Class: Diarylquinoline

Mechanism: Inhibits mycobacterial ATP synthase, depleting the organism's energy supply. It is active against replicating and nonreplicating Mycobacterium tuberculosis.
Katzung's Basic and Clinical Pharmacology, 16th Edition, p. 1320

Usual adult schedule: 400 mg orally once daily for 2 weeks, then 200 mg three times weekly for 22 weeks, taken with food. Exact use, duration, and companion drugs must follow susceptibility results and a TB specialist or national program protocol.
Katzung's Basic and Clinical Pharmacology, 16th Edition, p. 1320

Role in current treatment: WHO includes bedaquiline in recommended MDR/RR-TB regimens, including shorter all-oral regimens in eligible patients. The 2025 WHO guidance also describes 6-month regimens containing bedaquiline, such as BPaLM for suitable patients and BDLLfxC as a conditional option. See the WHO TB treatment guidance.

Important adverse effects: QT-interval prolongation, hepatotoxicity or raised liver enzymes, nausea, arthralgia, headache, and dizziness. ECG and liver-function monitoring are generally required.

Major interactions: It is metabolized mainly by CYP3A4. Avoid strong CYP3A4 inducers, particularly rifampicin/rifampin, which markedly lowers bedaquiline concentrations. Use caution with CYP3A4 inhibitors and with other QT-prolonging drugs such as clofazimine, fluoroquinolones, delamanid, and certain antiarrhythmics or antipsychotics.
Goodman & Gilman’s The Pharmacological Basis of Therapeutics, newer anti-TB drugs section.

Pharmacokinetic point: It has a very long terminal half-life, about 5.5 months, so adverse effects and interactions can persist after treatment stops.
Katzung's Basic and Clinical Pharmacology, 16th Edition, p. 1320