Rifampicine
antibiotic
Third-party optionBy the Layer Nutrition editorial team · How the atlas classifies the 664 molecules
What this medicine is for
Rifampicin belongs to the category “antibiotic”. Antibiotics treat infections caused by bacteria. They are taken as a course, over a set duration, until the end of the prescription.
Specifically, for Rifampicin: Treats a bacterial infection. Its use is generally limited in time, adjusted to the situation.
Under which brands it is found
In France, about 5 reimbursable presentations containing Rifampicin are recorded. It is found under several brand names and as generics.
- Rifadine
- Rifadine Iv
- Rifater
- Rifinah
- Rimactan
Generics and the original brand are equivalent for the active substance; only the appearance, the name or the excipients may differ.
On the plate: vitamin D
Under rifampin, the body inactivates vitamin D faster, and prolonged treatment can deplete its reserves. Food helps supply it each day, along with the sun and whatever your physician recommends.
Vitamin D is found above all in oily fish: salmon, sardines, mackerel. Egg yolk provides a useful share, as do mushrooms, the only non-animal foods to contain it in any notable amount, especially when they have been exposed to UV light. Putting one of these foods on your table several times a week supports the intake.
Vitamin D is stored in fat and is better retained when it accompanies a meal containing a little fat, for instance a drizzle of olive oil over vegetables or avocado. Relying on oily fish two to three times a week remains the simplest way to fill the plate regularly, in addition to your treatment.
How rifampin works
Rifampin is an antibiotic that targets the core of bacterial machinery: DNA-dependent RNA polymerase, the enzyme that copies DNA into RNA. By binding to it, rifampin blocks RNA synthesis, either by physically obstructing the exit of the nascent RNA transcript or by lowering the enzyme's affinity for short transcripts. Deprived of its RNA, the bacterium can no longer manufacture its proteins and dies.
This target belongs to the microbial world alone: rifampin acts on the RNA polymerase of bacteria and not on the equivalent enzyme in human cells. This selectivity explains its bactericidal action, meaning that it kills the germ rather than merely slowing its growth. Against Mycobacterium tuberculosis, it remains active both on bacteria lodged inside cells and on those that stay outside.
Why rifampin is prescribed
The approved indications revolve first around tuberculosis, in both its active and latent forms, where rifampin holds a central place in treatment. It is also used to clear the asymptomatic carriage of Neisseria meningitidis, the bacterium responsible for certain forms of meningitis, in people who harbour it in the throat without being ill.
Beyond its marketing authorisation, rifampin is sometimes used against leprosy, against certain infections with methicillin-resistant Staphylococcus aureus (MRSA) and to relieve pruritus, the stubborn itching of liver diseases with bile retention. The choice of the drug, its dose and its duration rests with the physician, according to the infection being treated.
How to take it day to day
Rifampin is taken on an empty stomach, with a large glass of water, one hour before or two hours after a meal, because food reduces its absorption. Its steady-state half-life is short, two to three hours, which makes regular dosing important to maintain an effective level. You do not stop it on your own initiative, even if you feel better: a shortened course gives the germ a chance to survive and become resistant.
One visible effect often surprises at the start: the drug temporarily colours the urine, sweat, saliva, tears and stool yellow, red-orange or brown. This phenomenon is harmless and disappears once treatment stops. Soft contact lenses worn during treatment, however, can be permanently stained red, which is why glasses are preferable during this period.
The effects to know about
The liver is the organ to monitor first. Prolonged treatment is accompanied by minor and transient elevations of serum transaminases in 10 to 20% of patients, laboratory abnormalities that generally call for neither dose adjustment nor discontinuation. More rarely, rifampin causes clinically evident liver injury, with jaundice, which can be severe or even fatal, and whose onset typically occurs one to six weeks after treatment begins. In addition, serum bilirubin often rises during the first days then falls again: this transient phenomenon reflects a hindrance to bilirubin transport in the liver, not damage to the liver cells.
Other effects do not depend on the dose and stem from hypersensitivity reactions: hives, a flu-like syndrome, a drop in platelets (thrombocytopenia), destruction of red blood cells (haemolysis) and kidney involvement. Conversely, digestive disturbances and the orange colouring of body fluids are dose-dependent. Any unusual sign, fever, jaundice, rash or marked fatigue, should be reported to the physician without delay.
Why vitamin D can fall
Prolonged treatment with rifampin can lead to vitamin D deficiency, and even to osteomalacia, that softening of bone linked to a lack of vitamin D, particularly in people whose reserves were already marginal. Rifampin activates a nuclear receptor, PXR (pregnane X receptor), also called SXR, which serves as a sensor of drugs and xenobiotics within the cell.
How this activation translates into a loss of vitamin D remains debated. According to a first hypothesis, PXR would increase the production of 25-hydroxyvitamin D3-24-hydroxylase, or CYP24, a mitochondrial enzyme that inactivates vitamin D metabolites (Pascussi, 2005). Other work rules out this pathway and assigns this catabolism instead to CYP3A4 (Zhou, 2006). The net result, however, is constant: under rifampin, vitamin D is inactivated faster and its reserves can be depleted over the weeks of treatment.
Interactions and monitoring
Rifampin is a potent inducer of cytochromes P450, those liver enzymes that metabolise drugs (CYP3A4, CYP2C9, CYP2C19, CYP2C8, CYP1A2). By stimulating them, it speeds up the elimination of many treatments and sharply lowers their concentrations: statins, anticoagulants, opioids and oral contraceptives are among the most affected. This reduced effectiveness of hormonal contraceptives makes it necessary to add another method of contraception throughout the treatment. Any drug combination deserves to be checked by the physician or pharmacist.
Laboratory monitoring rests above all on watching liver function, particularly the transaminases, since their elevations are frequent and since overt liver injury, though rare, can be serious. A transient rise in bilirubin at the start of treatment is expected and does not by itself signal liver distress. This monitoring framework makes it possible to spot the rare complications early and to adjust management if needed.
Sources
- Rifampin - StatPearls - NCBI Bookshelf
- Rifampin - MedlinePlus Drug Information
- Rifampin - LiverTox - NCBI Bookshelf
- Possible involvement of pregnane X receptor-enhanced CYP24 expression in drug-induced osteomalacia
- Steroid and xenobiotic receptor and vitamin D receptor crosstalk mediates CYP24 expression and drug-induced osteomalacia
Related molecules
To explore in the « Anti-infectives » family and its neighbours.
See the whole « Anti-infectives » family · Back to the atlas
Supplements to consider
Beyond the plate, a single isolated nutrient can be worth discussing, to confirm with your doctor or pharmacist. Here is which one and in which form.
Probiotics
Probiotics are live micro-organisms, mainly lactobacilli and bifidobacteria. The CFU count and the number of strains are among the selection criteria; gastro-resistant capsules protect the bacteria from stomach acidity.
Preferred form gastro-resistant capsules, several strains, CFU count stated
Frequently asked questions
What are the most common side effects of rifampin?
The patient leaflet notably mentions an orange to reddish discoloration of urine, tears and sweat, along with digestive upset. For the full list of side effects and what to do about them, refer to the patient leaflet and speak with your doctor or pharmacist.
Why does rifampin turn your urine orange or red?
This discoloration of urine, but also of tears, saliva and sweat, is a known effect of the molecule and appears in the patient leaflet; it can also permanently stain soft contact lenses. If any sign worries you, your doctor or pharmacist can advise you.
Does rifampin make birth control less effective?
Rifampin is a strong enzyme inducer and the patient leaflet indicates that it can reduce the effectiveness of hormonal contraceptives. What to do about it and any alternatives are a matter for your doctor or pharmacist.
Can you drink alcohol while taking rifampin?
Rifampin puts a load on the liver and its patient leaflet calls for caution regarding alcohol and liver damage. For your specific situation, ask your doctor or pharmacist for advice.
Should you keep an eye on vitamin D while taking rifampin?
As a strong enzyme inducer, rifampin speeds up the metabolism of many substances, and research links this treatment to a drop in vitamin D levels. A blood test measuring 25-hydroxyvitamin D can objectively assess your status; the active ingredient to consider is then vitamin D3 (cholecalciferol), in a simple form, to be evaluated with a healthcare professional.
Are probiotics worth taking for gut flora during an antibiotic like rifampin?
An antibiotic alters the balance of the gut flora, and research links taking probiotics to digestive comfort during and after a course of antibiotics. The active ingredients often studied are strains such as Lactobacillus rhamnosus or the yeast Saccharomyces boulardii, in the form of live cultures, to be discussed with your pharmacist.
Ces réponses portent sur le volet nutritionnel. Pour toute question sur votre médicament, la notice et votre médecin ou pharmacien font foi.