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Dear Readers! I started this blog when my daughter was in the NICU. She had ventriculitis. Her CSF report grew E.coli. But, she was injected Teicoplanin directly into her brain. The doctors made two errors here:

Teicoplanin is for gram-positive bacteria only. It does not treat E.coli.
Teicoplanin is not for intraventricular use. The manufacturer strongly discourage injecting Teicoplanin into the brain.

My daughter bled into the brain. She lived for another two years and ultimately died.

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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:
- Neisseria meningitidis treatment for asymptomatic carriers to eradicate 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 give in addition to other antitubercular medications.

Dosing:
- Manufacturer's labeling:
  - One dose of 10 mg/kg/day (up to 600 mg/day) is given each day.
- Alternate recommendations: ATS/CDC/IDSA Drug-susceptible tuberculosis guideline recommendations:
  - One time-daily therapy: 10 mg once day per kg (usual dose: 600 mg).

Note: During the intensive and continuation periods, once daily administration is ideal; however, directly observed therapy (DOT) administered five days a week is a viable alternative.

Twice-weekly or three-times-weekly DOT:

10 mg/kg/dose (average dose: 600 mg), given twice or three times each week.

Regimens:

The initial 2-month phase of a 4-drug regimen for the treatment of pulmonary tuberculosis and tuberculous meningitis is followed by continuation phases of 4–7 months of rifampin and isoniazid for pulmonary tuberculosis and 7–10 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).
An initial treatment plan using fewer than four medications may be taken into consideration if the isoniazid resistance rate is less than 4%.
When susceptibility data are available, reconsider the necessity for a fourth medication.
For tuberculous meningitis, adjunctive corticosteroid therapy, tapered over 6 to 8 weeks, is also advised (examples: dexamethasone, prednisolone).
The dosage modification depends on the chosen treatment plan; refer to the most recent 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 for four months, with a daily cap of 600 mg.

Note: Pyrazinamide should not be used with.

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

Oral: For seven to ten days, take 300 mg twice day.

Note:

Make sure that Rocky Mountain spotted fever (RMSF) has been ruled out before using rifampin because it is ineffective for treating RMSF.
Rifampin is also ineffective for treating Lyme disease; alternative antimicrobial treatments should be used if co-infection with B. burgdorferi is suspected.

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

Oral, IV: Vancomycin should be taken with 600 mg once daily or 300 to 450 mg twice daily for 4 to 6 weeks.

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

Oral: For six weeks, take 600 to 900 mg once daily when taking doxycycline.
To more clearly identify the role of rifampin in this situation, additional information may be required.

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: 300 to 450 mg twice daily when combined with additional anti-staphylococcal medications, or 600 mg once daily.

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

MRSA:
- For at least six weeks, take 300 mg each 8 hours (combine with vancomycin for the entire duration of therapy and gentamicin for the first 2 weeks).
MSSA:
- For at least six weeks, take 300 mg each 8 hours (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: For four days, take 600 mg once daily.

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

Lepromatous (multibacillary):
- National Hansen Disease Program:
  - In conjunction with clofazimine and dapsone, 600 mg once daily for 24 months.
- World Health Organization:
  - For a year, take 600 mg once a month with clofazimine and dapsone.
Tuberculoid (paucibacillary):
- National Hansen Disease Program:
  - Combined with dapsone for a 12-month period, 600 mg once daily.
- World Health Organization:
  - Dapsone and 600 mg once every month for six months.

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

Pathogen-specific therapy:
- Oral, IV: 600 mg once daily;
- Utilize alongside other antimicrobials.

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

Oral, IV: 5 to 10 days at 600 mg per day;
Note:
- Using at least one additional systemic anti-staphylococcal antibiotic is required.
- The data is insufficient to support its usage in patients with recurrent infections, hence it is not advised as a first-line treatment for decolonization.

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

Mycobacterium avium complex (nodular or bronchiectatic disease):
- Ethambutol 600 mg administered three times per week along with a macrolide (azithromycin or clarithromycin) three times per week
- Continue therapy until the patient has been receiving therapy for a year and is culture-negative.
Mycobacterium avium complex (severe nodular, bronchiectatic, or cavitary lung disease):
- Continue treatment until the patient has been culture-negative on medication for a year. The dosage is 600 mg (450 mg in individuals weighing under 50 kg) once daily in conjunction with a daily macrolide (azithromycin or clarithromycin) and ethambutol therapy.
- Early on in treatment, you might also think about adding amikacin or streptomycin three times a week.
Mycobacterium avium complex (cystic fibrosis patients):
- <50 kg:
  - 450 mg once daily in addition to ethambutol and a daily macrolide (azithromycin [recommended] or clarithromycin)
- >50 kg:
  - 600 mg once daily in addition to ethambutol and a daily macrolide (azithromycin [recommended] or clarithromycin)
Mycobacterium kansasii infection:
- Take 600 mg once daily along with daily doses of ethambutol and isoniazid; maintain therapy until the patient has been culture-negative for a year.

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

Oral, IV: For at least 8 weeks, in addition to trimethoprim/sulfamethoxazole, linezolid, or clindamycin, administer 600 mg once daily or 300 to 450 mg twice daily.

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:
- In addition to IV anti-staphylococcal drugs for 2 to 6 weeks, 300 to 450 mg every 12 hours.
Chronic Treatment following debridement and prosthesis retention or following 1-stage exchange:
- Total ankle, elbow, hip, or shoulder arthroplasty:
  - For three months, take 300 to 450 mg every 12 hours together with an oral staphylococcal antibiotic.
- Total knee arthroplasty:
  - For six months, take 300 to 450 mg every 12 hours together with an oral staphylococcal antibiotic.

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

Oral, IV: For four to six weeks, take 600 mg once a day or 300 to 450 mg twice a day with vancomycin.

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

Note: The majority of people with chronic carriage do not need antibiotics:

When combined with oral penicillin V:
- Oral: For the final four days of treatment, take 600 mg once day.
When combined with single dose IM penicillin G benzathine:
- Oral: For four days, take 300 mg twice daily.

Rifampin (Rifampicin) Dose in Children

Note:

Rarely is rifampin monotherapy recommended; the majority of reasons call for combined therapy with another antimicrobial drug.
Due to epidemiology (resistance) and new research, recommendations frequently change; if necessary, visit the CDC and WHO for the most recent advice.

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

Note:

Utilize at all times as part of a drug cocktail.
Less frequent dose regimens should be administered as directly monitored therapy (DOT).
Treatment plans for pulmonary tuberculosis typically start with a 4-drug intensive phase that lasts for 2 months, followed by 4–7 months of isoniazid and rifampin maintenance.
Depending on the treatment regimen chosen, rifampin frequency and dose varies; for more information, reference the most recent drug-sensitive TB guidelines.
ATS/CDC/IDSA Recommendations::

Note:

Refer to the special guidelines for HIV-exposed/positive patients for advice on how to handle medication interactions with antiretroviral therapy.
- Once-daily or 5-times-a-week (DOT):
  - Infants, Children, and Adolescents <15 years, weighing ≤40 kg:
    - Oral, IV: Once daily, 10 to 20 mg/kg, with a maximum dose of 600 mg
  - Children and Adolescents <15 years weighing >40 kg or Adolescents ≥15 years:
    - Oral, IV: 10 mg/kg once daily dosage (typical dose: 600 mg)
- Three-times-weekly DOT:

Note:

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

Note:

Not generally advised; not to be used by anyone with cavitary disease, HIV, or smear positivity.
Only after a once-daily (or five times per week) intensive phase of two weeks may this therapy be employed.
Missed doses have the same effect as weekly dosing, leading to medication resistance, ineffective treatment, and relapse.
Infants, Children, and Adolescents <15 years, weighing ≤40 kg:
- Oral, IV: 2 times a week, 10 to 20 mg/kg/dose
- 600 mg/dose is maximum dose
Children and Adolescents <15 years weighing >40 kg or Adolescents ≥15 years:
- Oral, IV: 2 times a week, 10 mg/kg/dose (typical dose: 600 mg)

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

Note: Those who cannot tolerate isoniazid or when isoniazid resistance is suspected may want to examine this option.

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

Note:

However, pharmacokinetic investigations indicate that smaller doses of rifampin do not fit the criterion. Lower dosages of 10 mg/kg/day have been described.
HIV-exposed/-positive:

Note: Due to drug-drug interactions with some antiretrovirals, it is not recommended for all HIV patients; for information on how to manage drug interactions with antiretroviral therapy, please refer to the particular guidelines (see Drug-Drug Interactions)

Infants and Children:
- Oral: onw timw, 10 to 20 mg/kg/dose everyday
- 600 mg/dose is maximum dose
- Use for 3 to 4 months in combination with isoniazid or for 4 to 6 months on its own.
- If you were exposed to an isoniazid mono-resistant source case, keep up your therapy for another six months.

Note: According to pharmacokinetic studies, rifampin at lower doses does not sufficiently expose patients to the drug.

Adolescents: Oral: Once daily for four months at 600 mg.

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

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

Note: It is ineffective when used as a monotherapy or on a regular basis in locations where tuberculosis is endemic.

Rifampin (Rifampicin) Dose in the treatment of Endocarditis:

Empiric therapy for prosthetic valve/material:
Note: Use alongside additional antibiotics
- Early infection (≤1-year postop)/ nosocomial infection associated with cannulation:
  - Children and Adolescents:
    - Oral, IV: In 8 hours, 20 mg/kg/day dividedly
    - 900 mg/day is maximum daily dose
- Late infection (>1-year postop):
  - Children and Adolescents:
    - Oral, IV: In 12 hours, 15 to 20 mg/kg/day dividedly
    - 600 mg/day is maximum daily dose

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

Infants, Children, and Adolescents:
- Oral, IV: Every 8 hours, 15 mg/kg/day dividedly
- 900 mg/day is maximum daily dose

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

Infants, Children, and Adolescents:
- Oral: 20 mg/kg/day given once daily for 4 days, with a dosage cap of 600 mg.

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

Infants, Children, and Adolescents:
- Oral: 20 mg/kg/day in divided doses administered every 12 hours for two days with a maximum dose of 600 mg

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

Infants, Children, and Adolescents:
- Oral: 2 doses, 10 to 20 mg/kg/day dividedly
- 600 mg/dose is maximum dose

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

Children and Adolescents:
- Oral: when paired with injectable benzathine penicillin G for 4 days, or 20 mg/kg/day split into two doses for the final 4 days of treatment when taken with oral penicillin V;
- 600 mg/day is maximum dose.

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

Children and Adolescents:
- Oral, IV: 5 to 10 days at a dose of 15 mg/kg/day divided into 12 hours;
- Note:
  - Using at least one additional systemic antistaphylococcal antibiotic is required.
  - The daily dosing cap is 600 mg.
  - No data are supplied for its use in patients with recurrent infections, making it not advised as a first-line decontamination treatment.

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.
Human granulocytic aplasmosis, commonly known as mild human anaplasmosis, may be treated during pregnancy with rifampin; small-scale case reports have shown that pregnant women who received rifampin treatment had healthy pregnancies and maternal outcomes.

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:

The manufacturer's labelling does not mention dosage modifications, so take cautious.

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 tipranavir, ritonavir/saquinavir, praziquantel, fosamprenavir, atazanavir, darunavir, or fosamprenavir.

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
- Acute exanthematous pustulosis (AGEP), toxic epidermal necrolysis (TEN), Stevens Johnson syndrome (SJS), and drug reactions with eosinophilia or systemic symptoms syndrome (DRESS) syndrome are examples of severe cutaneous adverse reactions.
- Stop receiving therapy if you experience symptoms or signs of SCAR.
Flu-like syndrome:
- Adults who regularly use >600mg have seen a significant rate of negative responses, 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:
- Early in therapy, hyperbilirubinemia can happen as a result of the competition between rifampin (bilirubin) and bilirubin in excretory pathways.
- 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:
- It should only be used for the short-term treatment of symptomatic carriers of meningococcal infections.
Porphyria
- Due to enzyme-inducing qualities, patients with porphyria should exercise caution as exacerbations have been seen.

Rifampin (rifampicin): Drug Interaction

Risk Factor C (Monitor therapy)
Apalutamide	The serum concentration of apalutamide may drop in response to CYP3A4 Inducers (Strong).
Ataluren	RifAMPin may lower the level of ataluren in the serum.
Barbiturates	The metabolism of barbiturates may be accelerated by rifamycin derivatives.
Bazedoxifene	Bazedoxifene's serum levels could drop due to RifAMPin. This could result in diminished effectiveness or, if bazedoxifene and oestrogen therapy are combined, a higher risk of endometrial hyperplasia.
BCG Vaccine (Immunization)	Antibiotics may reduce the BCG vaccine's therapeutic effect (Immunization).
Benperidol	The serum concentration of benperidol may fall in response to CYP3A4 Inducers (Strong).
Benzhydrocodone	CYP3A4 Inducers (Strong) may lower the level of benzhydrocodone in the blood. More specifically, hydrocodone serum concentrations might be decreased.
Beta-Blockers	Rifamycin derivatives may lower the level of beta-blockers in the blood. Atenolol, Carteolol (Ophthalmic), Levobunolol, Metipranolol, and Nadolol are exceptions.
Bosentan	RifAMPin may lower the level of bosentan in the serum. This effect is most likely to occur after the initial few weeks of concomitant rifampin use. Bosentan's serum levels may rise when RifAMPin is present. Most likely, this impact will be felt during the first several weeks of concurrent therapy (and may be greatest immediately following initiation of the combination). Management: Following the first four weeks of concurrent therapy, normal suggested monitoring should resume. Weekly monitoring of liver function tests is advised after that.
Brentuximab Vedotin	The serum concentration of Brentuximab Vedotin may decrease when CYP3A4 Inducers (Strong) are present. Particularly, levels of the active monomethyl auristatin E (MMAE) constituent could drop.
Brentuximab Vedotin	The serum concentration of Brentuximab Vedotin may drop in response to P-glycoprotein/ABCB1 Inducers. Particularly, levels of the active monomethyl auristatin E (MMAE) constituent could drop.
Buprenorphine	The serum concentration of buprenorphine may decrease after taking CYP3A4 Inducers (Strong).
Calcifediol	The serum concentration of calcifediol may drop in response to CYP3A4 Inducers (Strong).
Cannabidiol	The serum concentration of cannabidiol may drop in response to CYP3A4 Inducers (Strong).
Cannabidiol	The serum concentration of cannabidiol may drop in response to CYP2C19 Inducers (Strong).
Cannabis	Cannabis serum concentrations may be reduced by strong CYP3A4 inducers. Serum concentrations of tetrahydrocannabinol and cannabidiol may fall, to be more precise.
CarBAMazepine	CarBAMazepine's serum levels may drop if CYP3A4 Inducers (Strong) are present.
Celiprolol	The serum concentration of celiprolol may drop in response to P-glycoprotein/ABCB1 Inducers.
Citalopram	Citalopram serum levels could drop due to RifAMPin.
Cladribine	It is possible that BCRP/ABCG2 Inducers will lower the level of Cladribine in the blood.
Cladribine	The serum concentration of Cladribine may drop in response to P-glycoprotein/ABCB1 Inducers.
Clopidogrel	The active metabolite(s) of clopidogrel may be present in higher serum quantities while taking CYP2C19 Inducers (Strong).
Codeine	The serum concentrations of the active metabolite(s) of codeine may be lowered by CYP3A4 Inducers (Strong).
Corticosteroids (Systemic)	Strong CYP3A4 Inducers may lower the level of corticosteroids in the blood (Systemic). Hydrocortisone (Systemic), PrednisoLONE (Systemic), and PredniSONE are exceptions.
CYP2B6 Substrates (High risk with Inducers)	The serum concentration of CYP2B6 Substrates may drop in response to CYP2B6 Inducers (Moderate) (High risk with Inducers).
CYP2C9 Substrates (High risk with Inducers)	The serum concentration of CYP2C9 Substrates may drop in response to CYP2C9 Inducers (Moderate) (High risk with Inducers).
Dabrafenib	CYP3A4 Inducers (Strong) may lower the level of dabrafenib in the blood.
Diclofenac (Systemic)	Diclofenac's serum levels may be decreased by moderately potent CYP2C9 inducers (Systemic).
Diethylstilbestrol	Diethylstilbestrol levels in the serum may be reduced by CYP3A4 Inducers (Strong).
Disopyramide	The blood content of Disopyramide may drop after using RifAMPin.
Doxercalciferol	The active metabolite(s) of doxercalciferol may be present in higher serum concentrations when CYP3A4 Inducers (Strong) are present.
Doxycycline	The serum concentration of Doxycycline may be lowered by RifAMPin.
Dronabinol	The serum concentration ofdronabinol may drop in response to CYP3A4 Inducers (Strong).
Efavirenz	Efavirenz's serum levels may drop if RifAMPin is used.
Eltrombopag	May raise the level of OATP1B1/1B3 (SLCO1B1/1B3) Substrates in the serum.
Estriol (Systemic)	Strong CYP3A4 Inducers may lower serum estriol concentrations (Systemic).
Estriol (Topical)	Strong CYP3A4 Inducers may lower serum estriol concentrations (Topical).
Evogliptin	Evogliptin's serum levels may be reduced by CYP3A4 Inducers (Strong).
FentaNYL	The blood concentration of FentaNYL may drop when CYP3A4 Inducers (Strong) are taken.
Fexofenadine	The blood concentration of Fexofenadine may drop after using RifAMPin. Fexofenadine's serum levels may rise in response to RifAMPin.
Gemfibrozil	May raise the level of OATP1B1/1B3 (SLCO1B1/1B3) Substrates in the serum.Agents indicated as exceptions should be examined in separate drug interaction monographs.
Gestrinone	RifAMPin may lower the level of gestrinone in the blood.
HYDROcodone	CYP3A4 Inducers (Strong) may lower the level of HYDROcodone in the blood.
Hydrocortisone (Systemic)	CYP3A4 Inducers (Strong) may lower the level of hydrocortisone in the blood (Systemic).
Ifosfamide	The active metabolite(s) of ifosfamide may be present in lower serum quantities when CYP3A4 Inducers (Strong) are present. The blood concentrations of the active metabolite(s) of ifosfamide may rise in response to CYP3A4 Inducers (Strong).
Isoniazid	Isoniazid's hepatotoxic effects may be increased by derivatives of rifamycin. Even so, this combined regimen is often used.
Lactobacillus and Estriol	The therapeutic effects of Lactobacillus and Estriol may be reduced by antibiotics.
LamoTRIgine	RifAMPin may speed up LamoTRIgine's metabolism.
Leflunomide	Leflunomide's active metabolite concentrations in the serum may rise as a result of RifAMPin.
Lesinurad	Lesinurad's serum levels may be decreased by CYP2C9 Inducers (Moderate).
Levomethadone	Levomethadone's serum levels may drop as a result of RifAMPin.
Lornoxicam	It's possible that CYP2C9 Inducers (Moderate) will lower the level of Lornoxicam in your blood.
Losartan	RifAMPin may lower the level of losartan in the serum.
Lumacaftor	May lower the level of P-glycoprotein/ABCB1 Substrates in the serum. The serum concentration of P-glycoprotein/ABCB1 Substrates may rise when using lumacaftor.
Mirabegron	RifAMPin may lower the level of Mirabegron in the serum.
Morphine (Systemic)	RifAMPin may lower the level of morphine in the blood (Systemic).
Nalmefene	RifAMPin may lower the level of nalmefene in the blood.
OLANZapine	OLANZapine's serum levels may drop if RifAMPin is used.
Oxcarbazepine	RifAMPin may lower serum levels of OXcarbazepine's active metabolite(s). Particularly, levels of the main active 10-monohydroxy metabolite may drop.
OxyCODONE	RifAMPin may lower the level of OxyCODONE in the serum.
P-glycoprotein/ABCB1 Inducers	May lower the level of Pglycoprotein/ABCB1 Substrates in the serum. P-glycoprotein inducers may also further restrict the distribution of p-glycoprotein substrates to particular cells, tissues, and organs that have high levels of p-glycoprotein (e.g., brain, T-lymphocytes, testes, etc.).
P-glycoprotein/ABCB1 Inhibitors	Pglycoprotein/ABCB1 Substrates serum levels can rise. Additionally, p-glycoprotein inhibitors may improve the distribution of pglycoprotein substrates to particular cells, tissues, and organs where high levels of p-glycoprotein are present (e.g., brain, T-lymphocytes, testes, etc.).
P-glycoprotein/ABCB1 Substrates	The serum concentration of P-glycoprotein/ABCB1 Substrates may be reduced by P-glycoprotein/ABCB1 Inducers. P-glycoprotein inducers may also further restrict the distribution of p-glycoprotein substrates to particular cells, tissues, and organs that have high levels of p-glycoprotein (e.g., brain, T-lymphocytes, testes, etc.). Betrixaban and Edoxaban are exceptions.
Polatuzumab Vedotin	CYP3A4 Inducers (Strong) may lower the level of Polatuzumab Vedotin in the serum. There may be less exposure to the cytotoxic small molecule in polatuzumab vedotin known as unconjugated MMAE.
Prasugrel	Prasugrel's ability to inhibit platelets may be lessened by RifAMPin.
Pravastatin	Pravastatin's serum levels may drop as a result of RifAMPin.
PrednisoLONE (Systemic)	PrednisoLONE serum levels may be decreased by CYP3A4 Inducers (Strong) (Systemic).
PredniSONE	The blood concentration of PredniSONE may drop when CYP3A4 Inducers (Strong) are taken.
Propacetamol	The drug RifAMPin may speed up propacetamol's metabolism. This could decrease the intended effects of propacetamol and raise the risk of liver damage.
Propafenone	Propafenone's serum levels may drop if you take CYP3A4 Inducers (Strong).
Ramelteon	Ramelteon's serum levels may drop when taken with CYP3A4 Inducers (Strong).
Reboxetine	Reboxetine's serum levels may drop if you take CYP3A4 Inducers (Strong).
Rosuvastatin	Rosuvastatin's serum levels may drop if you use RifAMPin.
Ruxolitinib	Ruxolitinib's serum levels may drop when CYP3A4 Inducers (Strong) are present.
SAXagliptin	The blood concentration of SAXagliptin may decrease in response to CYP3A4 Inducers (Strong).
Sertraline	CYP3A4 Inducers (Strong) may lower the level of sertraline in the blood.
SUFentanil	CYP3A4 Inducers (Strong) may lower the level of SUFentanil in the serum.
Sulfamethoxazole	Sulfamethoxazole's serum levels may drop if RifAMPin is used.
Terbinafine (Systemic)	Terbinafine serum levels may drop when RifAMPin is used (Systemic).
Teriflunomide	May raise the level of OATP1B1/1B3 (SLCO1B1/1B3) Substrates in the serum.
Tetrahydrocannabinol	Tetrahydrocannabinol's serum levels may be reduced by CYP3A4 Inducers (Strong).
Tetrahydrocannabinol and Cannabidiol	Tetrahydrocannabinol and cannabidiol serum concentrations may be lowered by CYP3A4 Inducers (Strong).
Thyroid Products	RifAMPin may lower the level of thyroid products in the blood.
TraMADol	The content of TraMADol in the serum may drop after taking CYP3A4 Inducers (Strong).
Treprostinil	The serum content of Treprostinil may drop after taking RifAMPin.
Trimethoprim	Trimethoprim's serum levels may drop as a result of RifAMPin.
Tropisetron	Tropisetron's serum levels may drop when taken with CYP3A4 Inducers (Strong).
Udenafil	CYP3A4 Inducers (Strong) may lower the level of udenafil in the blood.
Vitamin K Antagonists (eg, warfarin)	The metabolism of Vitamin K antagonists may be accelerated by rifamycin derivatives.
Zidovudine	Zidovudine serum concentrations may drop when using rifamycin derivatives.
Zuclopenthixol	CYP3A4 Inducers (Strong) may lower the level of zuclopenthixol in the blood.
Risk Factor D (Consider therapy modification)
Abiraterone Acetate	Abiraterone Acetate serum levels may be reduced by CYP3A4 Inducers (Strong). Management: Steer clear of whenever you can. Abiraterone acetate dosage should be increased from once daily to twice daily while using it concurrently if such a combination cannot be avoided.
Acalabrutinib	Acalabrutinib's serum levels may be reduced by CYP3A4 Inducers (Strong). Treatment: Patients receiving acalabrutinib should not use other medications that strongly stimulate CYP3A. Increase the dosage of acalabrutinib to 200 mg twice daily if strong CYP3A inducers cannot be avoided.
Afatinib	The serum concentration of Afatinib may drop in response to P-glycoprotein/ABCB1 Inducers. Treatment: In accordance with US labelling, if continuous P-gp inducer use is necessary, raise the afatinib dose by 10 mg as tolerated; then decrease it to the original dose 2-3 days after quitting P-gp inducers. Avoid mixing, as per Canadian labelling.
Alfentanil	Rifamycin derivatives may lower the level of alfentanil in the blood. Management: Keep an eye out for signs of diminished alfentanil efficacy. Alfentanil dosages will probably need to be increased. Alternative options include switching from alfentanil to another opioid anaesthetic (such as sufentanil).
Amiodarone	The active metabolite(s) of amiodarone may have lower serum concentrations after taking rifAMPin. Concentrations of desethylamiodarone in particular could drop. RifAMPin may lower the level of amiodarone in the blood. Management: Look for substitutes. Keep a watchful eye out for diminished amiodarone concentrations or effects when combined. Dose modification might be required.
Antifungal Agents (Azole Derivatives, Systemic)	Rifamycin derivatives' serum levels can rise. Rifabutin appears to be the only drug impacted. Rifamycin derivatives may lower the level of antifungal agents in the serum (Azole Derivatives, Systemic). Management: Whenever you can, stay away from these pairings. Isavuconazonium and voriconazole are regarded as contraindicated.
ARIPiprazole	ARIPiprazole's serum concentration may be reduced by CYP3A4 Inducers (Strong). Double the oral aripiprazole dose and constantly monitor the situation. If the inducer is stopped, lower the dose of oral aripiprazole (for adults) to 10-15 mg/day. Aripiprazole injectable with extended release should not be taken for longer than 14 days while with potent CYP3A4 inducers.
ARIPiprazole Lauroxil	The active metabolite(s) of ARIPiprazole Lauroxil may be present in lower serum quantities when CYP3A4 Inducers (Strong) are present. Management: If taken for more than 14 days with a potent CYP3A4 inducer, patients taking the 441 mg dose of aripiprazole lauroxil increase their dose to 662 mg. For individuals taking the higher doses of aripiprazole lauroxil, there is no need to change the dosage.
Avatrombopag	The serum concentration of Avatrombopag may be lowered by RifAMPin. Management: Depending on the avatrombopag indication, this interaction is managed differently.
Brexpiprazole	Brexpiprazole's serum levels may be reduced by CYP3A4 Inducers (Strong). Treatment: The dose of brexpiprazole should be progressively increased over the course of one to two weeks if it is combined with a potent CYP3A4 inducer.
Brivaracetam	Brivaracetam serum levels may be lowered by rifAMPin. Treatment: If brivaracetam and rifampin are taken together, increase the dose of brivaracetam by up to 100% (i.e., double the dose).
BusPIRone	BusPIRone serum levels may be decreased by CYP3A4 Inducers (Strong). Management: Take into account alternatives to this fusion. Monitor patients for diminished buspirone effects if coadministration of these medications is judged necessary, and increase buspirone doses as necessary.
Cabozantinib	The serum concentration of Cabozantinib may fall in response to CYP3A4 Inducers (Strong). Management: If at all feasible, stay away from taking cabozantinib with potent CYP3A4 inducers. Depending on the cabozantinib product used and the intended use, cabozantinib dose modifications are advised if taken in conjunction. Monograph for more information.
Calcium Channel Blockers	Calcium Channel Blockers' serum levels may be reduced by rifamycin derivatives. This predominantly affects calcium channel blockers used orally. Management: Using rifampin with certain calcium channel blockers is not advised according to the labelling in the US and Canada. Look up the relevant labelling. Exceptions: Clevidipine.
Canagliflozin	Canagliflozin's serum levels may drop if RifAMPin is used. In patients with estimated GFR >60 mL/min/1.73 m2, who take canagliflozin 100 mg/day and need more glycemic control, consider increasing canagliflozin dose to 300 mg/day.
Caspofungin	Caspofungin's serum levels may drop if RifAMPin is used. Treatment: Caspofungin prescribing information suggests a dose of 70 mg per day for adults (or 70 mg/m, up to a maximum of 70 mg, per day for paediatric patients) receiving rifampin. 2
CeFAZolin	May intensify RifAMPin's negative or harmful effects. In particular, there may be an elevated risk of bleeding. Management: Whenever possible, avoid taking rifampin and cefazolin concurrently. Prothrombin time or other coagulation tests should be closely watched if combined, and vitamin K should be given as needed.
Cephalosporins (N-methylthiotetrazole [NMTT] Side Chain Containing)	May intensify RifAMPin's negative or harmful effects. In particular, there may be an elevated risk of bleeding. Management: Whenever feasible, avoid using rifampin concurrently with cephalosporins that have an NMTT side chain. Prothrombin time or other coagulation parameters should be closely monitored if combined.
Chloramphenicol (Systemic)	RifAMPin may speed up chloramphenicol metabolism (Systemic).
Clarithromycin	The serum concentrations of the active metabolite(s) of clarithromycin may rise in response to CYP3A4 Inducers (Strong). Clarithromycin may raise the level of CYP3A4 inducers in the serum (Strong). CYP3A4 Inducers (Strong) may lower the level of clarithromycin in the blood. If a patient is receiving a CYP3A inducer, other antimicrobial therapy should be considered. Drugs that speed up the conversion of clarithromycin into 14hydroxyclarithromycin may change the drug's therapeutic action and reduce its effectiveness.
CycloSPORINE (Systemic)	CycloSPORINE metabolism may be increased by rifamycin derivatives (Systemic).
CYP2C19 Substrates (High risk with Inducers)	The metabolism of CYP2C19 Substrates may be increased by strong CYP2C19 Inducers (High risk with Inducers). Management: Take into account a substitute for one of the interfering medications. Specific contraindications may apply to some combinations. the relevant manufacturer's label.
CYP3A4 Substrates (High risk with Inducers)	The metabolism of CYP3A4 Substrates may be increased by strong CYP3A4 Inducers (High risk with Inducers). Management: Take into account a substitute for one of the interfering medications. Specific contraindications may apply to some combinations. the relevant manufacturer's label. Benzhydrocodone, Buprenorphine, CarBAMazepine, Etizolam, Hydrocodone, Tramadol, and Zolpidem are examples of exclusions.
Dasatinib	Dasatinib's serum levels may be lowered by CYP3A4 Inducers (Strong). Management: Avert wherever you can. Consider raising the dasatinib dose and closely monitoring clinical response and toxicity if such a combination cannot be avoided.
Deferasirox	RifAMPin may lower the level of Deferasirox in the serum. Management: If a combination must be used, consider increasing the first deferasirox dose by 50% and using clinical responses and monitoring of serum ferritin concentrations to direct future dosing.
Dexamethasone (Systemic)	Dexamethasone serum levels may be decreased by CYP3A4 Inducers (Strong) (Systemic). In patients taking potent CYP3A4 inducers, consider increasing the dose of dexamethasone, and watch out for signs of diminished steroid efficacy.
Dolutegravir	RifAMPin may lower the level of dolutegravir in the serum. Treatment: Increase the dosage of dolutegravir in adults and children to 50 mg twice day. For INSTI-experienced patients with clinically suspected INSTI resistance or specific INSTI linked resistance substitutions, consider alternatives to rifampin.
DOXOrubicin (Conventional)	Strong CYP3A4 Inducers may lower DOXOrubicin serum levels (Conventional). Treatment: In individuals receiving doxorubicin, look for alternatives to medications that are potent CYP3A4 inducers. Pfizer Inc., a U.S. manufacturer, advises against using certain mixtures.
DOXOrubicin (Conventional)	The serum concentration of DOXOrubicin may drop in response to P-glycoprotein/ABCB1 Inducers (Conventional). Treatment: Whenever possible, avoid using P-glycoprotein inducers in patients receiving doxorubicin. Pfizer Inc., a U.S. manufacturer, advises against using certain mixtures.
Elagolix	Elagolix's serum levels may be raised with RifAMPin. Management: It is not advised to combine elagolix 200 mg twice daily with rifampin. Use of elagolix 150 mg once daily in combination with rifampin should be limited to no more than 6 months.
Eluxadoline	Eluxadoline's serum levels may rise in response to RifAMPin. Management: If eluxadoline and rifampin are taken together, reduce the dose to 75 mg twice daily, and keep an eye on patients for any worsening eluxadoline side effects.
Enzalutamide	Enzalutamide's serum levels may be reduced by CYP3A4 Inducers (Strong). Management: Whenever possible, choose an alternate agent with little to no ability to induce CYP3A4. Increase the dosage of enzalutamide from 160 mg daily to 240 mg daily if this combination cannot be avoided.
Eravacycline	Eravacycline's serum levels may be reduced by CYP3A4 Inducers (Strong). When used with potent CYP3A4 inducers, the eravacycline dose should be increased to 1.5 mg/kg every 12 hours.
Erlotinib	Erlotinib's serum levels may drop when CYP3A4 Inducers (Strong) are taken. Management: If at all possible, avoid combining. Erlotinib dosage should be increased if a combination is necessary.
Estrogen Derivatives (Contraceptive)	Estrogen derivative serum levels may be reduced by rifamycin derivatives (Contraceptive). Failure with contraception is possible. Management: It is advised to use a complementary, nonhormonal method of birth control.
Etoposide	CYP3A4 Inducers (Strong) may lower the level of etoposide in the blood. Treatment: When treating patients taking etoposide, look for alternatives to potent CYP3A4-inducing drugs. If coupled, keep a close eye on the patients for a decreased etoposide response and the requirement for etoposide dose increases.
Etoposide Phosphate	The serum concentration of etoposide phosphate may be reduced by CYP3A4 Inducers (Strong). Treatment: In patients receiving etoposide phosphate, look for alternatives to powerful CYP3A4-inducing drugs if possible. If it's impossible to avoid certain combinations, keep a close eye on the patients' etoposide phosphate reaction.
Everolimus	CYP3A4 Inducers (Strong) may lower the level of Everolimus in the blood. Management: If at all possible, refrain from using potent CYP3A4 inducers concurrently. Use increments of no more than 5 mg to double the daily dose of everolimus if coadministration cannot be avoided. When necessary, closely monitor everolimus serum concentrations.
Exemestane	The serum concentration of Exemestane may be lowered by CYP3A4 Inducers (Strong). Management: The U.S. product labelling for exemestane advises using a higher dose (50 mg/day) in individuals who are also taking potent CYP3A4 inducers. With concurrent use of potent CYP3A4 inducers, a dose change is not advised according to the Canadian product labelling.
Fosphenytoin	RifAMPin may lower the level of fosphenytoin in the blood. Management: When possible, look for alternatives. If both medications are taken, keep a close eye out for any changes in serum phenytoin levels after starting or increasing the dose of rifampin, as well as any changes in concentrations and any adverse effects.
Gefitinib	Gefitinib's serum levels may be reduced by CYP3A4 Inducers (Strong). Treatment: In patients receiving strong CYP3A4 inducers, raise gefitinib dose to 500 mg daily in the absence of serious adverse effects; restart 250 mg dose 7 days after stopping the strong inducer. Keep a close eye on the clinical response.
GuanFACINE	The content of GuanFACINE in the serum may drop while taking CYP3A4 Inducers (Strong). Treatment: When starting guanfacine in a patient receiving a potent CYP3A4 inducer, increase the guanfacine dose by up to doubling. If starting strong CYP3A4 inducer medication in a patient who is currently receiving guanfacine, increase the dose of guanfacine gradually over 1 to 2 weeks.
HMG-CoA Reductase Inhibitors (Statins)	HMG-CoA Reductase Inhibitors' serum levels may drop when rifamycin derivatives are used (Statins). Management: Take into account using separate antilipemic medications (note: pitavastatin concentrations may increase with rifamycin treatment).
Imatinib	The serum concentration of imatinib may be lowered by rifamycin derivatives. Management: Whenever feasible, refrain from using imatinib and rifamycin derivatives together. If it is necessary to utilise such a combination, increase the imatinib dose by at least 50% and keep a careful eye on the patient's clinical reaction.
Imatinib	It is possible for CYP3A4 Inducers (Strong) to lower the level of imatinib in the blood. Management: When possible, avoid taking imatinib at the same time as potent CYP3A4 inducers. If it is necessary to utilise such a combination, increase the imatinib dose by at least 50% and keep a careful eye on the patient's clinical reaction.
Ixabepilone	Ixabepilone's serum levels may be reduced by CYP3A4 Inducers (Strong). Management: Whenever possible, stay away from this combo. If it is necessary to employ this combination, ixabepilone dosage should be gradually increased from 40 mg/m to 60 mg/m (given as a 4-hour infusion)
Larotrectinib	Larotrectinib's serum levels may be reduced by CYP3A4 Inducers (Strong). Avoid using potent CYP3A4 inducers when taking larotrectinib. Larotrectinib dosage should be doubled if this combination cannot be avoided. reduced to the original dose once the inducer has been stopped after a 3 to 5 times the inducer half-life interval.
Lefamulin	Lefamulin serum levels may be reduced by CYP3A4 Inducers (Strong). Management: Unless the advantages outweigh the hazards, avoid using lefamulin concurrently with potent CYP3A4 inducers.
Lefamulin	Lefamulin serum levels may be reduced by P-glycoprotein/ABCB1 Inducers. Management: Unless the advantages outweigh the hazards, avoid using lefamulin concurrently with P-glycoprotein/ABCB1 inducers.
Lefamulin (Intravenous)	Strong CYP3A4 Inducers may lower Lefamulin serum levels (Intravenous). Avoid using powerful CYP3A4 inducers and lefamulin IV infusion simultaneously unless the benefits outweigh the risks.
Lefamulin (Intravenous)	Lefamulin levels in the serum may be decreased by P-glycoprotein/ABCB1 Inducers (Intravenous). Management: Lefamulin (intravenous) should not be used concurrently with P-glycoprotein/ABCB1 inducers unless the advantages exceed the dangers.
LinaGLIPtin	The serum concentration of LinaGLIPtin may drop in response to CYP3A4 Inducers (Strong). Treatment: When administering a powerful CYP3A4 inducer to patients receiving linagliptin, strongly consider utilising an alternative. If this combination is utilised, keep a watchful eye on the patients for signs of diminished linagliptin effectiveness.
LinaGLIPtin	The serum concentration of LinaGLIPtin may drop in response to P-glycoprotein/ABCB1 Inducers. Treatment: If a patient is receiving linagliptin, strongly consider utilising an alternate to any strong P-glycoprotein inducer. If this combination is utilised, keep a watchful eye on the patients for signs of diminished linagliptin effectiveness.
Macrolide Antibiotics	Rifamycin derivatives' metabolism might be slowed down. Azithromycin (Systemic), Fidaxomicin, Roxithromycin, and Spiramycin are exceptions.
Manidipine	Manidipine's serum levels may drop when CYP3A4 Inducers (Strong) are taken. Treatment: Take into account avoiding the simultaneous use of manidipine and potent CYP3A4 inducers. If taken together, keep a watchful eye out for diminished manidipine effects and diminished efficacy. Manidipine dosages may need to be increased.
Maraviroc	It's possible that CYP3A4 Inducers (Strong) will lower the level of Maraviroc in your blood. Management: When used with potent CYP3A4 inducers, increase the adult dose of maraviroc to 600 mg twice daily. Patients who are also getting potent CYP3A4 inhibitors are not covered by this. With strong CYP3A4 inducers, do not administer maraviroc to patients with CrCl less than 30 mL/min.
Meperidine	Meperidine's serum levels may drop if CYP3A4 Inducers (Strong) are present. When using strong CYP3A4 inducers concurrently, the dose of meperidine may need to be increased. Keep an eye out for the effects of opioid withdrawal.
Methadone	The serum concentration of methadone may be lowered by derivatives of rifamycin. Management: When possible, look for alternatives. If administered concurrently, keep a close eye out for methadone withdrawal symptoms while starting the rifamycin derivative and for excessive sedation when stopping it.
MethylPREDNISolone	The serum concentration of methylPREDNISolone may drop in response to CYP3A4 Inducers (Strong). In patients taking potent CYP3A4 inducers, consider increasing the dose of methylprednisolone, and keep a watchful eye out for signs of diminished steroid efficacy.
Mirodenafil	CYP3A4 Inducers (Strong) may lower the level of mirodenafil in the blood. Management: Take into account avoiding the simultaneous use of strong CYP3A4 inducers and mirodenafil. Watch for diminished effects of the combination drug, mirodenafil. It might be necessary to raise the dose of mirodenafil to get the results you want.
Nevirapine	Nevirapine's serum levels may drop if RifAMPin is used. Management: Steer clear of whenever you can. Use immediate-release nevirapine (avoid extended-release nevirapine) at a dose of 200 mg twice daily without a lead-in when this combination is required, according to adult/adolescent HIV guidelines. Keep a watchful eye on the nevirapine reaction.
Nitrazepam	RifAMPin may lower the level of nitrazepam in the blood. Management: Keep a watchful eye out for nitrazepam's diminished effects. When possible, think about increasing the original nitrazepam dose or finding an alternate to one of these medications.
Osimertinib	Osimertinib's serum levels may be reduced by CYP3A4 Inducers (Strong).
Paliperidone	The serum concentration of paliperidone may be decreased by CYP3A4 (Strong) and P-glycoprotein inducers. Management: If at all possible, refrain from combining inducers of both CYP3A4 and P-glycoprotein throughout the 3-month dosage interval with the 3-month extended-release injectable suspension (Invega Trinza). When combining medications, think about utilising extended-release tablets.
Perampanel	CYP3A4 Inducers (Strong) may lower the level of Perampanel in the serum. When using perampanel alongside strong and moderate CYP3A4 inducers, the beginning dose should be increased to 4 mg/day.
Phenytoin	RifAMPin may lower the level of phenytoin in the blood. Management: When possible, look for alternatives. If both medications are taken, keep a watchful eye out for any changes in serum phenytoin levels after starting or increasing the dose of rifampin, or for any rises in levels and potentially harmful side effects after stopping or lowering the dose.
Pitavastatin	Pitavastatin's serum levels may rise as a result of rifamycin derivatives. Limit your intake of pitavastatin to no more than 2 mg per day when taking rifampin at the same time.
Pitolisant	Pitolisant's serum levels may drop if you take CYP3A4 Inducers (Strong). Treatment: For patients who are taking a potent CYP3A4 inducer and are stable on pitolisant doses of 8.9 mg or 17.8 mg per day, double the pitolisant dose over the course of seven days (i.e., to either 17.8 mg per day or 35.6 mg per day, respectively).
Progestins (Contraceptive)	Rifamycin derivatives may lower progesterone levels in the blood (Contraceptive). Failure with contraception is possible. Management: It is possible for contraceptives to fail. It is advised to use an alternative, nonhormonal method of birth control.
Propofol	RifAMPin might make Propofol's hypotensive effect stronger. Management: It should be noted that patients who have been taking rifampin may experience clinically significant hypotension if propofol is administered to them. Avoid using this combination if you can.
Prothionamide	Prothionamide's hepatotoxic effects may be amplified by RifAMPin. Management: If at all feasible, avoid using rifampin and prothionamide concurrently. If combination use is thought to be necessary, keep a cautious eye out for any indications or symptoms of hepatotoxicity in the patients (eg, jaundice, elevations in liver function tests).
Pyrazinamide	May intensify RifAMPin's hepatotoxic effects. In patients receiving these 2 medications as part of a 2-month therapy plan for latent TB infection, severe (even fatal) liver impairment has been seen.
QUEtiapine	CYP3A4 Inducers (Strong) may lower the level of quetiapine in the serum. Management: To sustain therapeutic benefit, a dose increase of quetiapine (up to five times the usual dose) may be necessary. Within 7–14 days of stopping the inducer, lower the quetiapine dosage to the previous/regular level.
QuiNIDine	QuiNIDine serum levels may be lowered by rifamycin derivatives. Due to the potential for significant quinidine concentration declines, management should consider alternatives to quinidine and rifampin combination therapy. When starting or increasing the dosage of any rifamycin derivative, keep an eye out for any decreasing quinidine concentrations or effects.
Radotinib	The serum concentration of Radotinib may drop when CYP3A4 Inducers (Strong) are taken. Management: When possible, look into alternatives to this combination because there may be an increased chance of radotinib treatment failure.
Raltegravir	Raltegravir's serum levels may drop as a result of RifAMPin. When taken with rifampin, the dosage of raltegravir should be increased to 800 mg twice daily (adult dose). It is not advised to take rifampin and once-daily raltegravir (Isentress HD) simultaneously.
Repaglinide	Repaglinide's serum levels may drop as a result of RifAMPin. Management: Take into account alternatives to this fusion. This interaction may be significantly impacted by the timing of the dose; in clinical investigations, the least significant interaction was observed when repaglinide was administered one hour after rifampin (compared to 0, 12, or 24 h).
RisperiDONE	The serum concentration of RisperiDONE may drop in response to CYP3A4 Inducers (Strong). Management: If a powerful CYP3A4 inducer is started, think about raising the dose of oral risperidone (to no more than twice the initial dose). Consider increasing the IM dose or giving additional oral doses of risperidone to patients who are currently receiving it.
Rolapitant	The serum concentration of Rolapitant may fall in response to CYP3A4 Inducers (Strong). Management: Refrain from administering rolapitant to individuals who need to use potent CYP3A4 inducers on a regular basis. Even with shorter-term use of such inducers, keep an eye out for diminished rolapitant response and the requirement for alternative or extra antiemetic medication.
Selexipag	The active metabolite(s) of selexipag may have lower serum concentrations after treatment with rifAMPin.
Sirolimus	CYP3A4 Inducers (Strong) may lower the level of Sirolimus in the blood. Management: If at all feasible, refrain from using sirolimus and potent CYP3A4 inducers together. Check for decreased serum sirolimus concentrations if the two are combined. Increases in sirolimus dosage will probably be required to prevent subtherapeutic sirolimus levels.
Sodium Picosulfate	Antibiotics may reduce Sodium Picosulfate's therapeutic impact. Management: If a patient previously used or is currently using an antibiotic, think about utilising an alternative product for bowel cleansing prior to a colonoscopy.
Sulfonylureas	The serum concentration of sulfonylureas may be lowered by rifAMPin. Management: When possible, look for substitutions for these mixtures. If rifampin is started or the dose is increased, keep a watchful eye out for therapeutic effects of sulfonylureas that are lowered or amplified.
SUNItinib	The serum concentration of SUNItinib may decrease in response to CYP3A4 Inducers (Strong). Management: Avert wherever you can. It is advised to raise sunitinib dosage, which varies depending on the indication, if such a combination cannot be avoided. For information, see the entire monograph.
Tacrolimus (Systemic)	Tacrolimus serum levels may be decreased by derivatives of rifamycin (Systemic). Management: When feasible, take into account alternatives. If this combination is used, keep an eye out for changes in tacrolimus concentrations or effects after starting or increasing the dose of rifamycin, or for changes in tacrolimus concentrations or effects after stopping or decreasing the dose of rifamycin.
Tadalafil	Tadalafil's serum levels may be lowered by CYP3A4 Inducers (Strong). Management: Monitor for diminished effectiveness in cases of erectile dysfunction; no usual dose modifications are advised. Tadalafil should not be used to treat pulmonary arterial hypertension in patients taking a potent CYP3A4 inducer.
Tamoxifen	The metabolism of Tamoxifen may be accelerated by rifamycin derivatives.
Tamoxifen	The active metabolite(s) of tamoxifen's serum concentrations may be reduced by CYP3A4 Inducers (Strong). Tamoxifen's serum levels may drop when CYP3A4 Inducers (Strong) are taken. Management: Look at alternatives to using tamoxifen and potent CYP3A4 inducers together. If the combination cannot be avoided, keep an eye out for diminished tamoxifen therapeutic benefits.
Temsirolimus	Temsirolimus serum levels may be lowered by rifamycin derivatives. The concentration of the active metabolite sirolimus will probably drop even further as a result of rifamycins. Treatment: The prescribing literature for temsirolimus warns against taking it with potent CYP3A4 inducers like rifampin; nonetheless, if concurrent therapy is required, an increase in the adult dose to 50 mg/week should be taken into consideration.
Temsirolimus	Temsirolimus' serum levels may drop if you use CYP3A4 Inducers (Strong). If a concurrent strong CYP3A4 inducer is required, consider raising the dose of temsirolimus from 25 mg IV/week to 50 mg IV/week.
Thiazolidinediones	Thiazolidinediones' metabolism may be accelerated by rifAMPin. Management: Take into account options to using rifampin and thiazolidinedione anti-diabetic medications together. Keep an eye out for any diminished effects of the thiazolidinedione derivative in individuals receiving these combinations.
Thiotepa	The serum concentrations of the active metabolite(s) of thiotepa may rise in response to CYP3A4 Inducers (Strong). Thiotepa serum levels may be decreased by CYP3A4 Inducers (Strong). Treatment: According to the prescribing advice for thiotepa, using the drug concurrently with potent CYP3A4 inducers is not advised. If concurrent use is inevitable, keep an eye out for any negative consequences.
TiaGABine	The serum concentration of tiagabine may drop in response to CYP3A4 Inducers (Strong). Treatment: Patients who are concurrently taking a potent CYP3A4 inducer will likely need to take tiagabine at dosages that are approximately 2-fold higher and titrate their doses more quickly.
Typhoid Vaccine	The Typhoid Vaccine's therapeutic benefits may be reduced by antibiotics. The only strain impacted is the live attenuated Ty21a strain. Treatment: Patients receiving systemic antibacterial drugs should refrain from receiving the live attenuated typhoid vaccination (Ty21a). It is recommended to wait at least 3 days following the last dose of antibacterial medication before administering this vaccine.
Valproate Products	The serum concentration of valproate products may drop after taking rifAMPin.
Vemurafenib	Vemurafenib's serum levels may be lowered by CYP3A4 Inducers (Strong). Management: While possible, substitute another medication for vemurafenib when taking it concurrently with a potent CYP3A4 inducer. Vemurafenib dosage can be increased by 240 mg (1 tablet) as tolerated if a potent CYP3A4 inducer is necessary and inevitable.
Vilazodone	Vilazodone's serum levels may be reduced by CYP3A4 Inducers (Strong). Management: If a patient has been taking a powerful CYP3A4 inducer for more than 14 days, consider raising the dose of vilazodone by up to double (do not exceed 80 mg/day), depending on the patient's response. After stopping the inducer, lower the vilazodone dosage over a period of one to two weeks.
Vortioxetine	It's possible that CYP3A4 Inducers (Strong) will lower Vortioxetine's serum levels. Management: When taken with a potent drug metabolism inducer for longer than 14 days, consider raising the vortioxetine dose to no more than three times the original dose. After quitting the potent inducer, the vortioxetine dosage should be returned to normal within 14 days.
Zaleplon	Strong CYP3A4 Inducers may lower the level of zaleplon in the blood. Treatment: In patients receiving potent CYP3A4 inducers, take into account using an alternate hypnotic that is not metabolised by this enzyme. If zalephon is taken alongside a potent CYP3A4 inducer, keep an eye out for any reduction in zalephon's efficiency.
Risk Factor X (Avoid combination)
Abemaciclib	Abemaciclib's serum levels may be reduced by CYP3A4 Inducers (Strong).
Alpelisib	CYP3A4 Inducers (Strong) may lower the level of alpelisib in the blood.
Antihepaciviral Combination Products	Antihepaciviral Combination Products' serum concentration may be decreased by CYP3A4 Inducers (Strong).
Apixaban	CYP3A4 Inducers (Strong) may lower the level of apixaban in the blood.
Apremilast	The serum concentration of apremilast may drop in response to CYP3A4 Inducers (Strong).
Aprepitant	The serum concentration of aprepitant may fall in response to CYP3A4 Inducers (Strong).
Artemether	The serum concentrations of the active metabolite(s) of armemethrin may be lowered by CYP3A4 Inducers (Strong). Concentrations of dihydroartemisinin in particular might be decreased. Artemether's serum levels may drop if CYP3A4 Inducers are taken in large doses.
Asunaprevir	Asunaprevir's serum levels may drop as a result of RifAMPin. Single-dose rifampin may raise asunaprevir concentrations; this effect is most likely with longer-term coadministration. Asunaprevir's serum levels may rise in response to RifAMPin. This result is most likely the result of a single dose or brief rifampin administration. Asunaprevir concentrations are probably going to drop with continued coadministration.
Atazanavir	RifAMPin may lower atazanavir's serum levels.
Atovaquone	The serum levels of atovaquone may drop if rifamycin derivatives are consumed.
Axitinib	Axitinib's serum levels may be reduced by CYP3A4 Inducers (Strong).
BCG (Intravesical)	Antibiotics may diminish the therapeutic effect of BCG (Intravesical).
Bedaquiline	The serum concentration of bedaquiline may be lowered by CYP3A4 Inducers (Strong).
Betrixaban	P-glycoprotein/ABCB1 Inducers may lower the level of betrixaban in the serum.
Bictegravir	Bictegravir's serum concentration may drop if you take RifAMPin.
Bortezomib	The serum concentration of Bortezomib may fall in response to CYP3A4 Inducers (Strong).
Bosutinib	The serum concentration of bosutinib may decrease after taking CYP3A4 Inducers (Strong).
Brigatinib	The serum concentration of Brigatinib may decrease after taking CYP3A4 Inducers (Strong).
Cariprazine	Cariprazine's serum levels may drop if CYP3A4 Inducers (Strong) are present.
Ceritinib	Ceritinib's serum levels may drop when CYP3A4 Inducers (Strong) are taken.
Cholera Vaccine	The therapeutic benefit of the cholera vaccine may be reduced by antibiotic use. Management: Cholera vaccine should not be administered to individuals taking systemic antibiotics or within 14 days after taking oral or parenteral antibiotics.
CloZAPine	The content of CloZAPine in the serum may be reduced by CYP3A4 Inducers (Strong).
Cobicistat	RifAMPin may lower the level of Cobicistat in the serum.
Cobimetinib	The serum concentration of Cobimetinib may be reduced by CYP3A4 Inducers (Strong).
Copanlisib	The serum concentration of Copanlisib may fall in response to CYP3A4 Inducers (Strong).
Crizotinib	Crizotinib's serum levels may be reduced by CYP3A4 Inducers (Strong).
Dabigatran Etexilate	The serum concentration of dabigatran etexilate may drop in response to P-glycoprotein/ABCB1 Inducers. Management: Whenever feasible, avoid using dabigatran at the same time as P-glycoprotein inducers.
Daclatasvir	The serum concentration of Daclatasvir may be reduced by CYP3A4 Inducers (Strong).
Darolutamide	The serum concentration of Darolutamide may be decreased by inducers of CYP3A4 (Strong) and P-glycoprotein.
Darunavir	RifAMPin may lower the level of Darunavir in the serum.
Dasabuvir	Dasabuvir's serum levels may be reduced by CYP3A4 Inducers (Strong).
Deflazacort	The serum concentrations of the active metabolite(s) of Deflazacort may be reduced by CYP3A4 Inducers (Strong).
Delamanid	It's possible that CYP3A4 Inducers (Strong) will lower the level of delamanid in your blood.
Delavirdine	Delavirdine's metabolism may be accelerated by rifamycin derivatives. Rifamycin derivatives' serum levels may rise in response to delavirdine. Rifabutin serum concentration may rise specifically.
Dienogest	The serum concentration of Dienogest may drop in response to CYP3A4 Inducers (Strong). Management: Avoid using dienogest as a method of contraception while taking drugs that activate CYP3A4 and for at least 28 days after stopping such drugs. During this time, an alternative method of contraception ought to be employed.
DilTIAZem	DilTIAZem's serum levels may drop when RifAMPin is used.
Doravirine	CYP3A4 Inducers (Strong) may lower the level of doravirine in the blood.
Dronedarone	CYP3A4 Inducers (Strong) may lower the level of dronedarone in the blood.
Duvelisib	It's possible that CYP3A4 Inducers (Strong) will lower Duvelisib's serum levels.
Edoxaban	RifAMPin may lower the level of Edoxaban in the serum.
Elbasvir	Elbasvir's serum levels may drop when CYP3A4 Inducers (Strong) are taken.
Eliglustat	Eliglustat's serum levels may be reduced by CYP3A4 Inducers (Strong).
Elvitegravir	Elvitegravir's serum levels may drop if RifAMPin is used.
Encorafenib	Encorafenib's serum levels may be reduced by CYP3A4 Inducers (Strong).
Entrectinib	The serum concentration of Entrectinib may drop when CYP3A4 Inducers (Strong) are present.
Erdafitinib	CYP3A4 Inducers (Strong) may lower the level of erfatinib in the blood.
Esomeprazole	The serum levels of Esomeprazole may drop after using RifAMPin.
Etravirine	CYP3A4 Inducers (Strong) may lower the level of etravirine in the serum.
Fedratinib	Fedratinib's serum levels may be reduced by CYP3A4 Inducers (Strong).
Fimasartan	Fimasartan's serum levels may rise in response to RifAMPin.
Flibanserin	Flibanserin's serum levels may drop if you take CYP3A4 Inducers (Strong).
Fosamprenavir	The serum concentration of Fosamprenavir may drop after using RifAMPin. Particularly, levels of the active metabolite amprenavir may drop.
Fosaprepitant	The serum concentration of fosaprepitant may be reduced by CYP3A4 Inducers (Strong). Particularly, CYP3A4 Inducers (Strong) may lower levels of the active metabolite aprepitant in the blood.
Fosnetupitant	The active metabolite(s) of fosnetupitant may be present in lower serum concentrations when CYP3A4 Inducers (Strong) are present.
Fostamatinib	The active metabolite(s) of foamamatinib may be present in lower serum concentrations when CYP3A4 Inducers (Strong) are present.
Gemigliptin	The active metabolite(s) of gemigliptin may be present in lower serum quantities when CYP3A4 Inducers (Strong) are present. Gemigliptin's serum levels may be reduced by CYP3A4 Inducers (Strong).
Gilteritinib	The serum concentration of gilteritinib may decrease when CYP3A4 and P-glycoprotein inducers are used.
Glasdegib	Glasdegib's serum levels may be reduced by CYP3A4 Inducers (Strong).
Glecaprevir and Pibrentasvir	Glecaprevir and Pibrentasvir's serum concentrations may drop as a result of RifAMPin. The serum concentration of Glecaprevir and Pibrentasvir may rise as a result of RifAMPin. Rifampin may specifically enhance glecaprevir/pibrentasvir concentrations when administered as a single dosage, however chronic daily rifampin use may decrease glecaprevir/pibrentasvir concentrations.
Grazoprevir	The blood concentration of Grazoprevir may be lowered by RifAMPin. Rifampin single dosages, on the other hand, may raise Grazoprevir concentrations.
Ibrutinib	Ibrutinib's serum levels may drop when CYP3A4 Inducers (Strong) are taken.
Idelalisib	Idelalisib's serum levels may be reduced by CYP3A4 Inducers (Strong).
Indinavir	Indinavir's serum levels could drop due to RifAMPin.
Irinotecan Products	The active metabolite(s) of irinotecan products may be present in lower serum quantities when CYP3A4 Inducers (Strong) are present. Particularly, serum levels of SN-38 could be decreased. The serum concentration of irinotecan products may be reduced by CYP3A4 Inducers (Strong).
Isavuconazonium Sulfate	The active metabolite(s) of isavuconazonium sulphate may be present in lower serum quantities when CYP3A4 Inducers (Strong) are present. Particularly, CYP3A4 Inducers (Strong) may lower serum concentrations of isavuconazole.
Itraconazole	Itraconazole's serum concentration may drop if you take CYP3A4 Inducers (Strong).
Ivabradine	Ivabradine's serum levels may be reduced by CYP3A4 Inducers (Strong).
Ivacaftor	Ivacaftor's serum levels may drop if you take CYP3A4 Inducers (Strong).
Ivosidenib	Ivosidenib's serum levels may be lowered by CYP3A4 Inducers (Strong).
Ixazomib	Ixazomib's serum levels may be lowered by CYP3A4 Inducers (Strong).
Lapatinib	It's possible that CYP3A4 Inducers (Strong) will lower lapatinib's serum levels. Treatment: If therapy overlap is unavoidable, consider titrating lapatinib gradually from 1,250 mg per day to 4,500 mg per day (for metastatic breast cancer that is HER2 positive) or 1,500 mg per day to 5,500 mg per day (for breast cancer that is HER2 positive and hormone receptor positive), as tolerated.
Ledipasvir	Ledipasvir's serum levels may be reduced by P-glycoprotein/ABCB1 Inducers.
Letermovir	Letermovir's serum levels may drop as a result of RifAMPin.
Lopinavir	RifAMPin may intensify Lopinavir's harmful or hazardous effects. Particularly, there may be a greater chance of hepatocellular toxicity. RifAMPin may lower the level of lopinavir in the serum.
Lorlatinib	CYP3A4 Inducers (Strong) may lower the level of lorlatinib in the blood.
Lumefantrine	Lumefantrine's serum levels may be reduced by CYP3A4 Inducers (Strong).
Lurasidone	It is possible for CYP3A4 Inducers (Strong) to lower the level of lurasidone in the blood.
Macimorelin	The content of macimorelin in the serum may drop when taking CYP3A4 Inducers (Strong).
Macitentan	The serum concentration of Macitentan may drop when CYP3A4 Inducers (Strong) are taken.
Midostaurin	Midostaurin's serum levels may be reduced by CYP3A4 Inducers (Strong).
MiFEPRIStone	It's possible that CYP3A4 Inducers (Strong) will lower the level of MiFEPRIStone in the blood.
Mycophenolate	The serum levels of mycophenolate may be lowered by rifamycin derivatives. Particularly, the content of the active metabolite mycophenolic acid may be lowered by rifamycin derivatives.
Naldemedine	The serum concentration of naldemedine may drop in response to CYP3A4 Inducers (Strong).
Naloxegol	Naloxegol's serum levels may be reduced by CYP3A4 Inducers (Strong).
Nelfinavir	Nelfinavir's serum levels may drop if RifAMPin is used.
Neratinib	The serum concentration of neratinib may decrease after taking CYP3A4 Inducers (Strong).
Netupitant	It's possible that CYP3A4 Inducers (Strong) will lower Netupitant's serum levels.
NIFEdipine	CYP3A4 Inducers (Strong) may lower the level of NIFEdipine in the serum.
Nilotinib	CYP3A4 Inducers (Strong) may lower the level of Nilotinib in the serum.
NiMODipine	The serum concentration of NiMODipine may drop in response to CYP3A4 Inducers (Strong).
Nintedanib	Combination CYP3A4 and P-glycoprotein inducers have been shown to lower nintedanib serum levels.
Nisoldipine	Nisoldipine's serum levels may be reduced by CYP3A4 Inducers (Strong).
Olaparib	Olaparib's serum levels may drop when CYP3A4 Inducers (Strong) are present.
Omeprazole	Omeprazole's serum levels may drop if RifAMPin is used.
Palbociclib	It's possible that CYP3A4 Inducers (Strong) will lower palbociclib's serum levels.
Panobinostat	CYP3A4 Inducers (Strong) may lower the level of panobinostat in the blood.
PAZOPanib	The serum concentration of PAZOPanib may drop in response to CYP3A4 Inducers (Strong).
Pexidartinib	The serum concentration of pexidartinib may fall in response to CYP3A4 Inducers (Strong).
Pimavanserin	The serum concentration of pimavanserin may be reduced by CYP3A4 Inducers (Strong).
Piperaquine	The serum concentration of Piperaquine may decrease in response to CYP3A4 Inducers (Strong).
PONATinib	The serum concentration of PONATinib may decrease when CYP3A4 Inducers (Strong) are used.
Praziquantel	Praziquantel's serum levels may be lowered by CYP3A4 Inducers (Strong). Treatment: Praziquantel should not be used in conjunction with potent CYP3A4 inducers. Rifampin should be stopped 4 weeks before starting praziquantel therapy. The day after the last dose of praziquantel, rifampin may be started again.
Pretomanid	The serum concentration of protomanid may drop when CYP3A4 Inducers (Strong) are used.
QuiNINE	QuiNINE serum levels may be lowered by rifAMPin.
Ranolazine	Ranolazine's serum concentration may drop as a result of RifAMPin.
Regorafenib	Regorafenib's serum levels may be lowered by CYP3A4 Inducers (Strong).
Revefenacin	The active metabolite(s) of revefenacin may be present in higher serum quantities when OATP1B1/1B3 (SLCO1B1/1B3) Inhibitors are used.
Ribociclib	CYP3A4 Inducers (Strong) may lower the level of ribociclib in the blood.
Rilpivirine	Rilpivirine's serum levels may drop if rifamycin derivatives are consumed.
Ritonavir	Ritonavir's serum levels may drop as a result of RifAMPin.
Rivaroxaban	CYP3A4 Inducers (Strong) may lower the level of Rivaroxaban in the blood.
Roflumilast	The serum concentration of Roflumilast may be lowered by RifAMPin. Administration: Roflumilast The prescription guidelines for the United States advise against mixing rifampin with roflumilast. No such advise is included in the Canadian product monograph, however rifampin may lessen the therapeutic effects of roflumilast.
RomiDEPsin	RomiDEPsin's serum levels may rise in response to RifAMPin.
Saquinavir	Saquinavir's harmful or hazardous effects could be exacerbated by rifAMPin. Particularly, there may be a greater chance of hepatocellular toxicity. Saquinavir's serum levels may drop if you take RifAMPin.
Simeprevir	Simeprevir's serum levels may be lowered by CYP3A4 Inducers (Strong).
Siponimod	Siponimod's serum levels may drop if you use RifAMPin. Management: It is not advised to coadminister rifampin, a high inducer of CYP3A4 and a moderate inducer of CYP2C9, with siponimod.
Sofosbuvir	The serum concentration of sofosbuvir may drop in response to P-glycoprotein/ABCB1 Inducers.
Sonidegib	Sonidegib's serum levels may be reduced by CYP3A4 Inducers (Strong).
SORAfenib	The serum concentration of SORAfenib may drop when CYP3A4 Inducers (Strong) are taken.
Tasimelteon	The serum concentration of Tasimelteon may drop in response to CYP3A4 Inducers (Strong).
Tenofovir Alafenamide	Tenofovir Alafenamide's serum levels may drop as a result of RifAMPin.
Ticagrelor	The active metabolite(s) of ticagrelor may be present in lower serum concentrations when CYP3A4 Inducers (Strong) are present. The serum concentration of ticagrelor may fall in response to CYP3A4 Inducers (Strong)
Tipranavir	RifAMPin may lower the level of Tipranavir in the serum.
Tofacitinib	Tofacitinib's serum levels may be reduced by CYP3A4 Inducers (Strong).
Tolvaptan	Tolvaptan's serum levels may be reduced by CYP3A4 Inducers (Strong). Management: If concurrent use is required, tolvaptan dosages may need to be increased (while being closely watched for toxicity and clinical response).
Toremifene	The serum concentration of toremifene may drop when CYP3A4 Inducers (Strong) are taken.
Trabectedin	The serum concentration of Trabectedin may drop in response to CYP3A4 Inducers (Strong).
Ulipristal	Ulipristal's serum levels may drop when CYP3A4 Inducers (Strong) are present.
Upadacitinib	Upadacitinib's serum levels may be reduced by CYP3A4 Inducers (Strong).
Valbenazine	CYP3A4 Inducers (Strong) may lower the level of Valbenazine in the blood.
Vandetanib	The serum concentration of Vandetanib may decrease after taking CYP3A4 Inducers (Strong).
Velpatasvir	The serum concentration of Velpatasvir may fall in response to CYP2B6 Inducers (Moderate).
Velpatasvir	The serum concentration of Velpatasvir may fall in response to CYP3A4 Inducers (Strong).
Velpatasvir	The serum concentration of Velpatasvir may drop in response to P-glycoprotein/ABCB1 Inducers.
Venetoclax	Venetoclax's serum levels may be lowered by CYP3A4 Inducers (Strong).
VinCRIStine (Liposomal)	Strong CYP3A4 Inducers may lower VinCRIStine serum levels (Liposomal).
VinCRIStine (Liposomal)	VinCRIStine serum levels may be reduced by P-glycoprotein/ABCB1 Inducers (Liposomal).
Vinflunine	Vinflunine's serum levels may drop when CYP3A4 Inducers (Strong) are taken.
Vorapaxar	CYP3A4 Inducers (Strong) may lower the level of Vorapaxar in the blood.
Voriconazole	Rifamycin derivatives' serum levels can rise. Rifamycin derivatives may lower the level of voriconazole in the blood.
Voxilaprevir	Voxilaprevir's serum levels may rise as a result of RifAMPin. Rifampin may specifically enhance voxilaprevir concentrations when administered as a single dosage, however chronic daily usage of rifampin may cause a decrease in voxilaprevir concentrations. RifAMPin may lower the level of Voxilaprevir in the serum.
Zolpidem	RifAMPin may lower the level of zolpidem in the blood.

Monitoring parameters:

liver function (AST, ALT, bilirubin), CBC, mental status, sputum culture, and chest x-rays are periodically monitored (at baseline and every 2 to 4 weeks during therapy).
When treating individuals at risk for vitamin K deficiency, keep an eye on the results of coagulation tests.

How to administer Rifampin (Rifampicin)?

IV:

Use a final dosage of no more than 6 mg/mL when administering IV preparation by gradual IV infusion over a 30- to 3-hour period.
Don't administer SubQ or IM. Avoid imposing yourself.

Oral:

To enhance overall absorption, administer on an empty stomach (i.e., 1 hour before or 2 hours after meals or antacids).
Before using, the prepared oral suspension must be thoroughly shaken. You can combine the capsule's contents with jelly or applesauce.

Mechanism of action of Rifampin (Rifampicin):

Via attaching to the beta subunit of DNA-dependent RNA polymerase, prevents the synthesis of RNA by bacteria.

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

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:

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 Children

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: