Atazanavir
Contraindicated
Textbook
Significantly reduced atazanavir concentrations, leading to loss of antiviral effectiveness.
Contraindicated.
Source: G&G 14e · p1245-1266
Drug reference
rifampin
Rifamycin · Antimycobacterial
RifamycinAntimycobacterialATC null
CDSCO approved
EXCRETION
—
not curated
INTERACTIONS
12 major
incl. contraindicated
PREGNANCY
X
FDA category + note
Top interactionssee all 12 →
- AtazanavirContraindicatedTextbookG&G 14e · p1245-1266
- DarunavirContraindicatedTextbookG&G 14e · p1245-1266
- LumateperoneContraindicatedTextbookG&G 14e · p368
- LurasidoneContraindicatedTextbookG&G 14e · p368
Mechanism
Rifampin enters bacilli and binds to the β subunit of DNA-dependent RNA polymerase (rpoB) to form a stable drug-enzyme complex. Drug binding suppresses chain formation in RNA synthesis.
Indications
tuberculosis diseaselatent tuberculosis infectionmeningococcal disease prophylaxishaemophilus influenzae meningitis prophylaxisstaphylococcal endocarditis (in combination)osteomyelitis (in combination)infections associated with prosthetic materials (in combination)eradication of staphylococcal nasal carrier statebrucellosis (in combination)mycobacterium kansasii diseasemycobacterium avium diseasemycobacterium marinum diseasemycobacterium uclerans diseasemycobacterium malmoense diseasemycobacterium haemophilum diseaseleprosytuberculosisTuberculosis (in combination with isoniazid)Leprosy (in combination with dapsone)Prophylaxis for tuberculosisProphylaxis for meningococcal meningitis (during an epidemic)Tuberculosis (as efficacious as isoniazid)Prophylaxis of Meningococcal meningitisProphylaxis of H. influenzae meningitisMeningococcal carrier stateH. influenzae carrier stateMRSA infections (second/third choice)Diphtheroids infections (second/third choice)Legionella infections (second/third choice)Brucellosis (first line therapy in combination with doxycycline)Leprosy (most potent cidal drug for M.leprae, component of MDT)Methicillin-Susceptible S. aureus Prosthetic-Valve Endocarditis (in combination with antistaphylococcal penicillin and gentamicin)Methicillin-Resistant S. aureus Prosthetic-Valve Endocarditis (in combination with vancomycin and gentamicin)Prosthetic-valve endocarditis (used in combination for ≥6 weeks)Prosthetic device–related infectionsOsteomyelitisProsthetic-joint infections (in combination with ciprofloxacin)Brucellosis (acute nonfocal, combined with doxycycline)Brucella endocarditisAntimicrobial prophylaxis for Brucella exposure (combined with doxycycline for 3 weeks)Multidrug therapy for paucibacillary leprosyMultidrug therapy for multibacillary leprosy
Dosing
- Adult
- 600 mg, once daily, either at least 1 h before or 2 h after a meal
- Pediatric
- 15 mg/kg (range 10–20 mg/kg), with a maximum dose of 600 mg/day, given in the same way
- Renal adjustment
- Dose adjustment not specified beyond general clearance mechanisms.
- Hepatic adjustment
- Dose reduction needed
- Max dose
- 600 mg daily; 600 mg thrice weekly
Pharmacokinetics
Duration
long and dose-dependent PAE
Half-life
2–5 h
Bioavailability
68%
Protein binding
85%
Metabolism
Microsomal β-esterases and cholinesterases (autoinduction of clearance)
Excretion
Bile and feces (major), urine (minor)
Contraindications
- Severe reaction in case of previous severe reaction such as haemolysis, thrombocytopenia or renal failure (for reintroduction)
- hepatic dysfunction
- renal dysfunction
- erythema nodosum leprosum (ENL)
- reversal reaction (can release large quantities of mycobacterial antigens)
Side effects
Common
red-orange discoloration of skinred-orange discoloration of urinered-orange discoloration of fecesred-orange discoloration of salivared-orange discoloration of tearsred-orange discoloration of contact lensesrash (0.8%)fever (0.5%)nausea (1.5%)vomiting (1.5%)gastrointestinal disturbancesCutaneous syndrome (flushing, pruritus, rash, redness and watering of eyes)Flu syndrome (chills, fever, headache, malaise, bone pain)Abdominal syndrome (nausea, vomiting, abdominal cramps, diarrhoea)Orange-red discoloration of urine and secretionsElevated aminotransferase levels (14%)Rash (1–5%)Gastrointestinal events (nausea, vomiting, diarrhea; 1–2%)Orange discoloration of body fluidsUrine discoloration
Serious
- liver disease (mostly cholestasis)
- drug-induced liver injury
- death due to liver failure
- hypersensitivity reactions (flu-like syndrome: fever, chills, myalgias)
- eosinophilia (rare, with hypersensitivity)
- interstitial nephritis (rare, with hypersensitivity)
- acute tubular necrosis (rare, with hypersensitivity)
- thrombocytopenia (rare, with hypersensitivity)
- hemolytic anemia (rare, with hypersensitivity)
- shock (rare, with hypersensitivity)
- light chain proteinuria
- transient leukopenia
- anemia
- toxic optic neuropathy
- Hepatitis (dose-related, especially with >600 mg/day or pre-existing liver disease)
- Respiratory syndrome (breathlessness, shock, collapse)
- Purpura
- Haemolysis
- Shock
- Renal failure
- Hepatotoxicity (mild transient elevation of hepatic aminotransferases, rare at recommended doses)
Pregnancy & lactation
Pregnancy
X
Drug interactions
Darunavir
Contraindicated
Textbook
Significantly reduced darunavir concentrations, leading to loss of antiviral effectiveness.
Contraindicated.
Source: G&G 14e · p1245-1266
Lumateperone
Contraindicated
Textbook
Reduced AUC by >95%, leading to loss of efficacy.
Cannot be taken with CYP3A4 inducers.
Source: G&G 14e · p368
Lurasidone
Contraindicated
Textbook
Decreased Cmax to a seventh and AUC by 80%, leading to loss of efficacy.
DO NOT USE with strong inducers of CYP3A4.
Source: G&G 14e · p368
Valbenazine
Contraindicated
Textbook
Potential loss of valbenazine efficacy.
Not recommended.
Source: G&G 14e · p372
Velpatasvir
Contraindicated
Textbook
Approximately 82% reduction in velpatasvir AUC, potentially leading to treatment failure.
Rifampin and other potent inducers should be avoided. Do not use with potent P-gp or CYP3A inducers.
Source: G&G 14e · p1239, p1242
Budesonide
Severe
Textbook
budesonide AUC decreased by 99.7% (AUCR 0.003).
coadministration generally contraindicate[d] or at least require[s] dosage adjustment.
Source: G&G 14e · p1592
Cariprazine
Severe
Textbook
Potential loss of efficacy.
Not recommended.
Source: G&G 14e · p367
Cyclosporine
Severe
Textbook
Reduced oral bioavailability of cyclosporine.
Source: KDT 7e · p15
Doravirine
Severe
Textbook
Will reduce doravirine concentrations, potentially leading to loss of efficacy.
Should not be given with rifampin.
Source: G&G 14e · p1245-1266
Ethinylestradiol
Severe
Textbook
Decreased effectiveness of oral contraception, leading to contraceptive failure and unwanted pregnancy.
Patients should use alternative or additional contraceptive methods while on rifampin and for a period after discontinuation.
Source: KDT 7e · p36
Hiv Protease Inhibitors
Severe
Textbook
Reduced blood levels of protease inhibitors, rendering them ineffective in treating HIV infection.
In patients receiving these drugs, rifabutin (a less potent enzyme inducer) for 9–12 months may be substituted for rifampin.
Source: KDT 7e · p768, p778
Related guidelines
Other Rifamycin drugs
Ask House about rifampin
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Sources: KD Tripathi 7e, Goodman & Gilman 14e, Harrison 22e·Verified: 2026-05-10 · House clinical team