Which Vitamin is Given with Rifampicin? Pyridoxine and More

October 22, 2025 •

4 min read

Over 10 million people worldwide were sickened by tuberculosis in a recent year, making its treatment a global priority. One common antibiotic used, rifampicin, is frequently prescribed with another specific vitamin as part of standard treatment regimens to mitigate potential side effects.

Quick Summary

Pyridoxine (Vitamin B6) is routinely given with rifampicin in combination therapy with isoniazid to prevent peripheral nerve damage. Vitamin K and D levels may also be impacted, requiring monitoring.

Key Points

Pyridoxine (Vitamin B6) is key: It is given in combination therapy with isoniazid to prevent peripheral nerve damage.
Rifampicin alone usually doesn't need B6: When used as monotherapy, routine supplementation is not necessary unless specific risk factors for neuropathy are present.
Watch for Vitamin K deficiency: Rifampicin can increase the risk of bleeding due to Vitamin K deficiency, especially in malnourished patients.
Monitor Vitamin D levels: The drug can increase the breakdown of Vitamin D, which may affect calcium levels and require monitoring.
Always consult a doctor: Do not self-prescribe vitamins; always follow the guidance of a healthcare provider when on medication.
Check for combination therapy: The need for pyridoxine is primarily driven by the co-administration of isoniazid, not rifampicin alone.

The Primary Vitamin: Pyridoxine (Vitamin B6)

When people ask, "which vitamin is given with rifampicin?", the answer is most often Pyridoxine, or Vitamin B6. However, this is a crucial distinction to make: Pyridoxine is typically co-administered not because of rifampicin itself, but because rifampicin is frequently used in combination therapy with other antitubercular drugs, most notably isoniazid (INH). Isoniazid is known to interfere with the metabolism of pyridoxine and can lead to a condition called peripheral neuropathy, which involves numbness, pain, or weakness in the hands or feet.

The standard practice is to supplement with 25–50 mg of pyridoxine daily to prevent this nerve damage. For patients who already develop peripheral neuropathy, the dosage may be increased to 100 mg per day. It is especially important to provide pyridoxine to individuals with certain risk factors for neuropathy, including:

Diabetes
Alcoholism
Malnutrition
Chronic renal failure
HIV infection
Pregnancy or breastfeeding
Advanced age

Why Rifampicin Alone Doesn't Routinely Need Pyridoxine

Rifampicin on its own does not significantly deplete vitamin B6 levels or cause the same risk of peripheral neuropathy as isoniazid. Therefore, if a patient is on rifampicin monotherapy (only rifampicin and no INH) and has no other risk factors, routine pyridoxine supplementation is not usually required. Confusion often arises because the drugs are so often used together, and pyridoxine is packaged in fixed-dose combination products with both drugs.

Other Important Vitamin Considerations with Rifampicin

Beyond Vitamin B6, rifampicin can affect the levels of other vitamins in the body, primarily due to its ability to induce liver enzymes. This can necessitate monitoring and potential supplementation for certain high-risk patients.

Vitamin K and Bleeding Risk

Rifampicin can disrupt the body's use of Vitamin K, leading to a deficiency. This can increase the risk of bleeding problems, especially in patients with pre-existing poor nutritional status. In rare cases, this has led to severe coagulopathy. Your doctor may prescribe Vitamin K supplements to manage this risk and will likely monitor your clotting factors through blood tests.

Vitamin D and Bone Health

By inducing liver enzymes, rifampicin can accelerate the breakdown of Vitamin D. This can result in lower active Vitamin D levels, potentially affecting calcium and phosphate regulation and leading to high parathyroid hormone levels. While research is ongoing regarding the role of vitamin D supplementation in TB treatment, monitoring your levels is advisable.

Potential Role of Vitamin C

In-vitro studies have investigated the potential protective effects of Vitamin C against rifampicin-induced liver toxicity. These studies suggest Vitamin C might be a beneficial adjunctive therapy, but clinical evidence regarding its effectiveness and necessity is still mixed.

Comparing Vitamin Needs


Vitamin	Primary Reason for Supplementation	When is Supplementation Needed?	Affected by Rifampicin Only?	Affected by Isoniazid?
Vitamin B6 (Pyridoxine)	To prevent peripheral neuropathy	Routinely in combination therapy with isoniazid; also for high-risk patients on rifampicin monotherapy.	No.	Yes, interferes with metabolism.
Vitamin K	To prevent bleeding complications	In patients with poor nutritional status or other risk factors.	Yes.	No.
Vitamin D	To maintain bone health and calcium levels	Monitoring may be needed due to increased metabolism.	Yes.	Possibly, but more due to rifampicin's enzyme induction.
Vitamin C	Potential hepatoprotective effects (adjunctive therapy)	Under clinical investigation, not standard practice.	Possible benefits suggested in studies.	No.

Understanding the Mechanism

The key to understanding vitamin needs lies in the specific drugs used. While rifampicin induces certain liver enzymes, leading to increased metabolism of some compounds, isoniazid directly interferes with the metabolic pathway of pyridoxine. This is why the risk of neuropathy is so closely tied to isoniazid, and why pyridoxine is routinely added to combination regimens to counteract this specific effect. The enzyme-inducing properties of rifampicin are what impact vitamin D and can affect vitamin K, though the effect on K is more pronounced in vulnerable individuals.

Conclusion

In summary, the vitamin most commonly given alongside rifampicin is Pyridoxine (Vitamin B6), particularly when the antibiotic is combined with isoniazid to treat tuberculosis. This is a preventative measure against drug-induced peripheral neuropathy. Separately, rifampicin can also impact Vitamin K and Vitamin D levels, with Vitamin K deficiency carrying a higher risk of bleeding, particularly in patients with poor nutrition. The need for supplementation of Vitamin K and D should be determined by a healthcare provider based on individual risk factors and blood tests. Always consult your doctor before starting or stopping any vitamin supplement, especially during a course of powerful medication. For more information on drug interactions with isoniazid and rifampicin, refer to authoritative sources such as the Mayo Clinic's drug information page.

Frequently Asked Questions

No, Vitamin B6 is primarily necessary when rifampicin is taken in combination with isoniazid, another antitubercular drug. Isoniazid is the medication that causes a risk of peripheral neuropathy, which Vitamin B6 helps prevent.

In combination therapy with isoniazid, the standard prophylactic dose of Vitamin B6 (pyridoxine) is typically 25–50 mg daily. For treating active neuropathy, a doctor may increase the dose to 100 mg daily.

Signs of Vitamin K deficiency can include increased bruising, bleeding gums, nosebleeds, and in severe cases, abnormal bleeding from other sites. This risk is higher in individuals with poor nutritional status.

Yes, rifampicin can increase the metabolism of Vitamin D and may affect Vitamin K levels, especially in at-risk patients. Monitoring and supplementation may be needed for these vitamins as well.

Rifampicin induces certain liver enzymes, such as CYP3A4, which can accelerate the breakdown of Vitamin D. This can lead to lower levels of the active form of the vitamin in the body.

Patients with poor nutritional status, alcoholism, diabetes, chronic renal failure, HIV infection, or those who are elderly, pregnant, or breastfeeding are at higher risk for vitamin deficiencies and related side effects.

You should always consult your healthcare provider before taking any over-the-counter vitamins or supplements with rifampicin, as they could interfere with the medication or its absorption.