Drug Interaction Report

Rifabutin and Bedaquiline: Interaction Details

A pharmacist-reviewed analysis of the Rifabutin and Bedaquiline interaction: the documented clinical effects, severity rating, onset, mechanism, and management considerations, with cited references throughout.

AI-assisted, pharmacist-reviewed · Source data updated Aug 8, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature

Rifabutin

Mycobutin
+

Bedaquiline

Sirturo Sirturo®
Dr. Brian Staiger, PharmD, BCPS
Medically reviewed by
Dr. Brian Staiger, PharmD, BCPS
Updated Aug 8, 2026
Editorial policy · Data sources
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Interaction severity
Major
Potentially serious — often needs a change or close monitoring.
How we grade severity & evidence

Severity levels

  • Contraindicated: These should generally not be used together.
  • Major: Potentially serious — often needs a change or close monitoring.
  • Moderate: Can be significant — usually manageable with monitoring.
  • Minor: Usually limited clinical impact.

Evidence grades

  • Established: Well documented — supported by controlled studies or strong clinical data.
  • Probable: Good supporting evidence, though not definitively proven.
  • Suspected: Some evidence suggests this interaction, but it is not well established.
  • Possible: Limited or conflicting evidence; the interaction may occur.
  • Theoretical: Predicted from the drugs' pharmacology; not yet confirmed in people.

Ratings come from the documented interaction literature and are reviewed by a pharmacist. They describe the documented risk of the combination, not what will necessarily happen to you — your dose, timing, and health picture all matter.

Of 65 documented Rifabutin interactions, 57 are rated major — including this one.
Worried about symptoms right now? Contact your pharmacist or prescriber, or call Poison Control at 1-800-222-1222 (US). Call 911 for an emergency.
Onset
unspecified
Evidence
theoretical
Severity
Major

What happens

Increased bedaquiline metabolite M2 and M3 exposure, reduced bedaquiline exposure and reduced efficacy of bedaquiline

Interaction Deep Dive

Avoid the concomitant use of bedaquiline (a CYP3A4 substrate) with rifabutin, as it may reduce systemic bedaquiline exposure and may reduce the therapeutic effect of bedaquiline1. Coadministration of rifabutin with bedaquiline due to the adverse reactions is associated with increased bedaquiline metabolite (M2 and M3) exposure. In 17 healthy subjects, coadministration of bedaquiline (400 mg daily on day 1 and day 29) with rifabutin (300 mg daily) resulted in increased 1.4-fold M2 and approximately 3.0-fold M3 bedaquiline metabolites exposure 2.

Why it happens (mechanism)

Induction of CYP3A4-mediated metabolism of bedaquiline

Literature reports

1 report — tap to read

a) In 17 healthy subjects, coadministration of bedaquiline (400 mg daily on day 1 and day 29) with rifabutin (300 mg daily) resulted in increased 1.4-fold M2 and approximately 3.0-fold M3 bedaquiline metabolites exposure 2.

Common questions

Can I take Rifabutin and Bedaquiline together?

Increased bedaquiline metabolite M2 and M3 exposure, reduced bedaquiline exposure and reduced efficacy of bedaquiline Always confirm with your pharmacist or prescriber before making any change.

How serious is the Rifabutin and Bedaquiline interaction?

It is rated major. Potentially serious — often needs a change or close monitoring.

How quickly could this interaction happen?

The documented onset is "unspecified". The timing of this interaction is not well characterized.

How strong is the evidence for this interaction?

The evidence is graded "theoretical". Predicted from the drugs' pharmacology; not yet confirmed in people.

Questions for your pharmacist

  • Does my dose of Rifabutin or Bedaquiline need adjusting while I take them together?
  • What symptoms should prompt me to call you or my prescriber right away?
  • Does the timing of my doses matter for this combination?
  • Is there a safer alternative to one of these medications for me?

References (2)

  1. Product Information: SIRTURO(R) oral tablets, bedaquiline oral tablets. Janssen Products, LP (per FDA), Horsham, PA, 2024. DailyMed
  2. Product Information: MYCOBUTIN(R) oral capsules, rifabutin oral capsules. Pharmacia & Upjohn Co (per FDA), New York, NY, 2024. DailyMed
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Rifabutin

Keep reading about Rifabutin

All Rifabutin interactions (65)
Also serious with: Cabotegravir Nifedipine Olutasidenib Irinotecan Injection
Bedaquiline

Keep reading about Bedaquiline

All Bedaquiline interactions (320) Bedaquiline drug information
Also serious with: Fluconazole Ketoconazole Mesoridazine Levoketoconazole
Beyond drug–drug

These medications also interact with supplements

Prescription drugs aren't the whole picture — herbal and dietary supplements can interact with them too. From the evidence-graded Natural Medicines database:

Rifabutin + Activated Charcoal Grapefruit St. John's Wort Acacia Rigidula Adrafinil African Wild Potato Alkanna Alpine Ragwort + 172 more
Bedaquiline + Activated Charcoal American Hellebore Arsenic Cesium Ephedra Grapefruit Sida Cordifolia St. John's Wort + 138 more

major · moderate · minor — check everything you take with our drug–supplement interaction checker.

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This information is for education, not a substitute for professional medical advice. Do not start, stop, or change any medication without talking to your pharmacist or prescriber.