# Rifampicin in Nigeria

Rifampicin has 4 active NAFDAC registrations in our October 2026 copy of the register, from 3 registration holders; 1 further listing has lapsed.

- Source: https://ogbogwu.com/drugs/rifampicin/
- Drug class: Rifamycin antibiotic (Anti-Tuberculosis)
- Also known as: Rifampin, Rimactane
- Prescription required: yes
- On the WHO Model List of Essential Medicines
- Last updated: February 2026

## Price in Nigeria

Rifampicin prices in Nigeria vary by brand, strength, and where you buy it. Confirm the current price with a licensed pharmacy, and always check the product is NAFDAC-registered before you pay.

## What is Rifampicin?

Rifampicin is one of the most important antibiotics in the world, serving as the backbone of tuberculosis (TB) treatment globally and in Nigeria. It belongs to the rifamycin class of antibiotics and works by inhibiting bacterial RNA synthesis — specifically, it blocks the enzyme RNA polymerase, which bacteria need to produce proteins essential for their survival and replication. This mechanism makes rifampicin highly effective at killing Mycobacterium tuberculosis, the bacterium that causes TB. Nigeria ranks among the World Health Organisation's 30 high-burden countries for tuberculosis, with an estimated 467,000 new TB cases annually and approximately 155,000 TB-related deaths each year. Despite this enormous burden, case detection remains a major challenge — many TB cases go undiagnosed and untreated, particularly in underserved communities across northern Nigeria, urban slums in Lagos, and rural areas with limited access to diagnostic facilities.

In Nigeria, rifampicin is provided free of charge through the National Tuberculosis and Leprosy Control Programme (NTBLCP) under the DOTS (Directly Observed Therapy, Short-course) strategy. The DOTS programme ensures that patients take their medication under the direct observation of a healthcare worker, community volunteer, or treatment supporter, which significantly improves adherence and cure rates. TB treatment centres are located in general hospitals, primary health centres, and DOTS centres across all 36 states and the Federal Capital Territory. The standard TB treatment regimen consists of two phases: an intensive phase of 2 months using four drugs — Rifampicin, Isoniazid, Pyrazinamide, and Ethambutol (collectively known as RHZE) — followed by a continuation phase of 4 months using Rifampicin and Isoniazid alone (RH). The entire treatment duration is a minimum of 6 months, and it is absolutely critical that patients complete the full course.

One of the most distinctive and alarming (for patients who are not forewarned) characteristics of rifampicin is that it turns body fluids an orange-red colour. Urine, tears, sweat, saliva, and even semen will take on an orange to reddish tinge during treatment. This is completely harmless and is simply due to the colour of the drug and its metabolites being excreted from the body, but patients must be warned about this in advance to prevent unnecessary panic or discontinuation of treatment. Healthcare workers at DOTS centres in cities like Abuja, Kano, Lagos, Enugu, and Kaduna routinely counsel patients about this effect before starting treatment. Another critical consideration is that rifampicin is a potent inducer of liver enzymes (particularly CYP3A4), which means it significantly reduces the blood levels of many other medicines, including antiretrovirals, oral contraceptives, warfarin, and antidiabetic drugs. This is particularly important in Nigeria where TB-HIV co-infection is common, requiring careful medication management.

## What is Rifampicin used for?

- First-line treatment of drug-susceptible pulmonary tuberculosis (TB of the lungs) — the most common form of TB in Nigeria
- Treatment of extrapulmonary TB including TB meningitis, TB lymphadenitis (scrofula), spinal TB, abdominal TB, and miliary TB
- Treatment of TB-HIV co-infection, requiring careful coordination with antiretroviral therapy
- Treatment of leprosy (Hansen's disease) as part of multi-drug therapy — Nigeria still has pockets of leprosy in some states
- Treatment of selected cases of latent TB infection in high-risk individuals (such as HIV-positive patients and close contacts of active TB cases)
- Treatment of certain non-tuberculous mycobacterial infections and serious staphylococcal infections (including prosthetic joint infections) in combination with other antibiotics

## Dosage

Always follow a doctor's or pharmacist's instructions; this is general reference information.

- Adults: For TB treatment: 10mg per kg of body weight daily (usual dose is 450mg for patients weighing less than 50kg, or 600mg for patients weighing 50kg or more), taken as a single dose on an empty stomach, preferably 30 minutes to 1 hour before breakfast. Rifampicin is best absorbed on an empty stomach. The intensive phase lasts 2 months (RHZE combination), followed by 4 months of continuation phase (RH combination). Fixed-dose combination tablets containing rifampicin with other anti-TB drugs are commonly used in Nigeria to simplify dosing and improve adherence.
- Children: For TB treatment in children: 15mg per kg of body weight daily (range 10-20mg/kg), up to a maximum of 600mg daily. Paediatric formulations including dispersible tablets and suspensions are available. Child-friendly fixed-dose combinations (FDCs) are now distributed through the NTBLCP. Dosing is based on weight bands as per WHO guidelines. Always follow the dosing chart provided by the prescribing clinician at the DOTS centre.
- Elderly: The standard weight-based dose applies to elderly patients. However, elderly patients are at higher risk of hepatotoxicity (liver damage) and should have liver function tests monitored more frequently, particularly during the first two months of treatment. Dose reduction may be necessary in patients with significant liver impairment. Rifampicin should be used cautiously in elderly patients taking multiple other medications due to its extensive drug interactions.

Always take rifampicin on an empty stomach for optimal absorption — at least 30 minutes before a meal or 2 hours after eating. The entire course of treatment (minimum 6 months for drug-susceptible TB) must be completed even if symptoms improve within the first few weeks. Stopping treatment early is the single biggest cause of drug-resistant TB, including the deadly multidrug-resistant TB (MDR-TB). Attend all scheduled appointments at your DOTS centre. If you experience nausea, try taking the medication at bedtime on an empty stomach instead of in the morning.

## Side effects

Common: Orange-red discolouration of urine, tears, sweat, saliva, and other body fluids — this is harmless but can permanently stain contact lenses and light-coloured clothing; Nausea and vomiting — particularly at the start of treatment; taking the medication at bedtime can help; Loss of appetite — common in the first few weeks of treatment; Abdominal pain or stomach cramps; Mild skin rash or itching; Headache and dizziness.

Serious (seek medical help immediately): Hepatotoxicity (liver damage) — the most serious side effect of rifampicin. Symptoms include yellowing of the eyes and skin (jaundice), dark urine, pale stools, severe nausea, and right upper abdominal pain. This requires immediate medical attention and discontinuation of the drug.; Thrombocytopenia — a dangerous reduction in blood platelets that can cause unusual bruising, petechial rash, or prolonged bleeding. More common with intermittent dosing.; Acute kidney failure — particularly with intermittent or irregular dosing, which can trigger an immune-mediated reaction; Flu-like syndrome — fever, chills, muscle aches, and malaise, typically occurring with intermittent therapy; Severe allergic reaction (anaphylaxis) — rare but life-threatening; Haemolytic anaemia — destruction of red blood cells, causing severe anaemia, jaundice, and dark urine.

When to see a doctor: Seek immediate medical attention if you develop yellowing of the eyes or skin, severe abdominal pain, persistent vomiting, dark urine (beyond the expected orange tinge), unusual bruising or bleeding, severe skin rash, high fever, or difficulty breathing. In Nigeria, go directly to your DOTS treatment centre or the nearest hospital emergency department. Do not wait — hepatotoxicity from rifampicin can progress rapidly if not identified and managed early. Your healthcare provider may need to check your liver function tests and temporarily stop the medication. Never restart rifampicin on your own after a serious reaction — this must be done under medical supervision.

## Warnings

Do not take if: Known hypersensitivity to rifampicin or other rifamycin antibiotics (e.g., rifabutin, rifapentine); Jaundice or active severe liver disease — rifampicin is hepatotoxic and can worsen pre-existing liver damage; Concurrent use with certain protease inhibitor-based HIV regimens (such as atazanavir, darunavir, lopinavir/ritonavir) without appropriate dose adjustments, as rifampicin drastically reduces their levels; Concurrent use with voriconazole — rifampicin reduces voriconazole levels to subtherapeutic concentrations.

Interactions: Antiretroviral drugs — rifampicin dramatically reduces blood levels of protease inhibitors, NNRTIs (efavirenz, nevirapine), and integrase inhibitors (dolutegravir). For TB-HIV co-infected patients on TLD, an additional 50mg dolutegravir dose is required 12 hours after the TLD tablet.; Oral contraceptive pills — rifampicin significantly reduces the effectiveness of combined oral contraceptives and progestogen-only pills. Women of childbearing age must use alternative or additional contraception (such as condoms or depot medroxyprogesterone injections) during rifampicin treatment.; Warfarin and other anticoagulants — rifampicin reduces their effect, requiring dose increases and close INR monitoring; Antidiabetic drugs (metformin, glibenclamide, insulin) — rifampicin can reduce the effectiveness of oral hypoglycaemics, potentially worsening blood sugar control; Corticosteroids (prednisolone, dexamethasone) — rifampicin reduces corticosteroid levels; dose adjustment may be needed; Antiepileptic drugs (phenytoin, carbamazepine) — rifampicin reduces their levels, increasing seizure risk.

Pregnancy & breastfeeding: Rifampicin crosses the placenta and is excreted in breast milk. However, it is considered essential for the treatment of active TB during pregnancy, as untreated TB poses a far greater risk to both mother and baby than the medication itself. The WHO and Nigerian guidelines recommend that pregnant women with active TB should receive the standard rifampicin-containing regimen. There is a theoretical risk of postnatal bleeding in the newborn due to rifampicin's effect on Vitamin K-dependent clotting factors, and Vitamin K should be administered to the newborn at birth (which is routine practice in Nigeria). Breastfeeding mothers on rifampicin should continue breastfeeding, as the amount of drug in breast milk is minimal and not harmful to the infant. The breast milk may appear slightly orange-tinged, which is harmless.

## Brands in Nigeria

Well-known NAFDAC-registered brands: Rimactane (Novartis, made in Switzerland); Rifadin (Sanofi, made in France).
Full searchable brand list: https://ogbogwu.com/drugs/rifampicin/brands/

## How to verify it is genuine

1. Check for a valid NAFDAC registration number on the packaging. All genuine medicines sold in Nigeria must carry a NAFDAC registration number.
2. Use the NAFDAC Mobile Authentication Service (MAS): scratch the security panel on the packaging and send the unique code via SMS to 38353 to confirm authenticity.
3. Obtain TB medications only through the DOTS programme at designated treatment centres, government hospitals, or NAFDAC-registered pharmacies. TB medicines provided through the DOTS programme are quality-assured.
4. Inspect the capsules or tablets — rifampicin capsules are typically reddish-brown in colour. If the appearance differs significantly from what you have previously received, report this to your healthcare provider.
5. Check the expiry date and ensure the packaging is intact with no evidence of tampering, water damage, or fading of printed information.
6. Be cautious of unusually cheap rifampicin sold outside of the formal health system — substandard and counterfeit TB drugs are a serious threat to public health in Nigeria and can contribute to the development of drug-resistant TB.

Verify any NAFDAC number free (no login): https://ogbogwu.com/nafdac-checker/

## FAQs

### Is TB treatment free in Nigeria, and where can I get it?

Yes, TB treatment is completely free in Nigeria under the National Tuberculosis and Leprosy Control Programme (NTBLCP), which implements the DOTS strategy. Free TB diagnosis and treatment are available at DOTS centres located in general hospitals, primary health centres, and some private hospitals that partner with the programme across all 36 states and the FCT. Major treatment centres include those at Lagos University Teaching Hospital, National Hospital Abuja, Aminu Kano Teaching Hospital, University of Benin Teaching Hospital, and many state and local government health facilities. You do not need to pay for sputum tests, GeneXpert testing, chest X-rays (at many centres), or the TB medicines themselves. To access free treatment, visit any DOTS centre — you can walk in or be referred by a private clinic. Early diagnosis and treatment save lives and prevent transmission to family members.

### Why does rifampicin turn my urine orange, and should I be worried?

The orange-red discolouration of urine (and sometimes tears, sweat, and saliva) is a completely normal and expected effect of rifampicin. It is caused by the colour of the drug and its breakdown products being excreted from the body. It is not a sign of kidney damage or blood in the urine. This discolouration typically begins within a few hours of taking the first dose and continues throughout treatment. While harmless, you should be aware that it can permanently stain soft contact lenses (switch to glasses during treatment), discolour light-coloured clothing through sweat, and cause your tears to appear orange. If your urine turns dark brown or coca-cola coloured (rather than the expected orange), this may indicate a liver problem and you should see your doctor immediately. The orange colour will disappear once treatment is completed.

### Why is TB treatment so long (6 months), and can I stop when I feel better?

TB treatment takes a minimum of 6 months because the TB bacterium (Mycobacterium tuberculosis) is extremely resilient and grows very slowly. Some TB bacteria enter a dormant state inside the body where they are only slowly killed by the drugs. Most patients start feeling better within 2 to 4 weeks of starting treatment, and their sputum may become negative for TB bacteria within 2 months. However, this does NOT mean the infection is cured — dormant bacteria still remain and can reactivate if treatment is stopped early. Incomplete treatment is the main cause of drug-resistant TB, including multidrug-resistant TB (MDR-TB), which is far more difficult, expensive, and toxic to treat (up to 20 months of treatment with second-line drugs). In Nigeria, MDR-TB is a growing concern. You MUST complete the entire 6 months (or longer for certain forms of TB) even if you feel perfectly well. Your DOTS supporter and treatment centre team are there to help you stay on track.

### I am HIV-positive and have been diagnosed with TB. Can I take rifampicin with my ARVs?

Yes, you can and must take rifampicin for TB treatment even if you are HIV-positive, but your medication regimen needs careful management due to important drug interactions. Rifampicin is a potent liver enzyme inducer that significantly reduces the blood levels of many antiretroviral drugs. If you are on TLD (Tenofovir/Lamivudine/Dolutegravir), which is the standard first-line ARV in Nigeria, you will need an additional 50mg dose of dolutegravir taken 12 hours after your TLD tablet for the entire duration of rifampicin treatment. This is because rifampicin reduces dolutegravir levels by approximately 50%. Your ART centre clinician will arrange this dose adjustment. TB-HIV co-infection is very common in Nigeria — approximately 14% of TB patients are also HIV-positive. Both diseases must be treated simultaneously for the best outcomes. Attend both your TB DOTS appointments and your ART clinic appointments regularly, and inform all your healthcare providers about all the medicines you are taking.

## Sources

- NAFDAC Greenbook (official register of approved products in Nigeria)
- WHO Model List of Essential Medicines
- British National Formulary (BNF)
- Nigerian Standard Treatment Guidelines (Federal Ministry of Health)