinical Pharmacology and Therapeutics · 1980
Enzyme induction by rifampin increased catabolism of 25-hydroxyvitamin D, lowering circulating concentrations and affecting calcium metabolism.

FAQ

Common questions.

Quick answers about Rifampin, drawn from the data on this page.

What is Rifampin?

What is Rifampin used for?

Commonly cited benefits of Rifampin include: Treatment of active and latent Mycobacterium tuberculosis infection as part of combination therapy; Eradication of Neisseria meningitidis nasopharyngeal carriage (meningococcal prophylaxis); Treatment of leprosy in combination regimens; Adjunctive therapy for serious staphylococcal infections including prosthetic device and biofilm-associated infections. NutriStack rates the overall evidence as strong.

What is a typical dose of Rifampin?

A typical adult dose of Rifampin is Tuberculosis: 10 mg/kg/day (up to 600 mg) orally once daily on an empty stomach. Meningococcal prophylaxis: 600 mg orally every 12 hours for 2 days in adults.. The commonly recommended form is Oral capsule (also available as oral suspension and intravenous formulation). These are general ranges, not personalized advice; confirm the right dose with a clinician.

What are the side effects of Rifampin?

Reported side effects include orange-red discoloration of urine, sweat, tears, and other body fluids (can permanently stain soft contact lenses), hepatotoxicity with elevated liver enzymes, nausea, vomiting, abdominal discomfort, and anorexia, flu-like syndrome (fever, chills, myalgia), more common with intermittent dosing, rash and hypersensitivity reactions, thrombocytopenia and hemolytic anemia. This is educational information; check with a healthcare professional before use.

How strong is the evidence for Rifampin?

NutriStack rates this as Strong, meaning multiple high-quality meta-analyses or systematic reviews converge on the same finding. Full tier criteria are at https://nutristackapp.com/methodology/evidence-tiers.

Use this with your stack

Rifampin in NutriStack.

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