Rifampin (Rifampicin) - Uses, Dose, Side effects, MOA, Brands

Rifampin (Rifampicin) is a bactericidal antibiotic that is used to treat a variety of bacterial infections. It is primarily used in the treatment of mycobacterial tuberculosis in combination with isoniazid, ethambutol, pyrazinamide, and other drugs. It is also used to treat gram-positive bacterial infections including prosthetic valve infections and infected prosthesis (septic arthritis) caused by staphylococcus aureus.

Rifampin Uses:

Meningococcal prophylaxis:
- Treatment of asymptomatic carriers of Neisseria meningitidis to kill meningococci from the nasopharynx
Tuberculosis:
- Use to treat tuberculosis in combination with other ATT agents
Off Label Use of Rifampin in Adults:
- Anaplasmosis;
- Brain abscess, empyema, and epidural abscess (MRSA);
- Brucellosis;
- Cholestatic pruritus;
- Device-related osteoarticular infection (MRSA);
- Endocarditis (prosthetic valve), treatment;
- Haemophilus influenzae type B, chemoprophylaxis;
- Leprosy;
- Meningitis, bacterial (adjunct therapy);
- Nasal decolonization of S. aureus;
- Nontuberculous mycobacterial disease, pulmonary;
- Osteomyelitis (MRSA);
- Prosthetic joint infection;
- Septic thrombosis of the cavernous or dural venous sinus (MRSA);
- Streptococcus (group A) chronic carriage

Rifampin (Rifampicin) Dose in Adults

Rifampin (Rifampicin) Dose in the prophylaxis of Meningococcal infection:

Oral, IV: 600 mg two times per day for 2 days

Rifampin (Rifampicin) Dose in the treatment of active drug-susceptible tuberculosis: Oral, IV:

Note: Always administer in combination with other antitubercular drugs.

Dosing:
- Manufacturer's labeling:
  - 10 mg/kg/day one time per day (maximum: 600 mg/day)
- Alternate recommendations: ATS/CDC/IDSA Drug-susceptible tuberculosis guideline recommendations:
  - Once-daily therapy: 10 mg/kg/day once daily (usual dose: 600 mg).

Note: The preferred frequency of administration is one time per day during the intensive and continuation phases; however, 5-days-per-week administration by directly observed therapy (DOT) is an acceptable alternative.

Twice-weekly or three-times-weekly DOT:

10 mg/kg/dose (usual dose: 600 mg) administered 2 or 3 times weekly.

Regimens:

Treatment regimens for pulmonary tuberculosis and tuberculous meningitis consist of an initial 2-month phase of a 4-drug regimen, followed by a continuation phase of an additional 4 to 7 months of rifampin and isoniazid for pulmonary tuberculosis and a continuation phase of an additional 7 to 10 months of rifampin and isoniazid for tuberculous meningitis (optimal duration is not defined although continuation phase must continue for a minimum of 7 additional months).
If the isoniazid resistance rate is <4%, an initial treatment regimen with less than 4 drugs may be considered.
Readdress the need for a fourth drug when susceptibility results are available.
Adjunctive corticosteroid therapy (eg, dexamethasone, prednisolone) tapered over 6 to 8 weeks is also recommended for tuberculous meningitis.
Its dosage adjustment depends on the treatment regimen selected; consult current drug-sensitive TB guidelines.

Rifampin (Rifampicin) Dose in the treatment of latent tuberculosis infection (LTBI):

As an alternative to isoniazid:
- Oral, IV: 10 mg/kg/day (maximum: 600 mg/day) for 4 months.

Note: Combination with pyrazinamide is not recommended.

Rifampin (Rifampicin) Dose in the treatment of Anaplasmosis, mild cases (patients with a severe allergy to doxycycline) (off-label):

Oral: 300 mg two times per day for 7 to 10 days.

Note:

Rifampin is not an effective agent for Rocky Mountain spotted fever (RMSF);
Ensure that RMSF has been ruled out before use.
Rifampin is also not effective for Lyme disease; if co-infection with B. burgdorferi is suspected, treat with other antimicrobial agents.

Rifampin (Rifampicin) Dose in the treatment of brain abscess, empyema, and epidural abscess (MRSA) (off-label):

Oral, IV: 600 mg once daily or 300 to 450 mg twice daily along with vancomycin for 4 to 6 weeks.

Rifampin Dose in the treatment of Brucellosis (off-label):

Oral: 600 to 900 mg once per day for 6 weeks;
Use in combination with doxycycline. Additional data may be necessary to further define the role of rifampin in this condition.

Rifampin (Rifampicin) Dose in the treatment of Cholestatic pruritus (off-label): Oral:

Dose based on bilirubin value:
- Bilirubin <3 mg/dL:
  - 150 mg daily
- Bilirubin ≥3 mg/dL:
  - 150 mg twice daily

Rifampin (Rifampicin) Dose in the treatment of Device-related osteoarticular infection (MRSA) (off-label):

Oral: 600 mg once daily or 300 to 450 mg twice daily in combination with other anti-staphylococcal antibiotics.

Rifampin (Rifampicin) Dose in the treatment of prosthetic valve endocarditis (off-label): Oral, IV:

MRSA:
- 300 mg every 8 hours for at least 6 weeks (combine with vancomycin for the entire duration of therapy and gentamicin for the first 2 weeks).
MSSA:
- 300 mg every 8 hours for at least 6 weeks (combine with nafcillin or oxacillin till the end of therapy and gentamicin for the first 2 weeks).

Rifampin (Rifampicin) Dose in the chemoprophylaxis of H. influenzae type B infection (off-label):

Oral: 600 mg once per day for 4 days.

Rifampin (Rifampicin) Dose in patients with Leprosy (off-label): Oral:

Lepromatous (multibacillary):
- National Hansen Disease Program:
  - 600 mg once per day for 24 months in combination with clofazimine and dapsone.
- World Health Organization:
  - 600 mg once every month for one year in combination with clofazimine and dapsone.
Tuberculoid (paucibacillary):
- National Hansen Disease Program:
  - 600 mg once daily for 12 months in combination with dapsone.
- World Health Organization:
  - 600 mg once monthly for 6 months in combination with dapsone.

Rifampin (Rifampicin) Dose in the treatment of Bacterial Meningitis (adjunct therapy) (off-label):

Pathogen-specific therapy (eg, staphylococci [in patients with prosthetic material], S. pneumoniae [when MIC to ceftriaxone is >2 mcg/mL]):
- Oral, IV: 600 mg once daily;
- Use in combination with other antimicrobials.

Rifampin (Rifampicin) Dose in the treatment of Nasal decolonization of Staphylococcus aureus (off-label):

Oral, IV: 600 mg/day for 5 to 10 days;
Note:
- Must use in combination with at least one other systemic anti-staphylococcal antibiotic.
- Not recommended as a first-line drug for decolonization;
- The evidence is weak for use in patients with recurrent infections.

Rifampin (Rifampicin) Dose in the treatment of Nontuberculous Pulmonary mycobacterial Disease (off-label): Oral, IV:

Mycobacterium avium complex (nodular or bronchiectatic disease):
- 600 mg 3 times weekly in combination with a 3-times-weekly regimen of a macrolide (azithromycin or clarithromycin) and ethambutol;
- Continue treatment until the patient is culture-negative on therapy for 1 year.
Mycobacterium avium complex (severe nodular, bronchiectatic, or cavitary lung disease):
- 600 mg (450 mg in patients weighing <50 kg) once daily in combination with a daily macrolide (azithromycin or clarithromycin) and ethambutol therapy;
- Continue treatment until the patient is culture-negative on therapy for 1 year.
- May also consider the addition of 3 times weekly amikacin or streptomycin early in therapy.
Mycobacterium avium complex (cystic fibrosis patients):
- <50 kg:
  - 450 mg once daily in combination with a daily macrolide (azithromycin [preferred] or clarithromycin) and ethambutol therapy
- >50 kg:
  - 600 mg once daily in combination with a daily macrolide (azithromycin [preferred] or clarithromycin) and ethambutol therapy
Mycobacterium kansasii infection:
- 600 mg once daily in combination with daily ethambutol and isoniazid therapy;
- continue treatment until the patient is culture-negative on therapy for 1 year.

Rifampin (Rifampicin) Dose in the treatment of Osteomyelitis (MRSA) (off-label):

Oral, IV: 600 mg once daily or 300 to 450 mg two times per day for at least 8 weeks in addition to trimethoprim/sulfamethoxazole, linezolid, or clindamycin.

Rifampin (Rifampicin) Dose in the treatment of Prosthetic joint infection (off-label): Staphylococci (oxacillin-susceptible or oxacillin-resistant): Oral:

Acute treatment following debridement and prosthesis retention or following 1-stage exchange:
- 300 to 450 mg every 12 hours in combination with IV anti-staphylococcal antibiotics for 2 to 6 weeks.
Chronic Treatment following debridement and prosthesis retention or following 1-stage exchange:
- Total ankle, elbow, hip, or shoulder arthroplasty:
  - 300 to 450 mg every 12 hours in combination with an oral anti-staphylococcal antibiotic for 3 months.
- Total knee arthroplasty:
  - 300 to 450 mg every 12 hours in combination with an oral anti-staphylococcal antibiotic for 6 months.

Rifampin (Rifampicin) Dose in the treatment of Septic thrombosis of cavernous or dural venous sinus (MRSA) (off-label):

Oral, IV: 600 mg once per day or 300 to 450 mg two times per day with concomitant vancomycin for 4 to 6 weeks.

Rifampin (Rifampicin) Dose in the treatment of Streptococcus (group A) chronic carriage (off-label):

Note: Most individuals with chronic carriage do not require antibiotics:

When combined with oral penicillin V:
- Oral: 600 mg once daily for the last 4 days of treatment.
When combined with single dose IM penicillin G benzathine:
- Oral: 300 mg two times per day for 4 days.

Rifampin (Rifampicin) Dose in Childrens

Note:

Rifampin monotherapy is rarely indicated; most indications require combination therapy with other antimicrobial agent.
Recommendations often change due to epidemiology (resistance) and emerging information; consult CDC and WHO for current recommendations, as appropriate.

Rifampin (Rifampicin) Dose in the treatment of active drug-susceptible tuberculosis infection (excluding meningitis):

Note:

Always use as part of a multidrug regimen.
Any regimens using less than once-daily dosing should administer dosing as directly observed therapy (DOT).
Treatment regimens for pulmonary tuberculosis consist of an initial 2-month intensive phase of a 4-drug regimen, later on, continuation with isoniazid and rifampin for 4-7 months.
Rifampin frequency and dosing differ depending on the treatment regimen selected; consult current drug-sensitive TB guidelines for detailed information.
ATS/CDC/IDSA Recommendations::

Note:

For HIV-exposed/positive, refer to specific guidelines for guidance on drug interaction management with antiretroviral therapy.
- Once-daily or 5-times-a-week (DOT):
  - Infants, Children, and Adolescents <15 years, weighing ≤40 kg:
    - Oral, IV: 10 to 20 mg/kg/dose once per day,maximum dose: 600 mg/dose
  - Children and Adolescents <15 years weighing >40 kg or Adolescents ≥15 years:
    - Oral, IV: 10 mg/kg/dose once per day(typical dose: 600 mg)
- Three-times-weekly DOT:

Note:

Although suggested dosing based on experience with twice-weekly regimen;
experts suggest three-times-weekly regimens are more effective than twice-weekly DOT regimens; three-times-weekly DOT may be used as part of an intensive phase and/or continuation phase dosing regimen; consult guidelines for specific information
- Infants, Children, and Adolescents <15 years, weighing ≤40 kg:
  - Oral, IV: 10 to 20 mg/kg/dose 3-times-weekly;
  - maximum dose: 600 mg/dose
- Children and Adolescents <15 years weighing >40 kg or Adolescents ≥15 years:
  - Oral, IV: 10 mg/kg/dose 3-times-weekly (typical dose: 600 mg)
- Twice-weekly DOT:

Note:

Regimen not generally recommended;
Do not use in HIV patients or those with smear-positive and/or cavitary disease.
This therapy should only be used following completion of a 2-week intensive phase once-daily (or 5-times a week) regimen.
Missed doses result in the equivalent of once-weekly dosing it causes drug resistance, treatment failure and relapse.
Infants, Children, and Adolescents <15 years, weighing ≤40 kg:
- Oral, IV: 10 to 20 mg/kg/dose twice weekly;
- maximum dose: 600 mg/dose
Children and Adolescents <15 years weighing >40 kg or Adolescents ≥15 years:
- Oral, IV: 10 mg/kg/dose twice weekly (typical dose: 600 mg)

Rifampin (Rifampicin) Dose in the treatment of Latent tuberculosis infection (LTBI):

Note: May be considered for those unable to tolerate isoniazid or if isoniazid-resistance is suspected.

Non-HIV-exposed/-positive:
- Infants, Children, and Adolescents:
  - Oral: 15 to 20 mg/kg/dose once daily;
  - The maximum dose: 600 mg/dose;
  - Use in combination with isoniazid for 3 to 4 months or as monotherapy for 4 months.

Note:

Lower doses of 10 mg/kg/day have been described; however, pharmacokinetic studies suggest that lower doses of rifampin do not meet the criteria.
HIV-exposed/-positive:

Note: Not appropriate for all HIV patients due to drug-drug interactions with some antiretrovirals; refer to specific guidelines for guidance on drug interaction management with antiretroviral therapy (see Drug-Drug Interactions)

Infants and Children:
- Oral: 10 to 20 mg/kg/dose once daily;
- The maximum dose: 600 mg/dose;
- Use in combination with isoniazid for 3 to 4 months or as monotherapy for 4 to 6 months.
- Continue therapy for 6 months if the exposure to an isoniazid mono-resistant source case.

Note: Pharmacokinetic studies suggest that lower doses of rifampin do not provide adequate drug exposure.

Adolescents: Oral: 600 mg once per day for 4 months.

Rifampin (Rifampicin) Dose in the treatment of exit-site or tunnel infection of peritoneal dialysis catheter:

Infants, Children, and Adolescents:
- Oral: 10 to 20 mg/kg/day divided into 2 doses.
- Maximum dose: 600 mg/dose.

Note: It is not effective as monotherapy or its routinely use in areas where TB is endemic.

Rifampin (Rifampicin) Dose in the treatment of Endocarditis:

Empiric therapy for prosthetic valve/material:
Note: Use in combination with other antibiotics:
- Early infection (≤1-year postop)/ nosocomial infection associated with cannulation:
  - Children and Adolescents:
    - Oral, IV: 20 mg/kg/day divided every 8 hours;
    - The maximum daily dose: 900 mg/day
- Late infection (>1-year postop):
  - Children and Adolescents:
    - Oral, IV: 15 to 20 mg/kg/day divided every 12 hours;
    - The maximum daily dose: 600 mg/day

Rifampin (Rifampicin) Dose in the treatment of prosthetic valve MRSA infection:

Infants, Children, and Adolescents:
- Oral, IV: 15 mg/kg/day divided every 8 hours;
- The maximum daily dose: 900 mg/day.

Rifampin (Rifampicin) Dose in the prophylaxis of H. influenzae infection:

Infants, Children, and Adolescents:
- Oral: 20 mg/kg/day once daily for 4 days, not to exceed 600 mg/dose.

Rifampin (Rifampicin) Dose in the prophylaxis of Meningococcal infection:

Infants, Children, and Adolescents:
- Oral: 20 mg/kg/day in divided doses every 12 hours for 2 days, not to exceed 600 mg/dose

Rifampin (Rifampicin) Dose in the treatment of Peritonitis (peritoneal dialysis):

Infants, Children, and Adolescents:
- Oral: 10 to 20 mg/kg/day divided into 2 doses;
- The maximum dose: 600 mg/dose.

Rifampin (Rifampicin) Dose in the treatment of Pharyngeal chronic carriers of group A streptococci:

Children and Adolescents:
- Oral: 20 mg/kg/day once daily for the last 4 days of treatment when combined with oral penicillin V or 20 mg/kg/day in 2 divided doses for 4 days when combined with intramuscular benzathine penicillin G;
- maximum daily dose: 600 mg/day.

Rifampin (Rifampicin) Dose in the treatment of Staphylococcus aureus, nasal carriers:

Children and Adolescents:
- Oral, IV: 15 mg/kg/day divided every 12 hours for 5 to 10 days;
- Note:
  - Must use in combination with at least one other systemic antistaphylococcal antibiotic.
  - Maximum daily dose: 600 mg/day.
  - Not recommended as a first-line drug for decolonization; no data is provided for its use in patients with recurrent infections.

Rifampin (Rifampicin) Pregnancy Risk Category: C

Rifampin crosses the placental barrier.
The mother and infant have experienced postnatal hemorhages after the administration of anticoagulants in the last few weeks.
If the likelihood of developing tuberculosis in the mother is high or moderate, it is recommended that she receive maternal treatment.
Rifampin could be used in pregnancy to treat mild human anaplasmosis, also known as human granulocytic aplasmosis [HGA]); small-scale case reports have demonstrated positive maternal and pregnancies in rifampin treated pregnant women.

Rifampin use during breastfeeding:

Breast milk contains rifampin.
The manufacturer suggests that you decide whether to stop breastfeeding or discontinue using the drug until there are no more adverse reactions.
Rifampin can be used to treat drug-susceptible tuberculosis. It is safe to breastfeed in cases where the first-line agent (ie, Ritamin) has been administered.
Breastfeeding infants with tuberculosis is not possible if there is too much drug in their breast milk.

Dose in Kidney Disease:

No dosage adjustment necessary.

Hemodialysis: No dosage adjustment necessary; administer after hemodialysis on dialysis days.

Dose in Liver disease:

There are no dosage adjustments provided in manufacturer's labeling; but should use with caution.

Side effects of Rifampin (Rifampicin):

Cardiovascular:
- Decreased Blood Pressure
- Flushing
- Shock
- Vasculitis
Central Nervous System:
- Ataxia
- Behavioral Changes
- Confusion
- Dizziness
- Drowsiness
- Fatigue
- Headache
- Lack Of Concentration
- Myasthenia
- Numbness
- Peripheral Pain
- Sore Mouth
Dermatologic:
- Erythema Multiforme
- Pemphigoid Reaction
- Pruritus
- Skin Rash
- Urticaria
Endocrine & Metabolic:
- Adrenocortical Insufficiency
- Menstrual Disease
Gastrointestinal:
- Abdominal Cramps
- Anorexia
- Diarrhea
- Epigastric Distress
- Flatulence
- Glossalgia
- Heartburn
- Nausea
- Staining Of Tooth
- Vomiting
Genitourinary:
- Hemoglobinuria
- Hematuria
Hematologic & Oncologic:
- Decreased Hemoglobin
- Disorder Of Hemostatic Components Of Blood (Vitamin K-Dependent)
- Disseminated Intravascular Coagulation
- Eosinophilia
- Hemolysis
- Hemolytic Anemia
- Hemorrhage
- Leukopenia
- Thrombocytopenia (Especially With High-Dose Therapy)
Hepatic:
- Abnormal Hepatic Function Tests
- Hepatic Insufficiency
- Hyperbilirubinemia
- Jaundice
Hypersensitivity:
- Hypersensitivity Reaction
Neuromuscular & Skeletal:
- Myopathy
Ophthalmic:
- Conjunctivitis
- Visual Disturbance
Renal:
- Acute Renal Failure
- Interstitial Nephritis
- Renal Insufficiency
- Renal Tubular Necrosis
Respiratory:
- Dyspnea
- Flu-Like Symptoms
- Wheezing
Miscellaneous:
- Fever

Contraindications to Rifampin (Rifampicin):

Allergy or sensitivity to rifampin or any component thereof
concurrent use of atazanavir, darunavir, fosamprenavir, praziquantel, ritonavir/saquinavir, saquinavir, or tipranavir.

Canadian labeling: Additional contraindications not in US labeling

Reduced bilirubin excretion can cause jaundice
Infants born prematurely or as newborns
Breastfeeding women
Hepatic impairment.

Warnings and precautions

Coagulopathy
- May cause bleeding disorders.
- Patients at high risk for vitamin K deficiency should have monitor coagulation tests performed during treatment.
- If abnormal bleeding or coagulation tests are performed, discontinue treatment. Consider supplement vitamin K administration if necessary.
Cholestasis:
- Reports of mild to severe cholestasis were made; stop taking any medication if you are confirmed to have it.
Dermatologic reactions
- There have been cases of severe cutaneous adverse reactions, such as Stevens Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), acute exanthematous pustulsis (AGEP), and drug reactions with eosinophilia or systemic symptoms syndrome (DRESS) syndrome.
- Stop receiving therapy if you experience symptoms or signs of SCAR.
Flu-like syndrome:
- Adults who consume >600mg once or twice weekly have reported a high rate of adverse reactions, including flu-like symptoms.
Hematologic effects
- Adults who take >600 mg twice or more weekly may experience thrombocytopenia or leukopenia.
Hepatotoxicity:
- Liver dysfunction may occur in those with hepatic diseases who have taken rifampin along with other hepatotoxic drugs.
- If liver function is impaired, discontinue use immediately.
Hyperbilirubinemia:
- As a result of the competition between rifampin (bilirubin) and bilirubin in excretory pathways, hyperbilirubinemia can occur in therapy early.
- If hyperbilirubinemia is accompanied by clinical symptoms or signs of severe hepatic dysfunction, discontinue treatment.
Hypersensitivity
- Reports of hypersensitivity reactions include rash, fever, angioedema and hypotension.
- Monitoring patients for hypersensitivity signs/symptoms is important. If symptoms (eg. fever, lymphadenopathy or liver abnormalities), are present, discontinue treatment.
Superinfection
- Extended use can lead to fungal and bacterial superinfections, including Clostridium.
- CDAD and pseudomembranous Colitis can occur. CDAD was observed for >2 months after antibiotic treatment.
Alcoholism
- Patients with a history or alcoholism should be cautious (even if they stop drinking ethanol during therapy).
Diabetes mellitus:
- Patients with diabetes mellitus should be cautious. Diabetes management is more difficult for patients who take rifampin.
Hepatic impairment
- Patients with liver dysfunction should be treated with caution and closely monitored.
Meningococcal Disease:
- You should not use it for meningococcal diseases, but only for the short-term treatment of symptomatic carriers.
Porphyria
- Patients with porphyria should be cautious; exacerbations have been reported because of enzyme-inducing properties.

Rifampin (rifampicin): Drug Interaction

Risk Factor C (Monitor therapy)
Apalutamide	CYP3A4 Inducers (Strong) may decrease the serum concentration of Apalutamide.
Ataluren	RifAMPin may decrease the serum concentration of Ataluren.
Barbiturates	Rifamycin Derivatives may increase the metabolism of Barbiturates.
Bazedoxifene	RifAMPin may decrease the serum concentration of Bazedoxifene. This may lead to loss of efficacy or, if bazedoxifene is combined with estrogen therapy, an increased risk of endometrial hyperplasia.
BCG Vaccine (Immunization)	Antibiotics may diminish the therapeutic effect of BCG Vaccine (Immunization).
Benperidol	CYP3A4 Inducers (Strong) may decrease the serum concentration of Benperidol.
Benzhydrocodone	CYP3A4 Inducers (Strong) may decrease the serum concentration of Benzhydrocodone. Specifically, the serum concentrations of hydrocodone may be reduced.
Beta-Blockers	Rifamycin Derivatives may decrease the serum concentration of Beta-Blockers. Exceptions: Atenolol; Carteolol (Ophthalmic); Levobunolol; Metipranolol; Nadolol.
Bosentan	RifAMPin may decrease the serum concentration of Bosentan. Following the initial several weeks of concurrent rifampin, this effect is most likely. RifAMPin may increase the serum concentration of Bosentan. This effect is most likely to be observed within the initial few weeks of concurrent therapy (and may be greatest immediately following initiation of the combination). Management: Weekly monitoring of liver function tests during the first 4 weeks of concurrent therapy is recommended, with a return to normal recommended monitoring thereafter as appropriate.
Brentuximab Vedotin	CYP3A4 Inducers (Strong) may decrease the serum concentration of Brentuximab Vedotin. Specifically, concentrations of the active monomethyl auristatin E (MMAE) component may be decreased.
Brentuximab Vedotin	P-glycoprotein/ABCB1 Inducers may decrease the serum concentration of Brentuximab Vedotin. Specifically, concentrations of the active monomethyl auristatin E (MMAE) component may be decreased.
Buprenorphine	CYP3A4 Inducers (Strong) may decrease the serum concentration of Buprenorphine.
Calcifediol	CYP3A4 Inducers (Strong) may decrease the serum concentration of Calcifediol.
Cannabidiol	CYP3A4 Inducers (Strong) may decrease the serum concentration of Cannabidiol.
Cannabidiol	CYP2C19 Inducers (Strong) may decrease the serum concentration of Cannabidiol.
Cannabis	CYP3A4 Inducers (Strong) may decrease the serum concentration of Cannabis. More specifically, tetrahydrocannabinol and cannabidiol serum concentrations may be decreased.
CarBAMazepine	CYP3A4 Inducers (Strong) may decrease the serum concentration of CarBAMazepine.
Celiprolol	P-glycoprotein/ABCB1 Inducers may decrease the serum concentration of Celiprolol.
Citalopram	RifAMPin may decrease the serum concentration of Citalopram.
Cladribine	BCRP/ABCG2 Inducers may decrease the serum concentration of Cladribine.
Cladribine	P-glycoprotein/ABCB1 Inducers may decrease the serum concentration of Cladribine.
Clopidogrel	CYP2C19 Inducers (Strong) may increase serum concentrations of the active metabolite(s) of Clopidogrel.
Codeine	CYP3A4 Inducers (Strong) may decrease serum concentrations of the active metabolite(s) of Codeine.
Corticosteroids (Systemic)	CYP3A4 Inducers (Strong) may decrease the serum concentration of Corticosteroids (Systemic). Exceptions: Hydrocortisone (Systemic); PrednisoLONE (Systemic); PredniSONE.
CYP2B6 Substrates (High risk with Inducers)	CYP2B6 Inducers (Moderate) may decrease the serum concentration of CYP2B6 Substrates (High risk with Inducers).
CYP2C9 Substrates (High risk with Inducers)	CYP2C9 Inducers (Moderate) may decrease the serum concentration of CYP2C9 Substrates (High risk with Inducers).
Dabrafenib	CYP3A4 Inducers (Strong) may decrease the serum concentration of Dabrafenib.
Diclofenac (Systemic)	CYP2C9 Inducers (Moderate) may decrease the serum concentration of Diclofenac (Systemic).
Diethylstilbestrol	CYP3A4 Inducers (Strong) may decrease the serum concentration of Diethylstilbestrol.
Disopyramide	RifAMPin may decrease the serum concentration of Disopyramide.
Doxercalciferol	CYP3A4 Inducers (Strong) may increase serum concentrations of the active metabolite(s) of Doxercalciferol.
Doxycycline	RifAMPin may decrease the serum concentration of Doxycycline.
Dronabinol	CYP3A4 Inducers (Strong) may decrease the serum concentration of Dronabinol.
Efavirenz	RifAMPin may decrease the serum concentration of Efavirenz.
Eltrombopag	May increase the serum concentration of OATP1B1/1B3 (SLCO1B1/1B3) Substrates.
Estriol (Systemic)	CYP3A4 Inducers (Strong) may decrease the serum concentration of Estriol (Systemic).
Estriol (Topical)	CYP3A4 Inducers (Strong) may decrease the serum concentration of Estriol (Topical).
Evogliptin	CYP3A4 Inducers (Strong) may decrease the serum concentration of Evogliptin.
FentaNYL	CYP3A4 Inducers (Strong) may decrease the serum concentration of FentaNYL.
Fexofenadine	RifAMPin may decrease the serum concentration of Fexofenadine. RifAMPin may increase the serum concentration of Fexofenadine.
Gemfibrozil	May increase the serum concentration of OATP1B1/1B3 (SLCO1B1/1B3) Substrates. See separate drug interaction monographs for agents listed as exceptions.
Gestrinone	RifAMPin may decrease the serum concentration of Gestrinone.
HYDROcodone	CYP3A4 Inducers (Strong) may decrease the serum concentration of HYDROcodone.
Hydrocortisone (Systemic)	CYP3A4 Inducers (Strong) may decrease the serum concentration of Hydrocortisone (Systemic).
Ifosfamide	CYP3A4 Inducers (Strong) may decrease serum concentrations of the active metabolite(s) of Ifosfamide. CYP3A4 Inducers (Strong) may increase serum concentrations of the active metabolite(s) of Ifosfamide.
Isoniazid	Rifamycin Derivatives may enhance the hepatotoxic effect of Isoniazid. Even so, this is a frequently employed combination regimen.
Lactobacillus and Estriol	Antibiotics may diminish the therapeutic effect of Lactobacillus and Estriol.
LamoTRIgine	RifAMPin may increase the metabolism of LamoTRIgine.
Leflunomide	RifAMPin may increase serum concentrations of the active metabolite(s) of Leflunomide.
Lesinurad	CYP2C9 Inducers (Moderate) may decrease the serum concentration of Lesinurad.
Levomethadone	RifAMPin may decrease the serum concentration of Levomethadone.
Lornoxicam	CYP2C9 Inducers (Moderate) may decrease the serum concentration of Lornoxicam.
Losartan	RifAMPin may decrease the serum concentration of Losartan.
Lumacaftor	May decrease the serum concentration of P-glycoprotein/ABCB1 Substrates. Lumacaftor may increase the serum concentration of P-glycoprotein/ABCB1 Substrates.
Mirabegron	RifAMPin may decrease the serum concentration of Mirabegron.
Morphine (Systemic)	RifAMPin may decrease the serum concentration of Morphine (Systemic).
Nalmefene	RifAMPin may decrease the serum concentration of Nalmefene.
OLANZapine	RifAMPin may decrease the serum concentration of OLANZapine.
Oxcarbazepine	RifAMPin may decrease serum concentrations of the active metabolite(s) of OXcarbazepine. Specifically, concentrations of the major active 10-monohydroxy metabolite may be reduced.
OxyCODONE	RifAMPin may decrease the serum concentration of OxyCODONE.
P-glycoprotein/ABCB1 Inducers	May decrease the serum concentration of Pglycoprotein/ABCB1 Substrates. P-glycoprotein inducers may also further limit the distribution of p-glycoprotein substrates to specific cells/tissues/organs where p-glycoprotein is present in large amounts (e.g., brain, T-lymphocytes, testes, etc.).
P-glycoprotein/ABCB1 Inhibitors	May increase the serum concentration of Pglycoprotein/ABCB1 Substrates. P-glycoprotein inhibitors may also enhance the distribution of pglycoprotein substrates to specific cells/tissues/organs where p-glycoprotein is present in large amounts (e.g., brain, T-lymphocytes, testes, etc.).
P-glycoprotein/ABCB1 Substrates	P-glycoprotein/ABCB1 Inducers may decrease the serum concentration of P-glycoprotein/ABCB1 Substrates. P-glycoprotein inducers may also further limit the distribution of p-glycoprotein substrates to specific cells/tissues/organs where p-glycoprotein is present in large amounts (e.g., brain, T-lymphocytes, testes, etc.). Exceptions: Betrixaban; Edoxaban.
Polatuzumab Vedotin	CYP3A4 Inducers (Strong) may decrease the serum concentration of Polatuzumab Vedotin. Exposure to unconjugated MMAE, the cytotoxic small molecule component of polatuzumab vedotin, may be decreased.
Prasugrel	RifAMPin may diminish the antiplatelet effect of Prasugrel.
Pravastatin	RifAMPin may decrease the serum concentration of Pravastatin.
PrednisoLONE (Systemic)	CYP3A4 Inducers (Strong) may decrease the serum concentration of PrednisoLONE (Systemic).
PredniSONE	CYP3A4 Inducers (Strong) may decrease the serum concentration of PredniSONE.
Propacetamol	RifAMPin may increase the metabolism of Propacetamol. . This may 1) diminish the desired effects of propacetamol; and 2) increase the risk of liver damage.
Propafenone	CYP3A4 Inducers (Strong) may decrease the serum concentration of Propafenone.
Ramelteon	CYP3A4 Inducers (Strong) may decrease the serum concentration of Ramelteon.
Reboxetine	CYP3A4 Inducers (Strong) may decrease the serum concentration of Reboxetine.
Rosuvastatin	RifAMPin may decrease the serum concentration of Rosuvastatin.
Ruxolitinib	CYP3A4 Inducers (Strong) may decrease the serum concentration of Ruxolitinib.
SAXagliptin	CYP3A4 Inducers (Strong) may decrease the serum concentration of SAXagliptin.
Sertraline	CYP3A4 Inducers (Strong) may decrease the serum concentration of Sertraline.
SUFentanil	CYP3A4 Inducers (Strong) may decrease the serum concentration of SUFentanil.
Sulfamethoxazole	RifAMPin may decrease the serum concentration of Sulfamethoxazole.
Terbinafine (Systemic)	RifAMPin may decrease the serum concentration of Terbinafine (Systemic).
Teriflunomide	May increase the serum concentration of OATP1B1/1B3 (SLCO1B1/1B3) Substrates.
Tetrahydrocannabinol	CYP3A4 Inducers (Strong) may decrease the serum concentration of Tetrahydrocannabinol.
Tetrahydrocannabinol and Cannabidiol	CYP3A4 Inducers (Strong) may decrease the serum concentration of Tetrahydrocannabinol and Cannabidiol.
Thyroid Products	RifAMPin may decrease the serum concentration of Thyroid Products.
TraMADol	CYP3A4 Inducers (Strong) may decrease the serum concentration of TraMADol.
Treprostinil	RifAMPin may decrease the serum concentration of Treprostinil.
Trimethoprim	RifAMPin may decrease the serum concentration of Trimethoprim.
Tropisetron	CYP3A4 Inducers (Strong) may decrease the serum concentration of Tropisetron.
Udenafil	CYP3A4 Inducers (Strong) may decrease the serum concentration of Udenafil.
Vitamin K Antagonists (eg, warfarin)	Rifamycin Derivatives may increase the metabolism of Vitamin K Antagonists.
Zidovudine	Rifamycin Derivatives may decrease the serum concentration of Zidovudine.
Zuclopenthixol	CYP3A4 Inducers (Strong) may decrease the serum concentration of Zuclopenthixol.
Risk Factor D (Consider therapy modification)
Abiraterone Acetate	CYP3A4 Inducers (Strong) may decrease the serum concentration of Abiraterone Acetate. Management: Avoid whenever possible. If such a combination cannot be avoided, increase abiraterone acetate dosing frequency from once daily to twice daily during concomitant use.
Acalabrutinib	CYP3A4 Inducers (Strong) may decrease the serum concentration of Acalabrutinib. Management: Avoid co-administration of strong CYP3A inducers in patients taking acalabrutinib. If strong CYP3A inducers cannot be avoided, increase the dose of acalabrutinib to 200 mg twice daily.
Afatinib	P-glycoprotein/ABCB1 Inducers may decrease the serum concentration of Afatinib. Management: Per US labeling: if requiring chronic use of P-gp inducers, increase afatinib dose by 10mg as tolerated; reduce to original afatinib dose 2-3 days after stopping P-gp inducers. Per Canadian labeling: avoid combination if possible.
Alfentanil	Rifamycin Derivatives may decrease the serum concentration of Alfentanil. Management: Monitor closely for decreased alfentanil effectiveness. Increased alfentanil doses will likely be needed. Alternatively, changing from alfentanil to a different opioid anesthetic (e.g., sufentanil) may also be considered.
Amiodarone	RifAMPin may decrease serum concentrations of the active metabolite(s) of Amiodarone. Specifically, desethylamiodarone concentrations may decrease. RifAMPin may decrease the serum concentration of Amiodarone. Management: Seek alternatives. When used together, monitor closely for decreased amiodarone concentrations/effects. Dose adjustment may be needed.
Antifungal Agents (Azole Derivatives, Systemic)	May increase the serum concentration of Rifamycin Derivatives. Only rifabutin appears to be affected. Rifamycin Derivatives may decrease the serum concentration of Antifungal Agents (Azole Derivatives, Systemic). Management: Avoid these combinations when possible. Voriconazole and isavuconazonium are considered contraindicated.
ARIPiprazole	CYP3A4 Inducers (Strong) may decrease the serum concentration of ARIPiprazole. Management: Double the oral aripiprazole dose and closely monitor. Reduce oral aripiprazole dose to 10-15 mg/day (for adults) if the inducer is discontinued. Avoid use of strong CYP3A4 inducers for more than 14 days with extended-release injectable aripiprazole.
ARIPiprazole Lauroxil	CYP3A4 Inducers (Strong) may decrease serum concentrations of the active metabolite(s) of ARIPiprazole Lauroxil. Management: Patients taking the 441 mg dose of aripiprazole lauroxil increase their dose to 662 mg if used with a strong CYP3A4 inducer for more than 14 days. No dose adjustment is necessary for patients using the higher doses of aripiprazole lauroxil.
Avatrombopag	RifAMPin may decrease the serum concentration of Avatrombopag. Management: Management of this interaction varies based on avatrombopag indication. Dose adjustments are required for patients using avatrombopag for chronic immune thrombocytopenia. See monograph for details.
Brexpiprazole	CYP3A4 Inducers (Strong) may decrease the serum concentration of Brexpiprazole. Management: If brexpiprazole is used together with a strong CYP3A4 inducer, the brexpiprazole dose should gradually be doubled over the course of 1 to 2 weeks.
Brivaracetam	RifAMPin may decrease the serum concentration of Brivaracetam. Management: Increase the brivaracetam dose by up to 100% (ie, double the dose) if used together with rifampin.
BusPIRone	CYP3A4 Inducers (Strong) may decrease the serum concentration of BusPIRone. Management: Consider alternatives to this combination. If coadministration of these agents is deemed necessary, monitor patients for reduced buspirone effects and increase buspirone doses as needed.
Cabozantinib	CYP3A4 Inducers (Strong) may decrease the serum concentration of Cabozantinib. Management: Avoid use of strong CYP3A4 inducers with cabozantinib if possible. If combined, cabozantinib dose adjustments are recommended and vary based on the cabozantinib product used and the indication for use. See monograph for details.
Calcium Channel Blockers	Rifamycin Derivatives may decrease the serum concentration of Calcium Channel Blockers. This primarily affects oral forms of calcium channel blockers. Management: The labeling for some US and Canadian calcium channel blockers contraindicate use with rifampin, however recommendations vary. Consult appropriate labeling. Exceptions: Clevidipine.
Canagliflozin	RifAMPin may decrease the serum concentration of Canagliflozin. Management: Consider increasing canagliflozin dose to 300 mg/day in patients with estimated GFR >60 mL/min/1.73 m2 who tolerate canagliflozin 100 mg/day and require greater glycemic control. Consider alternatives in patients with estimated GFR 45-60 mL/min/1.73 m2.
Caspofungin	RifAMPin may decrease the serum concentration of Caspofungin. Management: Caspofungin prescribing information recommends using a dose of 70 mg daily in adults (or 70 mg/m , up to a maximum of 70 mg, daily in pediatric patients) who are also receiving rifampin. 2
CeFAZolin	May enhance the adverse/toxic effect of RifAMPin. Specifically, the risk for bleeding may be increased. Management: Avoid concomitant use of rifampin with cefazolin when possible. If combined, closely monitor prothrombin time or other coagulation tests and administer vitamin K as needed.
Cephalosporins (N-methylthiotetrazole [NMTT] Side Chain Containing)	May enhance the adverse/toxic effect of RifAMPin. Specifically, the risk for bleeding may be increased. Management: Avoid concomitant use of rifampin with cephalosporins that contain an Nmethylthiotetrazole (NMTT) side chain when possible. If combined, closely monitor prothrombin time or other coagulation tests and administer vitamin K as needed.
Chloramphenicol (Systemic)	RifAMPin may increase the metabolism of Chloramphenicol (Systemic).
Clarithromycin	CYP3A4 Inducers (Strong) may increase serum concentrations of the active metabolite(s) of Clarithromycin. Clarithromycin may increase the serum concentration of CYP3A4 Inducers (Strong). CYP3A4 Inducers (Strong) may decrease the serum concentration of Clarithromycin. Management: Consider alternative antimicrobial therapy for patients receiving a CYP3A inducer. Drugs that enhance the metabolism of clarithromycin into 14hydroxyclarithromycin may alter the clinical activity of clarithromycin and may impair clarithromycin efficacy.
CycloSPORINE (Systemic)	Rifamycin Derivatives may increase the metabolism of CycloSPORINE (Systemic).
CYP2C19 Substrates (High risk with Inducers)	CYP2C19 Inducers (Strong) may increase the metabolism of CYP2C19 Substrates (High risk with Inducers). Management: Consider an alternative for one of the interacting drugs. Some combinations may be specifically contraindicated. Consult appropriate manufacturer labeling.
CYP3A4 Substrates (High risk with Inducers)	CYP3A4 Inducers (Strong) may increase the metabolism of CYP3A4 Substrates (High risk with Inducers). Management: Consider an alternative for one of the interacting drugs. Some combinations may be specifically contraindicated. Consult appropriate manufacturer labeling. Exceptions: Benzhydrocodone; Buprenorphine; CarBAMazepine; Etizolam; HYDROcodone; TraMADol; Zolpidem.
Dasatinib	CYP3A4 Inducers (Strong) may decrease the serum concentration of Dasatinib. Management: Avoid when possible. If such a combination cannot be avoided, consider increasing dasatinib dose and monitor clinical response and toxicity closely.
Deferasirox	RifAMPin may decrease the serum concentration of Deferasirox. Management: Avoid combination when possible; if the combination must be used, consider a 50% increase in initial deferasirox dose, with monitoring of serum ferritin concentrations and clinical responses to guide further dosing.
Dexamethasone (Systemic)	CYP3A4 Inducers (Strong) may decrease the serum concentration of Dexamethasone (Systemic). Management: Consider dexamethasone dose increases in patients receiving strong CYP3A4 inducers and monitor closely for reduced steroid efficacy.
Dolutegravir	RifAMPin may decrease the serum concentration of Dolutegravir. Management: Increase dolutegravir dose to 50 mg twice daily in adults or children. Consider alternatives to rifampin for INSTI experienced patients with clinically suspected INSTI resistance or certain INSTI associated resistance substitutions.
DOXOrubicin (Conventional)	CYP3A4 Inducers (Strong) may decrease the serum concentration of DOXOrubicin (Conventional). Management: Seek alternatives to strong CYP3A4 inducers in patients treated with doxorubicin. One U.S. manufacturer (Pfizer Inc.) recommends that these combinations be avoided.
DOXOrubicin (Conventional)	P-glycoprotein/ABCB1 Inducers may decrease the serum concentration of DOXOrubicin (Conventional). Management: Seek alternatives to P-glycoprotein inducers in patients treated with doxorubicin whenever possible. One U.S. manufacturer (Pfizer Inc.) recommends that these combinations be avoided.
Elagolix	RifAMPin may increase the serum concentration of Elagolix. Management: Use of the elagolix 200 mg twice daily dose with rifampin is not recommended. Limit combined use of the elagolix 150 mg once daily dose with rifampin to a maximum of 6 months.
Eluxadoline	RifAMPin may increase the serum concentration of Eluxadoline. Management: Decrease the eluxadoline dose to 75 mg twice daily if combined with rifampin and monitor patients for increased eluxadoline effects/toxicities.
Enzalutamide	CYP3A4 Inducers (Strong) may decrease the serum concentration of Enzalutamide. Management: Consider using an alternative agent that has no or minimal CYP3A4 induction potential when possible. If this combination cannot be avoided, increase the dose of enzalutamide from 160 mg daily to 240 mg daily.
Eravacycline	CYP3A4 Inducers (Strong) may decrease the serum concentration of Eravacycline. Management: Increase the eravacycline dose to 1.5 mg/kg every 12 hours when combined with strong CYP3A4 inducers.
Erlotinib	CYP3A4 Inducers (Strong) may decrease the serum concentration of Erlotinib. Management: Avoid combination if possible. If combination must be used, increase erlotinib dose by 50 mg increments every 2 weeks as tolerated, to a maximum of 450 mg/day.
Estrogen Derivatives (Contraceptive)	Rifamycin Derivatives may decrease the serum concentration of Estrogen Derivatives (Contraceptive). Contraceptive failure is possible. Management: Use of an alternative, nonhormonal contraceptive is recommended.
Etoposide	CYP3A4 Inducers (Strong) may decrease the serum concentration of Etoposide. Management: When possible, seek alternatives to strong CYP3A4-inducing medications in patients receiving etoposide. If combined, monitor patients closely for diminished etoposide response and need for etoposide dose increases.
Etoposide Phosphate	CYP3A4 Inducers (Strong) may decrease the serum concentration of Etoposide Phosphate. Management: When possible, seek alternatives to strong CYP3A4inducing medications in patients receiving etoposide phosphate. If these combinations cannot be avoided, monitor patients closely for diminished etoposide phosphate response.
Everolimus	CYP3A4 Inducers (Strong) may decrease the serum concentration of Everolimus. Management: Avoid concurrent use of strong CYP3A4 inducers if possible. If coadministration cannot be avoided, double the daily dose of everolimus using increments of 5 mg or less. Monitor everolimus serum concentrations closely when indicated.
Exemestane	CYP3A4 Inducers (Strong) may decrease the serum concentration of Exemestane. Management: Exemestane U.S. product labeling recommends using an increased dose (50 mg/day) in patients receiving concurrent strong CYP3A4 inducers. The Canadian product labeling does not recommend a dose adjustment with concurrent use of strong CYP3A4 inducers.
Fosphenytoin	RifAMPin may decrease the serum concentration of Fosphenytoin. Management: Seek alternatives when possible. If used together, monitor closely for decreased serum phenytoin concentrations following rifampin initiation/dose increase, or increased concentrations and toxic effects following rifampin discontinuation/dose decrease.
Gefitinib	CYP3A4 Inducers (Strong) may decrease the serum concentration of Gefitinib. Management: In the absence of severe adverse reactions, increase gefitinib dose to 500 mg daily in patients receiving strong CYP3A4 inducers; resume 250 mg dose 7 days after discontinuation of the strong inducer. Carefully monitor clinical response.
GuanFACINE	CYP3A4 Inducers (Strong) may decrease the serum concentration of GuanFACINE. Management: Increase the guanfacine dose by up to double when initiating guanfacine in a patient taking a strong CYP3A4 inducer. Increase guanfacine dose gradually over 1 to 2 weeks if initiating strong CYP3A4 inducer therapy in a patient already taking guanfacine.
HMG-CoA Reductase Inhibitors (Statins)	Rifamycin Derivatives may decrease the serum concentration of HMG-CoA Reductase Inhibitors (Statins). Management: Consider use of noninteracting antilipemic agents (note: pitavastatin concentrations may increase with rifamycin treatment). Monitor for altered HMG-CoA reductase inhibitor effects. Rifabutin and fluvastatin, or possibly pravastatin, may pose lower risk. Exceptions: Pitavastatin; Rosuvastatin.
Imatinib	Rifamycin Derivatives may decrease the serum concentration of Imatinib. Management: Avoid concurrent use of imatinib with the rifamycin derivatives when possible. If such a combination must be used, increase imatinib dose by at least 50% and monitor the patient's clinical response closely.
Imatinib	CYP3A4 Inducers (Strong) may decrease the serum concentration of Imatinib. Management: Avoid concurrent use of imatinib with strong CYP3A4 inducers when possible. If such a combination must be used, increase imatinib dose by at least 50% and monitor the patient's clinical response closely.
Ixabepilone	CYP3A4 Inducers (Strong) may decrease the serum concentration of Ixabepilone. Management: Avoid this combination whenever possible. If this combination must be used, a gradual increase in ixabepilone dose from 40 mg/m to 60 mg/m (given as a 4-hour infusion), as tolerated, should be considered.
Larotrectinib	CYP3A4 Inducers (Strong) may decrease the serum concentration of Larotrectinib. Management: Avoid use of strong CYP3A4 inducers with larotrectinib. If this combination cannot be avoided, double the larotrectinib dose. Reduced to previous dose after stopping the inducer after a period of 3 to 5 times the inducer half-life.
Lefamulin	CYP3A4 Inducers (Strong) may decrease the serum concentration of Lefamulin. Management: Avoid concomitant use of lefamulin with strong CYP3A4 inducers unless the benefits outweigh the risks.
Lefamulin	P-glycoprotein/ABCB1 Inducers may decrease the serum concentration of Lefamulin. Management: Avoid concomitant use of lefamulin with P-glycoprotein/ABCB1 inducers unless the benefits outweigh the risks.
Lefamulin (Intravenous)	CYP3A4 Inducers (Strong) may decrease the serum concentration of Lefamulin (Intravenous). Management: Avoid concomitant use of lefamulin intravenous infusion with strong CYP3A4 inducers unless the benefits outweigh the risks.
Lefamulin (Intravenous)	P-glycoprotein/ABCB1 Inducers may decrease the serum concentration of Lefamulin (Intravenous). Management: Avoid concomitant use of lefamulin (intravenous) with P-glycoprotein/ABCB1 inducers unless the benefits outweigh the risks.
LinaGLIPtin	CYP3A4 Inducers (Strong) may decrease the serum concentration of LinaGLIPtin. Management: Strongly consider using an alternative to any strong CYP3A4 inducer in patients who are being treated with linagliptin. If this combination is used, monitor patients closely for evidence of reduced linagliptin effectiveness.
LinaGLIPtin	P-glycoprotein/ABCB1 Inducers may decrease the serum concentration of LinaGLIPtin. Management: Strongly consider using an alternative to any strong P-glycoprotein inducer in patients who are being treated with linagliptin. If this combination is used, monitor patients closely for evidence of reduced linagliptin effectiveness.
Macrolide Antibiotics	May decrease the metabolism of Rifamycin Derivatives. Exceptions: Azithromycin (Systemic); Fidaxomicin; Roxithromycin; Spiramycin.
Manidipine	CYP3A4 Inducers (Strong) may decrease the serum concentration of Manidipine. Management: Consider avoiding concomitant use of manidipine and strong CYP3A4 inducers. If combined, monitor closely for decreased manidipine effects and loss of efficacy. Increased manidipine doses may be required.
Maraviroc	CYP3A4 Inducers (Strong) may decrease the serum concentration of Maraviroc. Management: Increase maraviroc adult dose to 600 mg twice daily when used with strong CYP3A4 inducers. This does not apply to patients also receiving strong CYP3A4 inhibitors. Do not use maraviroc with strong CYP3A4 inducers in patients with CrCl less than 30 mL/min.
Meperidine	CYP3A4 Inducers (Strong) may decrease the serum concentration of Meperidine. Management: Consider increasing meperidine dose if concomitant use with strong CYP3A4 inducers is required. Monitor for signs and symptoms of opioid withdrawal.
Methadone	Rifamycin Derivatives may decrease the serum concentration of Methadone. Management: Seek alternatives when possible. If used concomitantly, monitor closely for symptoms of methadone withdrawal upon rifamycin derivative initiation, and for excess sedation upon rifamycin derivative discontinuation.
MethylPREDNISolone	CYP3A4 Inducers (Strong) may decrease the serum concentration of MethylPREDNISolone. Management: Consider methylprednisolone dose increases in patients receiving strong CYP3A4 inducers and monitor closely for reduced steroid efficacy.
Mirodenafil	CYP3A4 Inducers (Strong) may decrease the serum concentration of Mirodenafil. Management: Consider avoiding the concomitant use of mirodenafil and strong CYP3A4 inducers. If combined, monitor for decreased mirodenafil effects. Mirodenafil dose increases may be required to achieve desired effects.
Nevirapine	RifAMPin may decrease the serum concentration of Nevirapine. Management: Avoid whenever possible. When this combination is necessary, use immediate-release nevirapine (avoid extended-release nevirapine) at a dose of 200 mg twice daily with no lead-in (per adult/adolescent HIV guidelines). Monitor nevirapine response closely.
Nitrazepam	RifAMPin may decrease the serum concentration of Nitrazepam. Management: Monitor closely for reduced effects of nitrazepam. When possible, consider alternatives to one of these drugs, or increases in initial nitrazepam doses.
Osimertinib	CYP3A4 Inducers (Strong) may decrease the serum concentration of Osimertinib.
Paliperidone	Inducers of CYP3A4 (Strong) and P-glycoprotein may decrease the serum concentration of Paliperidone. Management: Avoid using the 3-month extended-release injectable suspension (Invega Trinza) with inducers of both CYP3A4 and P-glycoprotein during the 3-month dosing interval if possible. If combination is necessary, consider using extendedrelease tablets.
Perampanel	CYP3A4 Inducers (Strong) may decrease the serum concentration of Perampanel. Management: Increase the perampanel starting dose to 4 mg/day when perampanel is used concurrently with moderate and strong CYP3A4 inducers.
Phenytoin	RifAMPin may decrease the serum concentration of Phenytoin. Management: Seek alternatives when possible. If used together, monitor closely for decreased serum phenytoin concentrations following rifampin initiation/dose increase, or increased concentrations and toxic effects following rifampin discontinuation/dose decrease.
Pitavastatin	Rifamycin Derivatives may increase the serum concentration of Pitavastatin. Management: Limit pitavastatin dose to a maximum of 2 mg/day with concurrent rifampin.
Pitolisant	CYP3A4 Inducers (Strong) may decrease the serum concentration of Pitolisant. Management: For patients who are stable on pitolisant doses of 8.9 mg or 17.8 mg/day and who are also taking a strong CYP3A4 inducer, increase the pitolisant dose over 7 days to double the original dose (ie, to either 17.8 mg/day or 35.6 mg/day, respectively).
Progestins (Contraceptive)	Rifamycin Derivatives may decrease the serum concentration of Progestins (Contraceptive). Contraceptive failure is possible. Management: Contraceptive failure is possible. Use of an alternative, nonhormonal contraceptive is recommended.
Propofol	RifAMPin may enhance the hypotensive effect of Propofol. Management: Note that use of propofol in a patient who has been taking rifampin may result in clinically significant hypotension. If possible, avoid use of this combination.
Prothionamide	RifAMPin may enhance the hepatotoxic effect of Prothionamide. Management: Avoid concomitant use of prothionamide and rifampin if possible. If combined use is considered necessary, monitor patients closely for signs and symptoms of hepatotoxicity (eg, jaundice, elevations in liver function tests).
Pyrazinamide	May enhance the hepatotoxic effect of RifAMPin. Severe (even fatal) liver injury has been reported in patients receiving these 2 drugs as a 2-month treatment regimen for latent TB infection.
QUEtiapine	CYP3A4 Inducers (Strong) may decrease the serum concentration of QUEtiapine. Management: An increase in quetiapine dose (as much as 5 times the regular dose) may be required to maintain therapeutic benefit. Reduce the quetiapine dose back to the previous/regular dose within 7-14 days of discontinuing the inducer.
QuiNIDine	Rifamycin Derivatives may decrease the serum concentration of QuiNIDine. Management: Consider alternatives to combination treatment with quinidine and rifampin due to large potential decreases in quinidine concentrations. Monitor for decreased quinidine concentrations/effects with initiation/dose increase of any rifamycin derivative.
Radotinib	CYP3A4 Inducers (Strong) may decrease the serum concentration of Radotinib. Management: Consider alternatives to this combination when possible as the risk of radotinib treatment failure may be increased.
Raltegravir	RifAMPin may decrease the serum concentration of Raltegravir. Management: Increase raltegravir dose to 800 mg twice daily (adult dose) when used concomitantly with rifampin. Concurrent use of rifampin with once-daily raltegravir (Isentress HD) is not recommended.
Repaglinide	RifAMPin may decrease the serum concentration of Repaglinide. Management: Consider alternatives to this combination. Dose timing may substantially affect this interaction; in clinical studies, the lowest magnitude of interaction was seen when repaglinide was given 1 h after rifampin (compared to 0, 12, or 24 h).
RisperiDONE	CYP3A4 Inducers (Strong) may decrease the serum concentration of RisperiDONE. Management: Consider increasing the dose of oral risperidone (to no more than double the original dose) if a strong CYP3A4 inducer is initiated. For patients on IM risperidone, consider an increased IM dose or supplemental doses of oral risperidone.
Rolapitant	CYP3A4 Inducers (Strong) may decrease the serum concentration of Rolapitant. Management: Avoid rolapitant use in patients requiring chronic administration of strong CYP3A4 inducers. Monitor for reduced rolapitant response and the need for alternative or additional antiemetic therapy even with shorter-term use of such inducers.
Selexipag	RifAMPin may decrease serum concentrations of the active metabolite(s) of Selexipag.
Sirolimus	CYP3A4 Inducers (Strong) may decrease the serum concentration of Sirolimus. Management: Avoid concomitant use of strong CYP3A4 inducers and sirolimus if possible. If combined, monitor for reduced serum sirolimus concentrations. Sirolimus dose increases will likely be necessary to prevent subtherapeutic sirolimus levels.
Sodium Picosulfate	Antibiotics may diminish the therapeutic effect of Sodium Picosulfate. Management: Consider using an alternative product for bowel cleansing prior to a colonoscopy in patients who have recently used or are concurrently using an antibiotic.
Sulfonylureas	RifAMPin may decrease the serum concentration of Sulfonylureas. Management: Seek alternatives to these combinations when possible. Monitor closely for diminished therapeutic effects of sulfonylureas if rifampin is initiated/dose increased, or enhanced effects if rifampin is discontinued/dose decreased.
SUNItinib	CYP3A4 Inducers (Strong) may decrease the serum concentration of SUNItinib. Management: Avoid when possible. If such a combination cannot be avoided, sunitinib dose increases are recommended, and vary by indication. See full monograph for details.
Tacrolimus (Systemic)	Rifamycin Derivatives may decrease the serum concentration of Tacrolimus (Systemic). Management: Consider alternatives when possible. If these combination are used, monitor for reduced tacrolimus concentrations/effects following rifamycin initiation/dose increase, or increased concentrations/effects following rifamycin discontinuation/dose decrease.
Tadalafil	CYP3A4 Inducers (Strong) may decrease the serum concentration of Tadalafil. Management: Erectile dysfunction: monitor for decreased effectiveness - no standard dose adjustments recommended. Avoid use of tadalafil for pulmonary arterial hypertension in patients receiving a strong CYP3A4 inducer.
Tamoxifen	Rifamycin Derivatives may increase the metabolism of Tamoxifen.
Tamoxifen	CYP3A4 Inducers (Strong) may decrease serum concentrations of the active metabolite(s) of Tamoxifen. CYP3A4 Inducers (Strong) may decrease the serum concentration of Tamoxifen. Management: Consider alternatives to concomitant use of strong CYP3A4 inducers and tamoxifen. If the combination cannot be avoided, monitor for reduced therapeutic effects of tamoxifen.
Temsirolimus	Rifamycin Derivatives may decrease the serum concentration of Temsirolimus. Rifamycins will likely cause an even greater decrease in the concentration of the active metabolite sirolimus. Management: Temsirolimus prescribing information recommends against coadministration with strong CYP3A4 inducers such as rifampin; however, if concurrent therapy is necessary, an increase in temsirolimus adult dose to 50 mg/week should be considered.
Temsirolimus	CYP3A4 Inducers (Strong) may decrease the serum concentration of Temsirolimus. Management: Consider increasing the dose of temsirolimus to 50 mg IV/week (from 25 mg IV/week) if a concomitant CYP3A4 strong inducer is necessary.
Thiazolidinediones	RifAMPin may increase the metabolism of Thiazolidinediones. Management: Consider alternatives to the concomitant use of rifampin with thiazolidinedione antidiabetic agents. Monitor patients receiving these combinations for decreased effects of the thiazolidinedione derivative.
Thiotepa	CYP3A4 Inducers (Strong) may increase serum concentrations of the active metabolite(s) of Thiotepa. CYP3A4 Inducers (Strong) may decrease the serum concentration of Thiotepa. Management: Thiotepa prescribing information recommends avoiding concomitant use of thiotepa and strong CYP3A4 inducers. If concomitant use is unavoidable, monitor for adverse effects.
TiaGABine	CYP3A4 Inducers (Strong) may decrease the serum concentration of TiaGABine. Management: Approximately 2-fold higher tiagabine doses and a more rapid dose titration will likely be required in patients concomitantly taking a strong CYP3A4 inducer.
Typhoid Vaccine	Antibiotics may diminish the therapeutic effect of Typhoid Vaccine. Only the live attenuated Ty21a strain is affected. Management: Vaccination with live attenuated typhoid vaccine (Ty21a) should be avoided in patients being treated with systemic antibacterial agents. Use of this vaccine should be postponed until at least 3 days after cessation of antibacterial agents.
Valproate Products	RifAMPin may decrease the serum concentration of Valproate Products.
Vemurafenib	CYP3A4 Inducers (Strong) may decrease the serum concentration of Vemurafenib. Management: Avoid concurrent use of vemurafenib with a strong CYP3A4 inducer and replace with another agent when possible. If a strong CYP3A4 inducer is indicated and unavoidable, the dose of vemurafenib may be increased by 240 mg (1 tablet) as tolerated.
Vilazodone	CYP3A4 Inducers (Strong) may decrease the serum concentration of Vilazodone. Management: Consider increasing vilazodone dose by as much as 2-fold (do not exceed 80 mg/day), based on response, in patients receiving strong CYP3A4 inducers for > 14 days. Reduce to the original vilazodone dose over 1-2 weeks after inducer discontinuation.
Vortioxetine	CYP3A4 Inducers (Strong) may decrease the serum concentration of Vortioxetine. Management: Consider increasing the vortioxetine dose to no more than 3 times the original dose when used with a strong drug metabolism inducer for more than 14 days. The vortioxetine dose should be returned to normal within 14 days of stopping the strong inducer.
Zaleplon	CYP3A4 Inducers (Strong) may decrease the serum concentration of Zaleplon. Management: Consider the use of an alternative hypnotic that is not metabolized by CYP3A4 in patients receiving strong CYP3A4 inducers. If zalephon is combined with a strong CYP3A4 inducer, monitor for decreased effectiveness of zaleplon.
Risk Factor X (Avoid combination)
Abemaciclib	CYP3A4 Inducers (Strong) may decrease the serum concentration of Abemaciclib.
Alpelisib	CYP3A4 Inducers (Strong) may decrease the serum concentration of Alpelisib.
Antihepaciviral Combination Products	CYP3A4 Inducers (Strong) may decrease the serum concentration of Antihepaciviral Combination Products.
Apixaban	CYP3A4 Inducers (Strong) may decrease the serum concentration of Apixaban.
Apremilast	CYP3A4 Inducers (Strong) may decrease the serum concentration of Apremilast.
Aprepitant	CYP3A4 Inducers (Strong) may decrease the serum concentration of Aprepitant.
Artemether	CYP3A4 Inducers (Strong) may decrease serum concentrations of the active metabolite(s) of Artemether. Specifically, dihydroartemisinin concentrations may be reduced. CYP3A4 Inducers (Strong) may decrease the serum concentration of Artemether.
Asunaprevir	RifAMPin may decrease the serum concentration of Asunaprevir. This effect is most likely with longer-term coadministration; single-dose rifampin may increase asunaprevir concentrations. RifAMPin may increase the serum concentration of Asunaprevir. This effect is likely following only single-dose or short-term rifampin administration. Longer-term coadministration is likely to result in decreased asunaprevir concentrations.
Atazanavir	RifAMPin may decrease the serum concentration of Atazanavir.
Atovaquone	Rifamycin Derivatives may decrease the serum concentration of Atovaquone.
Axitinib	CYP3A4 Inducers (Strong) may decrease the serum concentration of Axitinib.
BCG (Intravesical)	Antibiotics may diminish the therapeutic effect of BCG (Intravesical).
Bedaquiline	CYP3A4 Inducers (Strong) may decrease the serum concentration of Bedaquiline.
Betrixaban	P-glycoprotein/ABCB1 Inducers may decrease the serum concentration of Betrixaban.
Bictegravir	RifAMPin may decrease the serum concentration of Bictegravir.
Bortezomib	CYP3A4 Inducers (Strong) may decrease the serum concentration of Bortezomib.
Bosutinib	CYP3A4 Inducers (Strong) may decrease the serum concentration of Bosutinib.
Brigatinib	CYP3A4 Inducers (Strong) may decrease the serum concentration of Brigatinib.
Cariprazine	CYP3A4 Inducers (Strong) may decrease the serum concentration of Cariprazine.
Ceritinib	CYP3A4 Inducers (Strong) may decrease the serum concentration of Ceritinib.
Cholera Vaccine	Antibiotics may diminish the therapeutic effect of Cholera Vaccine. Management: Avoid cholera vaccine in patients receiving systemic antibiotics, and within 14 days following the use of oral or parenteral antibiotics.
CloZAPine	CYP3A4 Inducers (Strong) may decrease the serum concentration of CloZAPine.
Cobicistat	RifAMPin may decrease the serum concentration of Cobicistat.
Cobimetinib	CYP3A4 Inducers (Strong) may decrease the serum concentration of Cobimetinib.
Copanlisib	CYP3A4 Inducers (Strong) may decrease the serum concentration of Copanlisib.
Crizotinib	CYP3A4 Inducers (Strong) may decrease the serum concentration of Crizotinib.
Dabigatran Etexilate	P-glycoprotein/ABCB1 Inducers may decrease the serum concentration of Dabigatran Etexilate. Management: Avoid concurrent use of dabigatran with P-glycoprotein inducers whenever possible.
Daclatasvir	CYP3A4 Inducers (Strong) may decrease the serum concentration of Daclatasvir.
Darolutamide	Inducers of CYP3A4 (Strong) and P-glycoprotein may decrease the serum concentration of Darolutamide.
Darunavir	RifAMPin may decrease the serum concentration of Darunavir.
Dasabuvir	CYP3A4 Inducers (Strong) may decrease the serum concentration of Dasabuvir.
Deflazacort	CYP3A4 Inducers (Strong) may decrease serum concentrations of the active metabolite(s) of Deflazacort.
Delamanid	CYP3A4 Inducers (Strong) may decrease the serum concentration of Delamanid.
Delavirdine	Rifamycin Derivatives may increase the metabolism of Delavirdine. Delavirdine may increase the serum concentration of Rifamycin Derivatives. Specifically, Rifabutin serum concentration may be increased.
Dienogest	CYP3A4 Inducers (Strong) may decrease the serum concentration of Dienogest. Management: Avoid use of dienogest for contraception when using medications that induce CYP3A4 and for at least 28 days after discontinuation of a CYP3A4 inducer. An alternative form of contraception should be used during this time.
DilTIAZem	RifAMPin may decrease the serum concentration of DilTIAZem.
Doravirine	CYP3A4 Inducers (Strong) may decrease the serum concentration of Doravirine.
Dronedarone	CYP3A4 Inducers (Strong) may decrease the serum concentration of Dronedarone.
Duvelisib	CYP3A4 Inducers (Strong) may decrease the serum concentration of Duvelisib.
Edoxaban	RifAMPin may decrease the serum concentration of Edoxaban.
Elbasvir	CYP3A4 Inducers (Strong) may decrease the serum concentration of Elbasvir.
Eliglustat	CYP3A4 Inducers (Strong) may decrease the serum concentration of Eliglustat.
Elvitegravir	RifAMPin may decrease the serum concentration of Elvitegravir.
Encorafenib	CYP3A4 Inducers (Strong) may decrease the serum concentration of Encorafenib.
Entrectinib	CYP3A4 Inducers (Strong) may decrease the serum concentration of Entrectinib.
Erdafitinib	CYP3A4 Inducers (Strong) may decrease the serum concentration of Erdafitinib.
Esomeprazole	RifAMPin may decrease the serum concentration of Esomeprazole.
Etravirine	CYP3A4 Inducers (Strong) may decrease the serum concentration of Etravirine.
Fedratinib	CYP3A4 Inducers (Strong) may decrease the serum concentration of Fedratinib.
Fimasartan	RifAMPin may increase the serum concentration of Fimasartan.
Flibanserin	CYP3A4 Inducers (Strong) may decrease the serum concentration of Flibanserin.
Fosamprenavir	RifAMPin may decrease the serum concentration of Fosamprenavir. Specifically, concentrations of amprenavir (active metabolite) may be decreased.
Fosaprepitant	CYP3A4 Inducers (Strong) may decrease the serum concentration of Fosaprepitant. Specifically, CYP3A4 Inducers (Strong) may decrease serum concentrations of the active metabolite aprepitant.
Fosnetupitant	CYP3A4 Inducers (Strong) may decrease serum concentrations of the active metabolite(s) of Fosnetupitant.
Fostamatinib	CYP3A4 Inducers (Strong) may decrease serum concentrations of the active metabolite(s) of Fostamatinib.
Gemigliptin	CYP3A4 Inducers (Strong) may decrease serum concentrations of the active metabolite(s) of Gemigliptin. CYP3A4 Inducers (Strong) may decrease the serum concentration of Gemigliptin.
Gilteritinib	Combined Inducers of CYP3A4 and P-glycoprotein may decrease the serum concentration of Gilteritinib.
Glasdegib	CYP3A4 Inducers (Strong) may decrease the serum concentration of Glasdegib.
Glecaprevir and Pibrentasvir	RifAMPin may decrease the serum concentration of Glecaprevir and Pibrentasvir. RifAMPin may increase the serum concentration of Glecaprevir and Pibrentasvir. Specifically, a single dose of rifampin may increase glecaprevir/pibrentasvir concentrations, while chronic daily use of rifampin may decrease glecaprevir/pibrentasvir concentrations.
Grazoprevir	RifAMPin may decrease the serum concentration of Grazoprevir. Conversely, single doses of Rifampin may increase Grazoprevir concentrations.
Ibrutinib	CYP3A4 Inducers (Strong) may decrease the serum concentration of Ibrutinib.
Idelalisib	CYP3A4 Inducers (Strong) may decrease the serum concentration of Idelalisib.
Indinavir	RifAMPin may decrease the serum concentration of Indinavir.
Irinotecan Products	CYP3A4 Inducers (Strong) may decrease serum concentrations of the active metabolite(s) of Irinotecan Products. Specifically, serum concentrations of SN-38 may be reduced. CYP3A4 Inducers (Strong) may decrease the serum concentration of Irinotecan Products.
Isavuconazonium Sulfate	CYP3A4 Inducers (Strong) may decrease serum concentrations of the active metabolite(s) of Isavuconazonium Sulfate. Specifically, CYP3A4 Inducers (Strong) may decrease isavuconazole serum concentrations.
Itraconazole	CYP3A4 Inducers (Strong) may decrease the serum concentration of Itraconazole.
Ivabradine	CYP3A4 Inducers (Strong) may decrease the serum concentration of Ivabradine.
Ivacaftor	CYP3A4 Inducers (Strong) may decrease the serum concentration of Ivacaftor.
Ivosidenib	CYP3A4 Inducers (Strong) may decrease the serum concentration of Ivosidenib.
Ixazomib	CYP3A4 Inducers (Strong) may decrease the serum concentration of Ixazomib.
Lapatinib	CYP3A4 Inducers (Strong) may decrease the serum concentration of Lapatinib. Management: If therapy overlap cannot be avoided, consider titrating lapatinib gradually from 1,250 mg/day up to 4,500 mg/day (HER2 positive metastatic breast cancer) or 1,500 mg/day up to 5,500 mg/day (hormone receptor/HER2 positive breast cancer) as tolerated.
Ledipasvir	P-glycoprotein/ABCB1 Inducers may decrease the serum concentration of Ledipasvir.
Letermovir	RifAMPin may decrease the serum concentration of Letermovir.
Lopinavir	RifAMPin may enhance the adverse/toxic effect of Lopinavir. Specifically, the risk of hepatocellular toxicity may be increased. RifAMPin may decrease the serum concentration of Lopinavir.
Lorlatinib	CYP3A4 Inducers (Strong) may decrease the serum concentration of Lorlatinib.
Lumefantrine	CYP3A4 Inducers (Strong) may decrease the serum concentration of Lumefantrine.
Lurasidone	CYP3A4 Inducers (Strong) may decrease the serum concentration of Lurasidone.
Macimorelin	CYP3A4 Inducers (Strong) may decrease the serum concentration of Macimorelin.
Macitentan	CYP3A4 Inducers (Strong) may decrease the serum concentration of Macitentan.
Midostaurin	CYP3A4 Inducers (Strong) may decrease the serum concentration of Midostaurin.
MiFEPRIStone	CYP3A4 Inducers (Strong) may decrease the serum concentration of MiFEPRIStone.
Mycophenolate	Rifamycin Derivatives may decrease the serum concentration of Mycophenolate. Specifically, rifamycin derivatives may decrease the concentration of the active metabolite mycophenolic acid.
Naldemedine	CYP3A4 Inducers (Strong) may decrease the serum concentration of Naldemedine.
Naloxegol	CYP3A4 Inducers (Strong) may decrease the serum concentration of Naloxegol.
Nelfinavir	RifAMPin may decrease the serum concentration of Nelfinavir.
Neratinib	CYP3A4 Inducers (Strong) may decrease the serum concentration of Neratinib.
Netupitant	CYP3A4 Inducers (Strong) may decrease the serum concentration of Netupitant.
NIFEdipine	CYP3A4 Inducers (Strong) may decrease the serum concentration of NIFEdipine.
Nilotinib	CYP3A4 Inducers (Strong) may decrease the serum concentration of Nilotinib.
NiMODipine	CYP3A4 Inducers (Strong) may decrease the serum concentration of NiMODipine.
Nintedanib	Combined Inducers of CYP3A4 and P-glycoprotein may decrease the serum concentration of Nintedanib.
Nisoldipine	CYP3A4 Inducers (Strong) may decrease the serum concentration of Nisoldipine.
Olaparib	CYP3A4 Inducers (Strong) may decrease the serum concentration of Olaparib.
Omeprazole	RifAMPin may decrease the serum concentration of Omeprazole.
Palbociclib	CYP3A4 Inducers (Strong) may decrease the serum concentration of Palbociclib.
Panobinostat	CYP3A4 Inducers (Strong) may decrease the serum concentration of Panobinostat.
PAZOPanib	CYP3A4 Inducers (Strong) may decrease the serum concentration of PAZOPanib.
Pexidartinib	CYP3A4 Inducers (Strong) may decrease the serum concentration of Pexidartinib.
Pimavanserin	CYP3A4 Inducers (Strong) may decrease the serum concentration of Pimavanserin.
Piperaquine	CYP3A4 Inducers (Strong) may decrease the serum concentration of Piperaquine.
PONATinib	CYP3A4 Inducers (Strong) may decrease the serum concentration of PONATinib.
Praziquantel	CYP3A4 Inducers (Strong) may decrease the serum concentration of Praziquantel. Management: Use of praziquantel with strong CYP3A4 inducers is contraindicated. Discontinue rifampin 4 weeks prior to initiation of praziquantel therapy. Rifampin may be resumed the day following praziquantel completion.
Pretomanid	CYP3A4 Inducers (Strong) may decrease the serum concentration of Pretomanid.
QuiNINE	RifAMPin may decrease the serum concentration of QuiNINE.
Ranolazine	RifAMPin may decrease the serum concentration of Ranolazine.
Regorafenib	CYP3A4 Inducers (Strong) may decrease the serum concentration of Regorafenib.
Revefenacin	OATP1B1/1B3 (SLCO1B1/1B3) Inhibitors may increase serum concentrations of the active metabolite(s) of Revefenacin.
Ribociclib	CYP3A4 Inducers (Strong) may decrease the serum concentration of Ribociclib.
Rilpivirine	Rifamycin Derivatives may decrease the serum concentration of Rilpivirine.
Ritonavir	RifAMPin may decrease the serum concentration of Ritonavir.
Rivaroxaban	CYP3A4 Inducers (Strong) may decrease the serum concentration of Rivaroxaban.
Roflumilast	RifAMPin may decrease the serum concentration of Roflumilast. Management: Roflumilast U.S. prescribing information recommends against combining rifampin with roflumilast. The Canadian product monograph makes no such recommendation but notes that rifampin may reduce roflumilast therapeutic effects.
RomiDEPsin	RifAMPin may increase the serum concentration of RomiDEPsin.
Saquinavir	RifAMPin may enhance the adverse/toxic effect of Saquinavir. Specifically, the risk of hepatocellular toxicity may be increased. RifAMPin may decrease the serum concentration of Saquinavir.
Simeprevir	CYP3A4 Inducers (Strong) may decrease the serum concentration of Simeprevir.
Siponimod	RifAMPin may decrease the serum concentration of Siponimod. Management: Coadministration of siponimod with rifampin, a moderate inducer of CYP2C9 and a strong inducer of CYP3A4, is not recommended.
Sofosbuvir	P-glycoprotein/ABCB1 Inducers may decrease the serum concentration of Sofosbuvir.
Sonidegib	CYP3A4 Inducers (Strong) may decrease the serum concentration of Sonidegib.
SORAfenib	CYP3A4 Inducers (Strong) may decrease the serum concentration of SORAfenib.
Tasimelteon	CYP3A4 Inducers (Strong) may decrease the serum concentration of Tasimelteon.
Tenofovir Alafenamide	RifAMPin may decrease the serum concentration of Tenofovir Alafenamide.
Ticagrelor	CYP3A4 Inducers (Strong) may decrease serum concentrations of the active metabolite(s) of Ticagrelor. CYP3A4 Inducers (Strong) may decrease the serum concentration of Ticagrelor.
Tipranavir	RifAMPin may decrease the serum concentration of Tipranavir.
Tofacitinib	CYP3A4 Inducers (Strong) may decrease the serum concentration of Tofacitinib.
Tolvaptan	CYP3A4 Inducers (Strong) may decrease the serum concentration of Tolvaptan. Management: If concurrent use is necessary, increased doses of tolvaptan (with close monitoring for toxicity and clinical response) may be needed.
Toremifene	CYP3A4 Inducers (Strong) may decrease the serum concentration of Toremifene.
Trabectedin	CYP3A4 Inducers (Strong) may decrease the serum concentration of Trabectedin.
Ulipristal	CYP3A4 Inducers (Strong) may decrease the serum concentration of Ulipristal.
Upadacitinib	CYP3A4 Inducers (Strong) may decrease the serum concentration of Upadacitinib.
Valbenazine	CYP3A4 Inducers (Strong) may decrease the serum concentration of Valbenazine.
Vandetanib	CYP3A4 Inducers (Strong) may decrease the serum concentration of Vandetanib.
Velpatasvir	CYP2B6 Inducers (Moderate) may decrease the serum concentration of Velpatasvir.
Velpatasvir	CYP3A4 Inducers (Strong) may decrease the serum concentration of Velpatasvir.
Velpatasvir	P-glycoprotein/ABCB1 Inducers may decrease the serum concentration of Velpatasvir.
Venetoclax	CYP3A4 Inducers (Strong) may decrease the serum concentration of Venetoclax.
VinCRIStine (Liposomal)	CYP3A4 Inducers (Strong) may decrease the serum concentration of VinCRIStine (Liposomal).
VinCRIStine (Liposomal)	P-glycoprotein/ABCB1 Inducers may decrease the serum concentration of VinCRIStine (Liposomal).
Vinflunine	CYP3A4 Inducers (Strong) may decrease the serum concentration of Vinflunine.
Vorapaxar	CYP3A4 Inducers (Strong) may decrease the serum concentration of Vorapaxar.
Voriconazole	May increase the serum concentration of Rifamycin Derivatives. Rifamycin Derivatives may decrease the serum concentration of Voriconazole.
Voxilaprevir	RifAMPin may increase the serum concentration of Voxilaprevir. Specifically, a single dose of rifampin may increase voxilaprevir concentrations, while chronic daily use of rifampin may decrease voxilaprevir concentrations. RifAMPin may decrease the serum concentration of Voxilaprevir.
Zolpidem	RifAMPin may decrease the serum concentration of Zolpidem.

Monitoring parameters:

Periodic (baseline and every 2 to 4 weeks during therapy) monitoring of liver function (AST, ALT, bilirubin), CBC, mental status, sputum culture, chest x-ray 2 to 3 months into treatment.
Monitor coagulation tests during treatment in patients at risk of vitamin K deficiency.

How to administer Rifampin (Rifampicin)?

IV:

Administer IV preparation by slow IV infusion over 30 minutes to 3 hours at a final concentration not to exceed 6 mg/mL.
Do not administer IM or SubQ. Avoid extravasation.

Oral:

Administer on an empty stomach (ie, 1 hour before, or 2 hours after meals or antacids) to increase total absorption.
The compounded oral suspension must be shaken well before using. May mix contents of the capsule with applesauce or jelly.

Mechanism of action of Rifampin (Rifampicin):

Blocks bacterial RNA production by binding to the beta-subunit of DNA-dependentRNA polymerase.

Time:

=24 Hours

Absorption:

Oral: It is better to eat it than to ingest it.

Distribution:

Highly lipophilic
crosses blood-brain barrier well
Relative diffusion of blood into cerebrospinal fluid.
Appropriate with or without inflammation (exceeds MICs).
CSF: blood level ratio: Inflamed meninges: 25%

Protein binding:

Metabolism:

Hepatic;
undergoes enterohepatic recirculation

Half-life elimination:

3 to 4 hours;
prolonged with hepatic impairment;
End-stage renal disease: 1.8 to 11 hours

Time to peak, serum:

Oral: 2 to 4 hours

Excretion:

Feces (60% to 65%) and urine (~30%) as unchanged drug

International Brand Names of Rifampin:

Rifadin
Rofact
Arficin
Bactromax
Benemicin
Corifam
Eremfat
Fuhe
Lyrimpin
Macox
Maficin
Manorifcin
Mycin
Myconil
Oxitrin
Ramicin
Rifacilin
Rifacin
Rifacure
Rifadex
Rifadin
Rifadine
Rifaldin
Rifamcin
Rifamed
Rifampicin
Rifampicin Labatec
Rifampin
Rifapin
Rifarad
Rifaren
Rifarm
Rifasynt
Rifatan
Rifocina
Rifocina Spray
Rifodex
Rifoldin
Rifoldine
Rimactan
Rimactane
Rimactan[inj.]
Rimafed
Rimapen
Rimecin
Rimpacin
Rimpin
Rimycin
Ripin
Shu Lan Xin
Stririfa
Tubocin

Rifampin Brand Names in Pakistan:

Rifampicin Syrup 100 Mg/5ml in Pakistan
Afracin	Consolidated Chemical Laboratories (Pvt) Ltd.
Lederrif	Pfizer Laboratories Ltd.
Remedil	Adamjee Pharmaceuticals (Pvt) Ltd.
Rifac	Geofman Pharmaceuticals
Rifacin	Pharmawise Labs. (Pvt) Ltd.
Rifadin	Pacific Pharmaceuticals Ltd.
Rifamed	Mediceena Pharma (Pvt) Ltd.
Rifampicin	Zafa Pharmaceutical Laboratories (Pvt) Ltd.
Rifucin	Pacific Pharmaceuticals Ltd.

Rifampicin Suspension 100 Mg/5ml in Pakistan
Rimactal	Novartis Pharma (Pak) Ltd

Rifampicin Tablets 150 Mg in Pakistan
Rifacin	Pharmawise Labs. (Pvt) Ltd.
Rifapin	Schazoo Zaka

Rifampicin Tablets 300 Mg in Pakistan
Lederrif	Pfizer Laboratories Ltd.
Rifac	Geofman Pharmaceuticals
Rifacin	Pharmawise Labs. (Pvt) Ltd.
Rifacin	Pharmawise Labs. (Pvt) Ltd.
Unerif	Unexo Labs (Pvt) Ltd.
Unerif	Unexo Labs (Pvt) Ltd.

Rifampicin Tablets 450 Mg in Pakistan
Abrifam	Abbott Laboratories (Pakistan) Limited.
Lederrif	Pfizer Laboratories Ltd.
Rampicin	Dosaco Laboratories
Remedil	Adamjee Pharmaceuticals (Pvt) Ltd.
Rifac	Geofman Pharmaceuticals
Rifacin	Pharmawise Labs. (Pvt) Ltd.
Rifacin	Pharmawise Labs. (Pvt) Ltd.
Rifadin	Pacific Pharmaceuticals Ltd.
Rifagen	Genera Pharmaceuticals
Rifagen	Genera Pharmaceuticals
Rifamed	Mediceena Pharma (Pvt) Ltd.
Rifamed	Mediceena Pharma (Pvt) Ltd.
Rifampicin	Dosaco Laboratories
Rifapin	Schazoo Zaka
Rifucin	Pacific Pharmaceuticals Ltd.
Rimactal	Novartis Pharma (Pak) Ltd
Rimodin	P.D.H. Pharmaceuticals (Pvt) Ltd.
Unerif	Unexo Labs (Pvt) Ltd.
Unerif	Unexo Labs (Pvt) Ltd.

Rifampicin Tablets 600 Mg in Pakistan
Abrifam	Abbott Laboratories (Pakistan) Limited.
Lederrif	Pfizer Laboratories Ltd.
Rifadin	Pacific Pharmaceuticals Ltd.
Unerif	Unexo Labs (Pvt) Ltd.

Rifampicin Capsules 150 Mg in Pakistan
M.Picin	Amson Vaccines & Pharma (Pvt) Ltd.
Remedil	Adamjee Pharmaceuticals (Pvt) Ltd.
Rifac	Geofman Pharmaceuticals
Rifadin	Pacific Pharmaceuticals Ltd.
Rifamp	Lisko Pakistan (Pvt) Ltd
Rifampicin	Zafa Pharmaceutical Laboratories (Pvt) Ltd.
Rifampicin	Polyfine Chempharma (Pvt) Ltd.
Rifampicin	Zafa Pharmaceutical Laboratories (Pvt) Ltd.
Rifucin	Pacific Pharmaceuticals Ltd.
Rimacine	Karachi Chemical Industries
Rimodin	P.D.H. Pharmaceuticals (Pvt) Ltd.
Ripicin	Irza Pharma (Pvt) Ltd.

Rifampicin Capsules 300 Mg in Pakistan
Remedil	Adamjee Pharmaceuticals (Pvt) Ltd.
Rifac	Geofman Pharmaceuticals
Rifadin	Pacific Pharmaceuticals Ltd.
Rifamp	Lisko Pakistan (Pvt) Ltd
Rifampicin	Zafa Pharmaceutical Laboratories (Pvt) Ltd.
Rifampicin	Lahore Chemical & Pharmaceutical Works (Pvt) Ltd
Rifampicin	Lahore Chemical & Pharmaceutical Works (Pvt) Ltd
Rifampicin	Lahore Chemical & Pharmaceutical Works (Pvt) Ltd
Rifampicin	Polyfine Chempharma (Pvt) Ltd.
Rifampicin	Zafa Pharmaceutical Laboratories (Pvt) Ltd.
Rifampicin	Lahore Chemical & Pharmaceutical Works (Pvt) Ltd
Rifucin	Pacific Pharmaceuticals Ltd.
Rimacine	Karachi Chemical Industries
Rimactal	Novartis Pharma (Pak) Ltd
Rimodin	P.D.H. Pharmaceuticals (Pvt) Ltd.

Rifampicin Capsules 450 Mg in Pakistan
M.Picin	Amson Vaccines & Pharma (Pvt) Ltd.
Rifac	Geofman Pharmaceuticals
Rifamate	Wilshire Laboratories (Pvt) Ltd.
Rifamp	Lisko Pakistan (Pvt) Ltd
Rifampicin	Lahore Chemical & Pharmaceutical Works (Pvt) Ltd
Rifampicin	Zafa Pharmaceutical Laboratories (Pvt) Ltd.
Rifampicin	Zafa Pharmaceutical Laboratories (Pvt) Ltd.
Rifampicin	Polyfine Chempharma (Pvt) Ltd.
Rifampicin	Lahore Chemical & Pharmaceutical Works (Pvt) Ltd
Rimodin	P.D.H. Pharmaceuticals (Pvt) Ltd.
Ripicin	Irza Pharma (Pvt) Ltd.

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Rifampin Uses:

Meningococcal prophylaxis:

Tuberculosis:

Off Label Use of Rifampin in Adults:

Rifampin (Rifampicin) Dose in Adults

Rifampin (Rifampicin) Dose in the prophylaxis of Meningococcal infection:

Rifampin (Rifampicin) Dose in the treatment of active drug-susceptible tuberculosis: Oral, IV:

Dosing:

Rifampin (Rifampicin) Dose in the treatment of latent tuberculosis infection (LTBI):

As an alternative to isoniazid:

Rifampin (Rifampicin) Dose in the treatment of Anaplasmosis, mild cases (patients with a severe allergy to doxycycline) (off-label):

Rifampin (Rifampicin) Dose in the treatment of brain abscess, empyema, and epidural abscess (MRSA) (off-label):

Rifampin Dose in the treatment of Brucellosis (off-label):

Rifampin (Rifampicin) Dose in the treatment of Cholestatic pruritus (off-label): Oral:

Dose based on bilirubin value:

Rifampin (Rifampicin) Dose in the treatment of Device-related osteoarticular infection (MRSA) (off-label):

Rifampin (Rifampicin) Dose in the treatment of prosthetic valve endocarditis (off-label): Oral, IV:

MRSA:

MSSA:

Rifampin (Rifampicin) Dose in the chemoprophylaxis of H. influenzae type B infection (off-label):

Rifampin (Rifampicin) Dose in patients with Leprosy (off-label): Oral:

Lepromatous (multibacillary):

Tuberculoid (paucibacillary):

Rifampin (Rifampicin) Dose in the treatment of Bacterial Meningitis (adjunct therapy) (off-label):

Pathogen-specific therapy (eg, staphylococci [in patients with prosthetic material], S. pneumoniae [when MIC to ceftriaxone is >2 mcg/mL]):

Rifampin (Rifampicin) Dose in the treatment of Nasal decolonization of Staphylococcus aureus (off-label):

Rifampin (Rifampicin) Dose in the treatment of Nontuberculous Pulmonary mycobacterial Disease (off-label): Oral, IV:

Mycobacterium avium complex (nodular or bronchiectatic disease):

Mycobacterium avium complex (severe nodular, bronchiectatic, or cavitary lung disease):

Mycobacterium avium complex (cystic fibrosis patients):

Mycobacterium kansasii infection:

Rifampin (Rifampicin) Dose in the treatment of Osteomyelitis (MRSA) (off-label):

Rifampin (Rifampicin) Dose in the treatment of Prosthetic joint infection (off-label): Staphylococci (oxacillin-susceptible or oxacillin-resistant): Oral:

Acute treatment following debridement and prosthesis retention or following 1-stage exchange:

Chronic Treatment following debridement and prosthesis retention or following 1-stage exchange:

Rifampin (Rifampicin) Dose in the treatment of Septic thrombosis of cavernous or dural venous sinus (MRSA) (off-label):

Rifampin (Rifampicin) Dose in the treatment of Streptococcus (group A) chronic carriage (off-label):

When combined with oral penicillin V:

When combined with single dose IM penicillin G benzathine:

Rifampin (Rifampicin) Dose in Childrens

Rifampin (Rifampicin) Dose in the treatment of active drug-susceptible tuberculosis infection (excluding meningitis):

ATS/CDC/IDSA Recommendations::

Twice-weekly DOT:

Rifampin (Rifampicin) Dose in the treatment of Latent tuberculosis infection (LTBI):

Non-HIV-exposed/-positive:

HIV-exposed/-positive:

Rifampin (Rifampicin) Dose in the treatment of exit-site or tunnel infection of peritoneal dialysis catheter:

Infants, Children, and Adolescents:

Rifampin (Rifampicin) Dose in the treatment of Endocarditis:

Empiric therapy for prosthetic valve/material:

Rifampin (Rifampicin) Dose in the treatment of prosthetic valve MRSA infection:

Infants, Children, and Adolescents:

Rifampin (Rifampicin) Dose in the prophylaxis of H. influenzae infection:

Infants, Children, and Adolescents:

Rifampin (Rifampicin) Dose in the prophylaxis of Meningococcal infection:

Infants, Children, and Adolescents:

Rifampin (Rifampicin) Dose in the treatment of Peritonitis (peritoneal dialysis):

Infants, Children, and Adolescents:

Rifampin (Rifampicin) Dose in the treatment of Pharyngeal chronic carriers of group A streptococci:

Children and Adolescents:

Rifampin (Rifampicin) Dose in the treatment of Staphylococcus aureus, nasal carriers:

Children and Adolescents:

Rifampin (Rifampicin) Pregnancy Risk Category: C

Rifampin use during breastfeeding:

Dose in Kidney Disease:

Dose in Liver disease:

Side effects of Rifampin (Rifampicin):

Cardiovascular:

Central Nervous System:

Dermatologic:

Endocrine & Metabolic:

Gastrointestinal:

Genitourinary:

Hematologic & Oncologic:

Hepatic:

Hypersensitivity:

Neuromuscular & Skeletal:

Ophthalmic:

Renal: