Risk Factor C (Monitor therapy)

Abiraterone Acetate

The serum content of abiraterone acetate may drop when using rifapentine.

Barbiturates

The metabolism of barbiturates may be accelerated by rifamycin derivatives.

BCG Vaccine (Immunization)

Antibiotics may reduce the BCG vaccine's therapeutic effect (Immunization).

Benzhydrocodone

CYP3A4 Inducers (Moderate) 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

Cabozantinib

Cabozantinib's serum levels may drop due to rifapentine.

CloZAPine

CloZAPine's serum levels may be lowered by moderate CYP3A4 inducers.

Codeine

The active metabolite(s) of codeine's serum concentrations may be lowered by CYP3A4 Inducers (Moderate).

CYP2C9 Substrates (High risk with Inducers)

The serum concentration of CYP2C9 Substrates may be reduced by rifapentine (High risk with Inducers).

CYP3A4 Substrates (High risk with Inducers)

The serum concentration of CYP3A4 Substrates may drop when taking CYP3A4 Inducers (Moderate) (High risk with Inducers). Apixaban and Rivaroxaban are exceptions.

Dapsone (Systemic)

Dapsone serum levels may be decreased by rifamycin derivatives (Systemic).

Enzalutamide

Enzalutamide's serum levels may drop due to rifapentine.

Estriol (Systemic)

Estriol serum levels may be decreased by moderately potent CYP3A4 inducers (Systemic).

Estriol (Topical)

Estriol serum levels may be decreased by moderately potent CYP3A4 inducers (Topical).

Everolimus

Rifapentine may lower the level of Everolimus in the blood.

FentaNYL

The serum concentration of FentaNYL may drop in response to CYP3A4 Inducers (Moderate).

Glecaprevir and Pibrentasvir

Glecaprevir and Pibrentasvir's serum concentrations may be affected by CYP3A4 Inducers (Moderate).

HYDROcodone

The serum levels of HYDROcodone may drop in response to CYP3A4 Inducers (Moderate).

Ibrutinib

Ibrutinib's serum levels may be decreased by CYP3A4 Inducers (Moderate).

Ifosfamide

The active metabolite(s) of ifosfamide may be present in lower serum quantities when CYP3A4 Inducers (Moderate) are present. The active metabolite(s) of ifosfamide may be present in higher serum concentrations when CYP3A4 Inducers (Moderate) are used.

Irinotecan Products

The serum levels of the active metabolite(s) of irinotecan products may drop when rifapentine is taken. Particularly, serum levels of SN-38 could be decreased. The serum concentration of rifapentine-containing products may drop.

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.

Mirodenafil

The serum concentration of Mirodenafil may be decreased by CYP3A4 Inducers (Moderate).

Naldemedine

The serum concentration of naldemedine may drop in response to CYP3A4 Inducers (Moderate).

Nilotinib

Nilotinib's serum levels may drop due to rifapentine.

Pexidartinib

Pexidartinib's serum levels may be decreased by CYP3A4 Inducers (Moderate).

Pitolisant

Pitolisant's serum levels may drop when taken with CYP3A4 Inducers (Moderate).

Raltegravir

Raltegravir's serum levels may rise in response to rifapentine. Raltegravir's serum levels may drop due to rifapentine.

Rolapitant

The serum concentration of Rolapitant may fall in response to CYP3A4 Inducers (Moderate).

RomiDEPsin

RomiDEPsin's serum levels may drop due to rifapentine.

Upadacitinib

Upadacitinib's serum levels may be decreased by CYP3A4 Inducers (Moderate).

VinCRIStine (Liposomal)

VinCRIStine serum levels may be decreased by rifapentine (Liposomal).

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.

Zolpidem

CYP3A4 Inducers (Moderate) may lower the level of zolpidem in the blood.

Risk Factor D (Consider therapy modification)

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).

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.

Brigatinib

The serum concentration of Brigatinib may fall in response to CYP3A4 Inducers (Moderate). Management: Whenever possible, avoid taking brigatinib at the same time as mild CYP3A4 inducers. After seven days of treatment with the current brigatinib dose, increase the daily dose in increments of 30 mg, up to a maximum of twice the dose.

Calcium Channel Blockers

Calcium Channel Blockers' serum levels may be reduced by rifamycin derivatives. This predominantly affects calcium channel blockers used orally. Management: Some calcium channel blockers are not recommended for use with rifampin according to their labelling in the US and Canada.

Clarithromycin

The active metabolite(s) of clarithromycin may be present in higher serum quantities when CYP3A4 Inducers (Moderate) are present. It is possible for CYP3A4 Inducers (Moderate) to 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 14-hydroxyclarithromycin from clarithromycin may change the clinical action of clarithromycin and reduce its effectiveness.

CycloSPORINE (Systemic)

CycloSPORINE metabolism may be increased by rifamycin derivatives (Systemic).

Daclatasvir

Rifapentine may lower the level of Daclatasvir in the serum. Management: If used with rifapentine, US labelling advises raising the dose of daclatasvir to 90 mg once daily. The combination of daclatasvir and rifapentine is contraindicated, according to Canadian labelling.

Erdafitinib

Erdafitinib's serum levels may be decreased by CYP3A4 Inducers (Moderate). Management: Erdafitinib dosage adjustments may be necessary. For information, see the entire monograph.

Erlotinib

Erlotinib's serum levels could drop due to rifapentine. Management: If at all possible, avoid combining. Erlotinib dosage should be increased, if necessary, in combinations, by 50 mg increments every two weeks, as tolerated, up to a daily maximum of 450 mg.

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.

GuanFACINE

GuanFACINE serum levels may be decreased by CYP3A4 Inducers (Moderate). Treatment: When starting guanfacine in a patient receiving a moderate CYP3A4 inducer, increase the guanfacine dose by up to a factor of two. If starting a new treatment, gradually increase the dosage of guanfacine 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). Check for any changes in the effects of HMG-CoA reductase inhibitors. The risk may be lessened with rifabutin, fluvastatin, or pravastatin. Exceptions: Rosuvastatin and pitavastatin.

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.

Indinavir

Indinavir's serum levels could drop due to rifapentine. Management: Because of the potential for lower indinavir concentrations, decreased efficacy, and the emergence of resistance, you should think about avoiding the combination of indinavir and rifapentine whenever you can. 

Lefamulin

Lefamulin's serum levels may be decreased by CYP3A4 Inducers (Moderate). Management: Unless the advantages outweigh the hazards, avoid using lefamulin concurrently with mild CYP3A4 inducers.

Lefamulin (Intravenous)

Lefamulin serum levels may be decreased by moderate CYP3A4 inducers (Intravenous). Management: Lefamulin (intravenous) should not be used concurrently with moderate CYP3A4 inducers unless the advantages outweigh the dangers.

Lorlatinib

The hepatotoxic impact of lorlatinib may be enhanced by CYP3A4 Inducers (Moderate). Lorlatinib's serum levels may be decreased by CYP3A4 Inducers (Moderate). Avoid using lorlatinib in combination with mild CYP3A4 inducers. If such a mixture must be used, AST, ALT, and bilirubin levels should be checked within 48 hours after beginning the mixture and at least three times during the first week of use.

Lurasidone

Lurasidone's serum levels may be reduced by moderate CYP3A4 inducers. Management: If provided with moderate CYP3A4 inducers for seven or more days, watch for any diminished effects of the lurasidone and consider raising the dose.

Meperidine

Meperidine's serum levels may drop if you take CYP3A4 Inducers (Moderate). When using mild 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.

Palbociclib

Palbociclib's serum levels may be decreased by moderate CYP3A4 inducers. Management: The Canadian label advises against using mild CYP3A4 inducers, however the US label makes no particular advice on their use.

Perampanel

The serum concentration of Perampanel may be decreased by CYP3A4 Inducers (Moderate). When using perampanel alongside strong and moderate CYP3A4 inducers, the beginning dose should be increased to 4 mg/day.

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.

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.

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.

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.

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.

Tamoxifen

The metabolism of Tamoxifen may be accelerated by rifamycin derivatives.

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.

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.

Risk Factor X (Avoid combination)

Abemaciclib

Abemaciclib's serum levels may be reduced by moderate CYP3A4 inducers.

Antihepaciviral Combination Products

Antihepaciviral Combination Products' serum concentration may be decreased by CYP3A4 Inducers (Moderate).

Asunaprevir

Asunaprevir's serum levels may be decreased by CYP3A4 Inducers (Moderate).

Atovaquone

The serum levels of atovaquone may drop if rifamycin derivatives are consumed.

Axitinib

Axitinib's serum levels may be decreased by CYP3A4 Inducers (Moderate).

BCG (Intravesical)

Antibiotics may lessen BCG's therapeutic effects (Intravesical).

Bedaquiline

Bedaquiline's serum levels may be lowered by moderately potent CYP3A4 inducers.

Bictegravir

Bictegravir's serum levels may drop due to rifapentine.

Bosutinib

Bosutinib's serum levels may be decreased by CYP3A4 Inducers (Moderate).

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.

Cobicistat

Cobicistat's serum levels may drop if rifapentine is used.

Cobimetinib

Cobimetinib's serum levels may be decreased by CYP3A4 Inducers (Moderate).

Darunavir

Darunavir's serum levels may drop ifripentin is used.

Dasabuvir

Dasabuvir's serum levels may be decreased by moderate CYP3A4 inducers.

Deflazacort

The serum concentrations of the active metabolite(s) of Deflazacort may be lowered by CYP3A4 Inducers (Moderate).

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.

Doravirine

Doravirine's serum levels may drop if rifapentine is used.

Elbasvir

Elbasvir's serum levels may be reduced by moderate CYP3A4 inducing drugs.

Elvitegravir

Elvitegravir's serum levels could drop due to rifapentine.

Encorafenib

Encorafenib's serum levels may be decreased by CYP3A4 Inducers (Moderate).

Entrectinib

Entrectinib's serum levels may be lowered by moderately potent CYP3A4 inducers.

Etravirine

Rifapentine may lower the level of etravirine in the serum.

Fedratinib

Fedratinib's serum levels may be affected by CYP3A4 Inducers (Moderate).

Flibanserin

Flibanserin's serum levels may drop if CYP3A4 Inducers (Moderate) are taken.

Grazoprevir

The serum concentration of Grazoprevir may fall in response to CYP3A4 Inducers (Moderate).

Ledipasvir

Ledipasvir's serum levels may drop if rifapentine is used.

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.

Neratinib

Neratinib's serum levels may be reduced by CYP3A4 Inducers (Moderate).

Nisoldipine

The serum concentration of nisoldipine may fall in response to CYP3A4 Inducers (Moderate).

Olaparib

Olaparib's serum levels may be decreased by CYP3A4 Inducers (Moderate).

Pimavanserin

Pimavanserin's serum levels may be decreased by moderate CYP3A4 inducers.

Pretomanid

Pretomanid's serum levels may be decreased by CYP3A4 Inducers (Moderate).

Ranolazine

Ranolazine's serum levels may be reduced by moderate CYP3A4 inducers.

Rilpivirine

Rilpivirine's serum levels may drop if rifamycin derivatives are consumed.

Simeprevir

Simeprevir's serum levels may be decreased by CYP3A4 Inducers (Moderate).

Sofosbuvir

Sofosbuvir's serum levels may drop due to rifapentine.

Sonidegib

Sonidegib's serum levels may be decreased by CYP3A4 Inducers (Moderate).

Tenofovir Alafenamide

Tenofovir Alafenamide's serum levels may drop due to rifapentine.

Velpatasvir

The serum concentration of Velpatasvir may fall in response to CYP3A4 Inducers (Moderate).

Venetoclax

Venetoclax serum levels may be decreased by CYP3A4 Inducers (Moderate).

Voriconazole

Rifamycin derivatives' serum levels can rise. Rifamycin derivatives may lower the level of voriconazole in the blood.