Hepatitis B Vaccination During Rifampin Therapy
Yes, you can and should receive the hepatitis B vaccine while taking rifampin—there are no contraindications to hepatitis B vaccination during rifampin therapy, and the vaccine should be administered according to standard schedules.
Key Recommendation
The available guidelines from the CDC's Advisory Committee on Immunization Practices (ACIP) do not list rifampin as a contraindication to hepatitis B vaccination 1. Hepatitis B vaccination should proceed normally while on rifampin treatment.
Important Clinical Context
Why This Matters
- Rifampin does not impair vaccine response: Unlike immunosuppressive medications, rifampin is not known to reduce the immunogenicity of hepatitis B vaccine 1
- Tuberculosis patients may benefit from HepB vaccination: If you're taking rifampin for tuberculosis treatment, completing your hepatitis B vaccine series is particularly important, as TB patients may have healthcare exposures or other risk factors 2
Standard Vaccination Schedule Applies
- Complete the full vaccine series according to the standard schedule (0,1, and 6 months for most formulations, or 0 and 1 month for Heplisav-B) 3, 4
- If the schedule is interrupted, do not restart the series—simply continue with the next dose when able 3
- The vaccine series does not need to be restarted regardless of delays 3
Monitoring Considerations
Hepatotoxicity Awareness
- Rifampin itself can cause hepatotoxicity, particularly when combined with other anti-tuberculosis medications like isoniazid and pyrazinamide 2
- Inactive hepatitis B carriers on rifampin-based TB treatment show higher rates of moderate-to-severe hepatotoxicity (8% vs 2% in non-carriers) 2
- Monthly liver function tests are recommended during rifampin-based TB treatment, especially if you're an HBsAg carrier 2
Post-Vaccination Testing
- Routine post-vaccination serologic testing (anti-HBs) is recommended 1-2 months after the final vaccine dose for certain high-risk groups including healthcare personnel, hemodialysis patients, and immunocompromised individuals 3, 5
- Testing confirms adequate seroprotection (anti-HBs ≥10 mIU/mL) 1
Common Pitfalls to Avoid
- Do not delay vaccination waiting to complete rifampin therapy—there is no reason to postpone 1
- Do not restart the vaccine series if doses are delayed beyond the recommended intervals 3
- Do not confuse rifampin with immunosuppressive agents that would genuinely impair vaccine response 1
Clinical Bottom Line
Rifampin therapy does not interfere with hepatitis B vaccination. Proceed with vaccination according to standard ACIP guidelines, complete the full series, and consider post-vaccination serologic testing if you fall into a high-risk category 1, 3.