The rifamycins include rifampin, rifapentine, and rifabutin. Drugdrug interaction study with rifampin the safety and scientific validity of this study is the responsibility of the study sponsor and investigators. The concomitant administration of rifampin and warfarin resulted in the need for an unusually high maintenance dose of warfarin 20 mg per day in order. A total of 460 drugs are known to interact with rifampin. Drugdrug interaction with linezolid has been reported by several authors 14,414243444546 47 rifampin can markedly decrease the linezolid serum concentration thus affecting the. The average elimination halflife of hexobarbital was decreased from 624 to 262 min and that of tolbutamide from 292 to 160 min following rifampicin treatment in patients.
Several fdaapproved drug labels may be available for rifampin. Volume 92 the drug interactions described are based on studies conducted with either harvoni, the components of harvoni ledipasvir and sofosbuvir as individual agents, or are predicted drug interactions that may occur with harvoni. Drug interactions can make medication management challenging. The statins are widely used worldwide to reduce risk for cardiovascular events in both the primary and secondary prevention settings. Clinically important drug interactions have been documented between rifampin and numerous other drugs, such as oral anticoagulants. Mccancekatz, md, phd disclosures none adverse drug interactions accidents. Rifampin injection is given as an infusion into a vein take rifampin oral on an empty stomach, at least 1 hour before or 2 hours after a meal.
Rifampicin, an antituberculosis drug, is usually administered for 4 to 12 months with other antituberculosis drugs or medications from other classes. Heres a classic case demonstrating the rifampin and phenytoin interaction. The average elimination halflife of hexobarbital was decreased from 624 to 262 min and that of tolbutamide from 292 to 160 min following rifampicin treatment in patients with. Pharmacokinetic interaction between rifampin and the. Type in a drug name to check for interactions with rifampin. Rifampin rifabutin empiric dose increase of 20 30% starting 3 5 days post initiation of rifampin or rifabutin increase dose by 2030% of expected maintenance dose ritonavir or any protease inhibitor for hiv with ritonavir. Since many drugs are cytochrome p450 cyp3a4 substrates, it has become common practice to assess drugdrug interaction ddi potential. Rifampins concomitant use with warfarin results in a clinically significant drugdrug interaction. The patients seizures were well controlled on phenytoin as they had not had one in well over a year. Drugdrug interaction between rifampin and fluvastatin. There are 6 disease interactions with rifampin which include.
Rifampicin, an important drug in the treatment of tuberculosis, is used extensively despite its broad effects on drugdrug interactions, creating serious problems. Most of the unbound fraction is not ionized and, therefore, diffuses. A 47 year old patient with diabetes and seizure disorder is diagnosed with new onset osteomyelitis. If you get nothing else out of this article, i want it to be that rifampin is the most powerful cyp inducer known to man. Rifampicin is a member of the class of rifamycins that is a a semisynthetic antibiotic derived from amycolatopsis rifamycinica previously known as amycolatopsis mediterranei and streptomyces mediterranei it has a role as an ec 2.
Digoxin was found to be a weak substrate of organic aniontransporting polypeptide oatp 1b3 in transfected cells. In addition, rifampicin can reduce the plasma concentrations of drugs that are not metabolised e. Rifampin is known to have major interactions with several medications due to its strong pglycoprotein and liver enzyme inducer activity especially on cyp2c9, cyp3a4, cyp1a2 and cyp2c19 horn et al. Follow all directions on your prescription label and read all medication guides or instruction sheets. Bacteriologic cultures should be obtained before the start of therapy to confirm the susceptibility of the organism to rifampin and they should be repeated throughout therapy to monitor the response to treatment rifampin is available under the following different brand names. Wed like to understand how you use our websites in order to improve them. Pdf rifampicin, an important drug in the treatment of tuberculosis, is used extensively despite its broad effects on drugdrug interactions, creating. Rifampin is widely distributed throughout the body. The concomitantly administered effects of rifampicin on other drugs can result in their altered metabolism or.
Rifadin, rimactane rifampin uses, side effects, dosage. Examples of welldocumented, clinically significant interactions include warfarin, oral contraceptives, cyclosporine, glucocorticoids, ketoconazole, theophylline, quinidine, digitoxin, and. The brief version is a compilation of the tables and boxed recommendations. Rifampin is a potent inducer of hepatic p450 oxidative enzymes. Significant drug interactions with tuberculosis medications. Recommendations for management of clinically significant. For participants in the rifampin interaction study, rifampin 300 mg q. A while back i posted about how changing this drugs dosing, starting the medication, or discontinuing the medication can change how drugs are metabolized. Rifampin is a potent inducer of the cytochrome p450 and accounts for many of the drug interactions that occur during tb therapy. A possible drug interaction has been reported with rifampin and amiodarone in one patient receiving therapy with icd and amiodarone for history of atrial and ventricular arrhythmias.
Rifampin is a potent inducer of cytochrome p450 oxidative enzymes. Call your doctor immediately if you experience a fever, chills, joint pain or swelling, excessive tiredness or weakness, unusual bleeding or bruising, skin rash or itching, loss of appetite, nausea, vomiting, or yellowing of. Although generally quite safe, the statins can be associated with a variety of serious side adverse effects, including myalgia, myopathy, and changes in plasma enzymes of hepatic origin. Although rare, the most serious of these is rhabdomyolysis. Inclusion or absence of a drug label on the aidsinfo site does not imply endorsement or lack thereof by aidsinfo. The information is not intended to cover all possible uses, directions, precautions, drug interactions or adverse effects, nor should it be construed to indicate that use of a particular drug is. Rifampin is a potent inducer of the hepatic and intestinal cytochrome p450 cyp enzyme system and the pglycoprotein pgp transport system, which results in numerous clinically significant drug interactions. Rifampin daily 4 months your doctor may have you meet with a health care worker to take your medicine.
Consult your healthcare professional before taking or. The official warfarin oh shit drug interaction list tl. Rifamycinsdrug interaction s food may delay and reduce the amount of. History of rifampicininducing drugdrug interactions. Update on rifampin and rifabutin drug interactions the american. Rifadin rifampin dose, indications, adverse effects.
The drug interaction between warfarin and rifampin is not well known. Rifampicininducing drugdrug interactions were recorded 25 years ago, and those affected include anticoagulants, hypoglycaemia agents and contraceptives 3032. Major drug interaction using isoniazid together with rifampin can cause serious side effects that may affect your liver. History of rifampicininducing drug drug interactions. Rifampin drug interaction in a hypoalbuminemic, renal failure patient. Rifampins effect on the auc 03 h of digoxin was biphasic. Show all medications in the database that may interact with rifampin. Coadministered drug dose of drug dose of rifampin effect on drug levels effect on rifampin levels potential clinical effects mechanism of interaction management. A potential for drug interactions often exists because rifampicin is a potent inducer of hepatic drug metabolism, as evidenced by a proliferation of smooth endoplasmic reticulum and an increase in the cytochrome p450 content in the liver. Update on rifampin drug interactions, iii jama network. However, zelunka9 published the first reported interaction in a. Rifadin rifampin capsules usp and rifadin iv rifampin. Basically it causes enzymes in the body to chew up material drugs, chemicals etc. Rifampin has been reported to increase the warfarin requirements in human subjects ingesting these agents simultaneously.
Pdf update on rifampin, rifabutin, and rifapentine drug. A clinicians guide to statin drugdrug interactions. Significant pharmacokinetic interactions between drugs used to treat or prevent opportunistic infections. What you need to know about your medicine for latent. Examples of welldocumented, clinically significant interactions include warfarin, oral contraceptives, cyclosporine, glucocorticoids, ketoconazole, theophylline, quinidine, digitoxin, and verapamil. Its approved to treat all forms of tuberculosis tb caused by mycobacterium tuberculosis. View interaction reports for rifampin and the medicines listed below. Drugdrug interactions general tuberculosis tb therapy information many cardiovascular agents are metabolized via the cytocrhome p450 cyp450 enzymatic system in the liver. Rifampin is a potent inducer of the cytochrome p450 and acctounts for the many of the drug interactions that occur during tb therapy. Drugdrug interaction study with rifampin full text view. Listing a study does not mean it has been evaluated by the u. Rifampin is the generic name of the drug rifadin, an antibiotic used to treat bacterial infections. Rifampin can induce cyp3a4 and cause marked reductions in pi con.
Get emergency medical help if you have signs of an allergic reaction hives, rash, feeling lightheaded, wheezing, difficult breathing, swelling in your face or throat or a severe skin reaction fever, sore throat, burning in your eyes, skin pain, red or purple skin rash that spreads and causes blistering and peeling seek medical treatment if you have a serious drug. Update on rifampin drug interactions, iii jama internal. Rifampins acute inhibitory and chronic inductive drug. The information in the brief version is excerpted directly from the fulltext guidelines.
Rifampicininducing drug drug interactions were recorded 25 years ago, and those affected include anticoagulants, hypoglycaemia agents and contraceptives 3032. Rifamycinsdrug interactions rd is a 49 yo bm who was started on rifampin for ltbi. The administration of all medications, including rifampin, indinavir, ritonavir, and nucleoside analogues, was observed by an investigator on the days of the pharmacokinetic evaluations. This information is generalized and not intended as specific medical advice. Managing drug interactions in the treatment of hivrelated. Inh drug interactions rifampin drug interactions produced by heartland national tb center. Inpatient guideline for management of significant warfarin. Rifabutin is a weaker inducer of the cytochrome p450 system, potentially interacting with some of the same medications as rifampin. Rifamycins are moderate to potent inducers of drugs undergoing. Significant drug interactions with tuberculosis medications rifampin rifabutin.
The focus of this document is the drugdrug interaction between rifamycin antibiotics rifampin, rifabutin, and rifapentine and four classes of antiretroviral drugs. This report is the first description of this drug interaction in 20 years and highlights the need for appropriate management of phenytoin in a patient with complicated needs for pharmacotherapy. Drug interactions can be classified into two broad categories. To retrieve all information, including data published postapproval, use the all studies containing rifampin query. It is present in effective concentrations in many organs and body fluids, including cerebrospinal fluid. The clinical importance of such interactions includes autoinduction leading to suboptimal or failed treatment. Rifampin is a prescription medication used for treatment of both tuberculosis and the meningococcal carrier state. Of these, rifampin is most commonly used, either as firstline therapy in combination with other agents for treatment of mycobacterial disease including tuberculosis or for select invasive staphylococcal infections as part of combination therapy. Drugdrug interaction between rifampin and fluvastatin the safety and scientific validity of this study is the responsibility of the study sponsor and investigators.
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