Version July 2025
General dosing, susceptible infection: IV, Oral: 10 mg/kg/day every 24 hours (Ref).
Haemophilus influenzae, chemo prophylaxis after close contact with a patient with invasive disease: Limited data available: IV, Oral: 10 mg/kg/day once daily for 4 days (Ref).
Meningococcal disease, chemoprophylaxis after close contact with a patient with invasive disease or elimination in asymptomatic carriers: IV, Oral: 10 mg/kg/day in divided doses every 12 hours for 2 days.
Staphylococcus spp. infections (adjunctive agent): Limited data available: IV, Oral: 10 to 20 mg/kg/day in divided doses every 12 hours in combination with appropriate first-line antibiotic therapy (Ref). Note: Rifampin was most commonly reported in combination with vancomycin with or without an aminoglycoside and was continued for ~10 to 16 days; however, durations of 1 to 35 days have been reported (Ref).
Dosage guidance:
Dosing: Dosing presented in mg/kg/dose and mg/kg/day; use caution.
Clinical considerations: Rifampin monotherapy is rarely indicated; most indications require combination therapy.
Anaplasmosis, mild, symptomatic (alternative agent):
Note: Reserve use for patients with severe allergy or intolerance to doxycycline. Rifampin is not effective for Rocky Mountain spotted fever or Lyme disease. If concurrent Lyme disease is suspected, use as part of an appropriate combination regimen (Ref).
Infants, Children, and Adolescents: Limited data available: Oral: 20 mg/kg/day in 2 divided doses for 7 to 10 days; maximum dose: 300 mg/dose (Ref).
Brucellosis, treatment: Limited data available: Children and Adolescents: Oral: 15 to 20 mg/kg/day in 1 to 2 divided doses as part of an appropriate combination regimen; maximum daily dose: 900 mg/day. Duration is ≥6 weeks and dependent on patient-specific factors including site of infection and presence of complications (Ref).
Endocarditis: Limited data available: Note: Use as part of an appropriate combination regimen.
Empiric therapy or culture-negative endocarditis (prosthetic valve/material) (Ref):
Early (≤1 year) prosthetic valve infection or nosocomial infection associated with vascular cannulation: Children and Adolescents: Oral, IV: 20 mg/kg/day divided every 8 hours; maximum daily dose: 900 mg/day.
Late (>1 year) prosthetic valve infection: Children and Adolescents: Oral, IV: 15 to 20 mg/kg/day divided every 12 hours; maximum daily dose: 600 mg/day.
MRSA endocarditis (prosthetic valve): Infants, Children, and Adolescents: Oral, IV: 15 mg/kg/day divided every 8 hours; maximum daily dose: 900 mg/day (Ref).
Exit-site or tunnel infection, peritoneal dialysis catheter: Limited data available: Infants, Children, and Adolescents: Oral: 10 to 20 mg/kg/day divided into 2 doses as part of an appropriate combination regimen. Maximum dose: 600 mg/dose (Ref). Note: Should not be used as monotherapy or routinely used in areas where tuberculosis (TB) is endemic.
Haemophilus influenzae disease, chemoprophylaxis after close contact with a patient with invasive disease:
Infants, Children, and Adolescents: Oral: 20 mg/kg/day once daily for 4 days; maximum dose: 600 mg/dose (Ref).
Leprosy: Limited data available: Note: In the United States, it is strongly recommended to contact the National Hansen's Disease Program for management of leprosy in children (Ref).
Children and Adolescents: Oral: 10 to 20 mg/kg/day once daily; maximum dose: 600 mg/dose. If used in combination with prednisone, rifampin should be administered once monthly. Should be given as part of an appropriate combination regimen for 12 months for tuberculoid (paucibacillary) disease and 24 months for lepromatous (multibacillary) disease (Ref); in resource-limited settings, the World Health Organization allows for shorter durations of monthly dosing for 6 months (paucibacillary) or 12 months (multibacillary) (Ref).
Meningococcal disease, chemoprophylaxis after close contact with a patient with invasive disease or elimination in asymptomatic carriers:
Infants, Children, and Adolescents: Oral: 20 mg/kg/day in divided doses every 12 hours for 2 days; maximum dose: 600 mg/dose.
Mycobacterium avium complex infection: Limited data available:
Pulmonary disease, nonsevere noncavitary nodular/bronchiectatic disease in patients without cystic fibrosis: Children and Adolescents: Oral: 15 mg/kg/dose 3 times weekly as part of an appropriate combination regimen; maximum dose: 450 mg in patients weighing <50 kg; maximum dose: 600 mg in patients weighing ≥50 kg (Ref). Note: Three-times-weekly dosing has been shown to be as effective as daily dosing in adults with mild to moderate disease with fewer adverse events (Ref).
Pulmonary disease, severe nodular/bronchiectatic disease, cavitary disease, or disease in patients with cystic fibrosis: Children and Adolescents: Oral: 10 to 20 mg/kg/day once daily as part of an appropriate combination regimen; maximum dose: 450 mg in patients weighing <50 kg; maximum dose: 600 mg in patients weighing ≥50 kg (Ref). Note: Daily dosing is recommended in patients with cystic fibrosis due to lack of data to support intermittent dosing and uncertainty regarding absorption and lung penetration in this population (Ref).
Duration of therapy: Continue treatment until patient is culture negative on therapy for ≥1 year (Ref).
Peritonitis (peritoneal dialysis), treatment: Infants, Children, and Adolescents: Oral: 10 to 20 mg/kg/day divided into 2 doses in combination with other appropriate antibiotics; maximum dose: 600 mg/dose (Ref).
Streptococcus, group A; chronic carriage: Limited data available: Note: Most individuals with chronic carriage do not require antibiotic treatment (Ref).
Children and Adolescents:
In combination with oral penicillin V: Oral: 20 mg/kg/day once daily for the last 4 days of treatment; maximum daily dose: 600 mg/day (Ref).
In combination with intramuscular benzathine penicillin G: Oral: 20 mg/kg/day in 2 divided doses for 4 days starting the day of the penicillin injection; maximum daily dose: 600 mg/day (Ref).
Tuberculosis, active (drug-susceptible); treatment (Ref):
Note: Always administer in combination with other antitubercular drugs (Ref). Currently recommended doses in guideline, particularly those on the lower end of the range, may not achieve desired exposure (Ref). Doses of 20 to 30 mg/kg/dose have been recommended for infants and young children or for treating disseminated tuberculosis or tuberculous meningitis (Ref).
Initial intensive phase: Note: Administer part of a standard 4-drug regimen for 2 months.
Infants, Children, and Adolescents <15 years weighing ≤40 kg: Oral, IV: 10 to 20 mg/kg/dose once daily (or 5 days/week by directly observed therapy [DOT]); maximum dose: 600 mg/dose.
Children and Adolescents <15 years weighing >40 kg or Adolescents ≥15 years: Oral, IV: 10 mg/kg/dose once daily (or 5 days/week by DOT); maximum dose: 600 mg/dose.
Continuation phase: Note: Administer in combination with isoniazid for ≥4 months; continuation phase duration should be longer for cavitary disease with positive cultures at completion of intensive phase (7 months), bone and joint disease (≥4 to 7 months), and CNS disease (7 to 10 months).
Infants, Children, and Adolescents <15 years weighing ≤40 kg: Oral, IV: 10 to 20 mg/kg/dose once daily (or 5 days/week by DOT); maximum dose: 600 mg/dose.
Children and Adolescents <15 years weighing >40 kg or Adolescents ≥15 years: Oral, IV: 10 mg/kg/dose once daily (or 5 days/week by DOT); maximum dose: 600 mg/dose.
Alternative dosing intervals: Daily or 5-times-weekly dosing is preferred, particularly during the intensive phase and in patients with HIV. If neither is feasible, daily (or 5-times-weekly) dosing for the intensive phase followed by 3-times-weekly dosing during the continuation phase may be considered. Directly observe therapy for any regimen that is <7 days/week dosing (Ref). Note: 3-times-weekly dosing for the duration of treatment and twice-weekly dosing during the continuation phase are associated with worse outcomes compared to daily dosing (Ref).
Tuberculosis, latent infection; treatment: Infants, Children, and Adolescents: Independent of HIV status: Oral: 15 to 20 mg/kg/day once daily; maximum dose: 600 mg/dose; use in combination with isoniazid for 3 months or as monotherapy for 4 months (Ref). Higher doses of 20 to 30 mg/kg/dose have been recommended for infants and young children (Ref).
Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.
There are no dosage adjustments provided in the manufacturer's labeling; however, based on experience in adults, dosage adjustment is likely unnecessary.
Baseline hepatic impairment: There are no dosage adjustments provided in the manufacturer's labeling; use with caution. If hepatic function worsens, discontinue therapy.
Hepatotoxicity during therapy: Discontinue therapy.
(For additional information see "Rifampin (rifampicin): Drug information")
Anaplasmosis, symptomatic (alternative agent) (off-label use):
Note: Reserve use for patients with severe allergy or intolerance to doxycycline. Rifampin is not effective for Rocky Mountain spotted fever or Lyme disease. If concurrent Lyme disease is suspected, use as part of an appropriate combination regimen (Ref).
Oral: 300 mg twice daily for 7 to 10 days (Ref).
Bartonella spp. infection (off-label use):
Bacteremia with or without endocarditis : Oral, IV: 300 mg twice daily in combination with doxycycline for 14 days (without endocarditis) or 6 weeks (with endocarditis), followed by doxycycline monotherapy (Ref). For patients with endocarditis undergoing valve replacement, duration depends on timing of surgery and immune status (Ref). Some experts do not suggest rifampin as part of the regimen for patients with HIV and bacteremia without endocarditis (Ref).
Other severe infection (including CNS infection) in patients with HIV: Oral, IV: 300 mg twice daily as part of an appropriate combination regimen. Duration of therapy is at least 3 months and depends on clinical course. Note: For CNS infection, use of adjunctive rifampin is optional (Ref).
Cat scratch disease, lymphadenitis (alternative agent): Oral: 300 mg twice daily for 7 to 10 days (Ref).
Cat scratch disease, disseminated in patients without HIV (hepatosplenic, prolonged systemic febrile illness, CNS infection, neuroretinitis): Oral, IV: 300 mg twice daily as part of an appropriate combination regimen. Duration is 10 to 14 days for hepatosplenic disease, prolonged systemic febrile illness, or CNS infection, and 4 to 6 weeks for neuroretinitis (Ref).
Brucellosis (off-label use):
Treatment: Oral: 600 to 900 mg once daily as part of an appropriate combination regimen. Duration is 6 weeks for uncomplicated nonfocal infection and at least 12 weeks for spondylitis, neurobrucellosis, and endocarditis (Ref).
Postexposure prophylaxis (high-risk laboratory exposure): Note: For exposure to Brucella abortus RB51, use an alternative prophylactic regimen due to resistance.
Oral: 600 mg once daily in combination with doxycycline for 3 weeks (Ref).
Endocarditis, treatment (off-label use):
Staphylococcus spp., prosthetic valve: Note: May also be used as part of empiric therapy for early (<1 year) culture negative prosthetic valve endocarditis (Ref).
Oral, IV: 900 mg/day in 3 equally divided doses as part of an appropriate combination regimen for ≥6 weeks; delay initiation of rifampin until 3 to 5 days after initiation of the other agents (Ref).
S. aureus, oral step-down therapy: Note: Data are limited; not first-line therapy. Some experts suggest oral antibiotics as an alternative for patients who inject drugs and are not able to complete standard of care therapy (Ref).
Oral: 600 mg twice daily in combination with dicloxacillin or linezolid (Ref) or 300 mg 3 times daily in combination with ciprofloxacin (Ref) for a total duration, including initial IV therapy, of 6 weeks (Ref).
Hidradenitis suppurativa (off-label use):
Oral: 600 mg/day in 1 or 2 divided doses in combination with clindamycin for 10 to 12 weeks (Ref).
Leprosy, treatment (off-label use):
Oral: 600 mg once daily as part of an appropriate combination regimen for 12 months for tuberculoid (paucibacillary) disease and 24 months for lepromatous (multibacillary) disease (Ref). Note: Rifampin is given once monthly if coadministered with prednisone (Ref). For resource-limited settings, the World Health Organization recommends 600 mg once monthly as part of an appropriate combination regimen for 6 months (paucibacillary) or 12 months (multibacillary) (Ref).
Meningococcal disease, chemoprophylaxis after close contact with a patient with invasive disease (off-label use):
Oral: 600 mg twice daily for 2 days. Note: Administer prophylaxis as soon as possible following exposure (ideally <24 hours after identification of index patient). Close contacts include persons with prolonged exposure (≥8 hours) in close proximity (<3 feet) to index patient or direct exposure to oral secretions (eg, household contacts, childcare center contacts) (Ref).
Mycobacterial (nontuberculous) (eg, M. avium complex) infection (off-label use):
Pulmonary disease, nonsevere noncavitary nodular/bronchiectatic disease in patients without cystic fibrosis: Oral: 600 mg 3 times weekly as part of an appropriate combination regimen (Ref).
Pulmonary disease, severe nodular/bronchiectatic disease, cavitary disease, or disease in patients with cystic fibrosis: Oral: 600 mg once daily as part of an appropriate combination regimen; reduce dose to 450 mg once daily for patients weighing <50 kg (Ref).
Duration of therapy: Continue treatment until patient is culture negative on therapy for ≥1 year (Ref).
Staphylococcus spp. infections, including bone and joint and CNS (adjunctive agent) (off-label use):
Note: Used primarily in the setting of retained hardware or other prosthetic material for activity against biofilm formation (Ref).
Oral, IV: 600 mg once daily or 300 to 450 mg twice daily in combination with an appropriate antistaphylococcal agent(s). Duration varies based on patient-specific factors, infection site, and intervention (Ref). Some experts suggest delaying initiation of rifampin until several days after initiation of other antistaphylococcal agents (Ref).
Streptococcus (group A) chronic carriage (off-label use):
Note: Most individuals with chronic carriage do not require antibiotics (Ref).
Oral: 600 mg/day in 1 or 2 divided doses for the last 4 days of treatment in combination with penicillin V (Ref) or for 4 days in combination with single-dose IM benzathine penicillin G (Ref).
Tuberculosis disease [active tuberculosis]:
Note: Always administer in combination with other antitubercular drugs (Ref).
Drug-susceptible:
Initial intensive phase: Oral, IV: 10 mg/kg (maximum dose: 600 mg) once daily (or 5 days per week by directly observed therapy [DOT]) as part of a standard 4-drug regimen for 2 months (Ref).
Continuation phase: Oral, IV: 10 mg/kg (maximum dose: 600 mg) once daily (or 5 days per week by DOT) in combination with isoniazid for at least 4 months or longer for cavitary disease with positive cultures (7 months), bone and joint disease (6 to 9 months), and CNS disease (≥12 months) (Ref).
Alternative dosing intervals: Daily or 5-times-weekly dosing is preferred, particularly during the intensive phase. If neither is feasible, may consider daily (or 5-times-weekly) dosing for the intensive phase followed by 3-times-weekly dosing during the continuation phase (Ref); 3-times-weekly dosing for the duration of treatment and twice-weekly dosing during the continuation phase are associated with worse outcomes compared to daily dosing (Ref). Use DOT for <7 days/week dosing (Ref).
Isoniazid-resistant, rifampin-susceptible: Oral/IV: 10 mg/kg (maximum dose: 600 mg) once daily as part of an appropriate combination regimen. Expert consultation for optimal regimen and duration of treatment is advised (Ref).
Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.
The renal dosing recommendations are based upon the best available evidence and clinical expertise. Senior Editorial Team: Bruce Mueller, PharmD, FCCP, FASN, FNKF; Jason A. Roberts, PhD, BPharm (Hons), B App Sc, FSHP, FISAC; Michael Heung, MD, MS.
Note: At rifampin doses ≤600 mg/day, reduced clearance by the kidney is compensated for by biliary excretion. However, at rifampin doses ≥900 mg/day, the hepatic excretory pathway is saturated and higher concentrations of rifampin are noted in patients with reduced kidney function (Ref).
Altered kidney function:
CrCl >15 mL/minute: No dosage adjustment necessary (Ref).
CrCl <15 mL/minute: No dosage adjustment necessary for usual indication-specific doses ≤600 mg/day. For usual indication-specific doses ≥900 mg/day, consider limiting dose to 600 mg/day or monitoring more closely for adverse effects (Ref) except when used for meningococcal chemoprophylaxis (no adjustment necessary due to short duration of therapy) (Ref).
Hemodialysis, intermittent (thrice weekly): Not significantly dialyzable (Ref); no dosage adjustment necessary for usual indication-specific doses ≤600 mg/day. For usual indication-specific doses ≥900 mg/day, consider limiting dose to 600 mg/day or monitoring more closely for adverse effects (Ref) except when used for meningococcal chemoprophylaxis (no adjustment necessary due to short duration of therapy) (Ref).
Peritoneal dialysis: Not significantly dialyzable (Ref); no dosage adjustment necessary for usual indication-specific doses ≤600 mg/day. For usual indication-specific doses ≥900 mg/day, consider limiting dose to 600 mg/day or monitoring more closely for adverse effects (Ref) except when used for meningococcal chemoprophylaxis (no adjustment necessary due to short duration of therapy) (Ref).
CRRT: No dosage adjustment necessary (Ref).
PIRRT (eg, sustained, low-efficiency diafiltration): No dosage adjustment necessary (Ref).
Hepatic impairment prior to treatment initiation:
There are no dosage adjustments provided in manufacturer's labeling; use with caution.
Hepatotoxicity during treatment:
New or worsening hepatic damage: Discontinue rifampin.
Clostridioides difficile infection (CDI) has occurred, including Clostridioides difficile-associated diarrhea (in one case in a patient receiving concurrent clindamycin) (Ref) and Clostridioides difficile colitis. Antituberculosis medications, such as rifampin have rarely been associated with CDI. Additionally, rifampin may decrease the risk of CDI from higher risk antibiotics (eg, clindamycin) and has been used in the treatment of CDI (Ref).
Onset: Varied; may start on the first day of antibiotic therapy or up to 3 months postantibiotic (Ref).
Risk factors:
• Antibiotic exposure (highest risk factor) (Ref)
• Type of antibiotic (Ref)
• Long durations in a hospitalization or other health care setting (recent or current) (Ref)
• Older adults (Ref)
• Immunocompromised conditions (Ref)
• A serious underlying condition (Ref)
• GI surgery/manipulation (Ref)
• Antiulcer medications (eg, proton pump inhibitors and H2 blockers) (Ref)
• Chemotherapy (Ref)
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) have been reported (Ref).
Mechanism: Not clearly established; likely immunologic (Ref).
Onset: Varied; with intermittent dosing, reactions have occurred within 3 to 6 months (Ref).
Risk factors:
• Intermittent exposure (Ref)
Hepatotoxicity of hepatocellular, cholestatic, and mixed patterns have been reported; may include asymptomatic abnormal hepatic function tests, isolated jaundice or hyperbilirubinemia, symptomatic self-limited hepatitis, or fulminant hepatic failure and death. Severe reactions, including fatalities, have occurred in patients with preexisting hepatic failure and in patients receiving concurrent hepatotoxic agents.
Mechanism: Not clearly established; possible mechanisms include hypersensitivity or metabolic idiosyncratic reactions (Ref).
Onset: Most cases occurred within 4 weeks in one study (Ref).
Risk factors:
• Longer duration of therapy (Ref)
• Age >60 years (Ref)
• Alcohol use disorder (Ref)
• Concurrent use of other hepatotoxic agents (eg, isoniazid, pyrazinamide) (Ref)
• Female sex (Ref)
• Low body mass index (Ref)
• Malnutrition (Ref)
• Preexisting liver disease (eg, chronic viral hepatitis) (Ref)
• HIV (Ref)
Hypersensitivity reactions, both immediate (urticaria, angioedema, anaphylaxis) (Ref) and delayed have been reported. Flu-like symptoms or more severe shock-like syndrome may also occur (Ref). Delayed hypersensitivity reactions range from maculopapular skin rash (Ref) and fixed drug eruption (Ref) to rare severe cutaneous adverse reactions, including acute generalized exanthematous pustulosis (Ref), drug reaction with eosinophilia and systemic symptoms (DRESS) (Ref), Stevens-Johnson syndrome, and toxic epidermal necrolysis (Ref). Since rifampin is usually administered as part of a multidrug regimen, causality is difficult to determine in most cases (Ref). Hypersensitivity angiitis (Ref) and lichenoid eruption (Ref) have also occurred.
Mechanism: Immediate hypersensitivity reactions: Non–dose-related; likely immunologic (ie, IgE-mediated, with specific antibodies formed against a drug allergen following initial exposure) (Ref), although angioedema may be caused by a non–IgE-mediated mechanism (Ref). The flu-like syndrome may be caused by circulating antibodies complexing with rifampin (Ref) or direct toxic effect of the drug (Ref). Delayed hypersensitivity reactions: Non–dose-related; immunologic (ie, involving a T-cell mediated drug-specific immune response) (Ref).
Onset: Immediate hypersensitivity reactions: Rapid; generally occur within 1 hour of administration but may occur up to 6 hours after exposure (Ref). Some cases of urticaria associated with rifampin have been delayed occurring 2 to 3 weeks after initiation of drug (Ref). Flu-like syndrome generally occurs within 1 to 4 hours (Ref). Delayed hypersensitivity reactions: Varied; typically occur days to 8 weeks after drug exposure (Ref), but may occur more rapidly (usually within 1 to 4 days) upon reexposure (Ref).
Risk factors:
• Dose: Flu-like syndrome is considered dose-dependent (Ref)
• Intermittent regimen: Flu-like syndrome occurs more frequently with intermittent regimens (Ref)
• Age >60 years (Ref)
• HIV (Ref)
• Cross-reactivity: Conflicting reports of cross-reactivity with rifabutin (Ref)
Potentially fatal interstitial pulmonary disease has been reported, including pneumonitis, hypersensitivity pneumonitis, eosinophilic pneumonitis, pulmonary infiltrates, acute respiratory distress syndrome, bronchiolitis obliterans organizing pneumonia, and pulmonary fibrosis (Ref). Patients with rifampin-induced pneumonitis typically present with low-grade fever and shortness of breath with or without cough (Ref).
Mechanism: Unknown; possibly immunologic (Ref).
Onset: Pneumonitis: Varied; 3 days to 13 weeks in a bimodal pattern with early and late onset but difficult to determine as fever is a common symptom in patients undergoing tuberculosis therapy (Ref).
The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified.
Postmarketing:
Cardiovascular: Decreased blood pressure, facial edema (Ref), flushing, hypersensitivity angiitis (Ref), peripheral edema, shock (Ref)
Dermatologic: Acute generalized exanthematous pustulosis (Ref), cutaneous lupus erythematosus (Ref), erythema multiforme, lichenoid eruption (Ref), pemphigoid reaction, pruritus (Ref), psoriasiform eruption (Ref), skin rash (Ref), Stevens-Johnson syndrome (Ref), toxic epidermal necrolysis (Ref), urticaria
Endocrine & metabolic: Adrenocortical insufficiency (Ref), increased uric acid, menstrual disease
Gastrointestinal: Abdominal cramps, anorexia, cholestasis, Clostridioides difficile-associated diarrhea (Ref), Clostridioides difficile colitis, diarrhea, epigastric discomfort, flatulence, glossalgia, heartburn, nausea, staining of tooth (Ref), vomiting
Genitourinary: Hematuria (Ref), hemoglobinuria (Ref)
Hematologic & oncologic: Acute intravascular hemolysis (Ref), agranulocytosis (Ref), decreased hemoglobin (Ref), disorder of hemostatic components of blood (vitamin K-dependent) (Ref), disseminated intravascular coagulation (Ref), eosinophilia, hemolysis (Ref), hemolytic anemia (Ref), hemorrhage (Ref), leukopenia, thrombocytopenia (especially with high-dose therapy) (Ref), thrombotic microangiopathy (including hemolytic-uremic syndrome and thrombotic thrombocytopenic purpura) (Ref)
Hepatic: Abnormal hepatic function tests (Ref), hepatic cirrhosis (Ref), hepatic failure (Ref), hepatitis (including shock-like syndrome with hepatic involvement) (Ref), hepatotoxicity (Ref), hyperbilirubinemia (Ref), jaundice (Ref)
Hypersensitivity: Anaphylaxis (Ref), angioedema (Ref), fixed drug eruption (Ref)
Immunologic: Drug reaction with eosinophilia and systemic symptoms (Ref)
Nervous system: Ataxia, behavioral changes, cerebral hemorrhage (Ref), confusion, dizziness, drowsiness, fatigue, headache, lack of concentration, myasthenia, numbness, psychosis (Ref), sore mouth
Neuromuscular & skeletal: Limb pain, myopathy (Ref)
Ophthalmic: Conjunctivitis
Renal: Acute interstitial nephritis (Ref), acute renal injury, increased blood urea nitrogen, renal insufficiency, renal tubular necrosis (Ref)
Respiratory: Acute respiratory distress syndrome (Ref), bronchiolitis obliterans organizing pneumonia, eosinophilic pneumonitis, dyspnea, flu-like symptoms (Ref), hypersensitivity pneumonitis (Ref), interstitial pulmonary disease, pneumonitis (Ref), pulmonary fibrosis (Ref), pulmonary infiltrates, wheezing
Miscellaneous: Fever, paradoxical reaction (recurrence or appearance of new infection symptoms; may be transient)
Hypersensitivity to rifampin, any rifamycins, or any component of the formulation; concurrent use of atazanavir, darunavir, fosamprenavir, lurasidone, praziquantel, ritonavir/saquinavir, saquinavir, or tipranavir.
Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.
Canadian labeling: Additional contraindications (not in US labeling): Jaundice associated with reduced bilirubin excretion; premature and newborn infants; breastfeeding women; hepatic function impairment.
Disease-related concerns:
• Diabetes mellitus: Use with caution in patients with diabetes mellitus; management of diabetes may be more difficult in patients taking rifampin.
• Hepatic impairment: Use with caution in patients with hepatic impairment.
• Meningococcal disease: Do not use for treatment of meningococcal disease, only for short-term treatment of asymptomatic carrier states.
• Porphyria: Use with caution in patients with porphyria; exacerbations have been reported due to enzyme-inducing properties.
Other warnings/precautions:
• Compliance: Monitor for compliance in patients on intermittent therapy.
• Contact lenses: Remove soft contact lenses during therapy since permanent staining may occur.
• Discoloration: Teeth (may be permanent), urine, feces, saliva, sweat, and tears may be discolored (yellow, orange, red, or brown).
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Capsule, Oral:
Generic: 150 mg, 300 mg
Solution Reconstituted, Intravenous [preservative free]:
Rifadin: 600 mg (1 ea)
Rifadin: 600 mg (1 ea) [contains sodium formaldehyde sulfoxylate]
Generic: 600 mg (1 ea)
Yes
Capsules (rifAMPin Oral)
150 mg (per each): $3.24 - $9.60
300 mg (per each): $4.59 - $11.40
Solution (reconstituted) (Rifadin Intravenous)
600 mg (per each): $214.27
Solution (reconstituted) (rifAMPin Intravenous)
600 mg (per each): $183.60 - $192.63
Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided when more than one manufacturer's AWP price is available and uses the low and high price reported by the manufacturers to determine the range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing data is updated monthly.
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Capsule, Oral:
Rofact: 150 mg, 300 mg
25 mg/mL Oral Suspension (ASHP Standard Concentration) (ASHP 2022)
A 25 mg/mL oral suspension may be made with capsules and one of three different vehicles (a 1:1 mixture of Ora-Sweet and Ora-Plus, a 1:1 mixture of Ora-Sweet SF and Ora-Plus, or cherry syrup concentrate diluted 1:4 with Simple Syrup, NF). Empty the contents of ten 300 mg capsules into a mortar and reduce to a fine powder. Add 20 mL of the vehicle and mix to a uniform paste; mix while adding the vehicle in incremental proportions to almost 120 mL; transfer to a calibrated bottle, rinse mortar with vehicle, and add quantity of vehicle sufficient to make 120 mL. Label "shake well," "protect from light," and "refrigerate." Stable for 28 days refrigerated (preferred) or at room temperature (Allen 1998; Nahata 2014).
10 mg/mL Oral Suspension
A 10 mg/mL oral suspension may be made with capsules and one of four different vehicles (Simple Syrup [Syrup NF], Simple Syrup [Humco Laboratories], SyrPalta Syrup [Emerson Laboratories], or Raspberry Syrup [Humco Laboratories]). Empty the contents of four 300 mg capsules or eight 150 mg capsules onto a piece of weighing paper. If necessary, crush contents to produce a fine powder. Transfer powder to a 4 oz amber glass or plastic (high-density polyethylene [HDPE], polypropylene, or polycarbonate) bottle. Rinse paper and spatula with 20 mL of chosen vehicle, add rinse to bottle, and shake vigorously. Add 100 mL of same vehicle to bottle to make a total of 120 mL and shake vigorously. Stable for 28 days at room temperature (25°C ± 3°C) or refrigerated (2°C to 8°C); shake well prior to use.
A 10 mg/mL oral suspension may be made with capsules and Simple Syrup, NF. Empty the contents of four 300 mg capsules into a mortar. If necessary, crush contents to produce a fine powder. Add 20 mL of Simple Syrup, NF and mix to a uniform paste; mix while adding simple syrup in incremental proportions to almost 120 mL; transfer to a calibrated bottle, rinse mortar with simple syrup, and add quantity of vehicle sufficient to make 120 mL. Label "shake well." Stable for 42 days at room temperature (Nahata 2014).
Oral: Administer on an empty stomach with a full glass of water (ie, 1 hour prior to or 2 hours after meals) to increase total absorption (food may delay and reduce the amount of rifampin absorbed). The compounded oral suspension must be shaken well before using. May mix contents of capsule with applesauce, pudding, or other semisoft foods (Ref).
Parenteral: Administer by slow IV infusion over 30 minutes to 3 hours. Do not administer IM or SUBQ. Avoid extravasation.
IV: Administer IV preparation by slow IV infusion over 30 minutes to 3 hours at a final concentration not to exceed 6 mg/mL. Do not administer IM or SUBQ.
May be an irritant; avoid extravasation. Restart infusion at another site if extravasation occurs.
Oral: Administer on an empty stomach (ie, 1 hour prior to, or 2 hours after meals or antacids) to increase total absorption. The compounded oral suspension must be shaken well before using. May mix contents of capsule with applesauce or jelly.
Capsule: Store at 25°C (77°F); excursions permitted to 15°C to 30°C (59°F to 86°F); avoid excessive heat.
Injection: Store intact vials at 25°C (77°F); excursions permitted to 15°C to 30°C (59°F to 86°F); avoid excessive heat (>40°C [104°F]). Protect the intact vials from light. Reconstituted vials are stable for 30 hours at room temperature. Stability of parenteral admixture at room temperature (25°C [77°F]) is 8 hours for D5W or 6 hours for NS. Note: As of July 2018, the storage of reconstituted vials was changed from 24 hours to 30 hours at room temperature, the stability when admixed in D5W was changed from 4 hours to 8 hours, and the stability when admixed in NS from 24 hours to 6 hours in the Rifadin prescribing information. Similar changes may not be reflected in the Rifadin prescribing information for product distributed prior to July 2018 or in generic manufacturer's labeling.
Treatment of all forms of tuberculosis in combination with other agents (FDA approved in pediatric patients [age not specified] and adults); elimination of meningococci from the nasopharynx in asymptomatic carriers (FDA approved in all ages). Has also been used for treatment of anaplasmosis, treatment of cholestatic pruritus, and prophylaxis in contacts of patients with invasive Haemophilus influenzae type B infection. In combination with other agents, has also been used for treatment of brucellosis, treatment of endocarditis, treatment of staphylococcal infections, treatment of Mycobacterium avium complex infections, treatment of leprosy, treatment of peritonitis, exit site, and tunnel infections in patients with peritoneal dialysis catheters, and eradication of chronic group A Streptococcus carriage.
Rifadin may be confused with Rifater, Ritalin
RifAMPin may be confused with ribavirin, rifabutin, Rifamate, rifapentine, rifAXIMin
Substrate of OATP1B1/1B3, P-glycoprotein (Minor); Note: Assignment of Major/Minor substrate status based on clinically relevant drug interaction potential; Inhibits OATP1B1/1B3; Induces BCRP, CYP1A2 (Weak), CYP2B6 (Moderate), CYP2C19 (Strong), CYP2C8 (Moderate), CYP2C9 (Moderate), CYP3A4 (Strong), OATP1B1/1B3, P-glycoprotein, UGT1A1, UGT1A9;
Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the drug interactions program by clicking on the “Launch drug interactions program” link above.
Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the drug interactions program
Abemaciclib: CYP3A4 Inducers (Strong) may decrease serum concentration of Abemaciclib. Risk X: Avoid
Abiraterone Acetate: CYP3A4 Inducers (Strong) may decrease serum concentration of Abiraterone Acetate. Management: Avoid coadministration with strong CYP3A4 inducers. For patients treated with single-agent abiraterone who require therapy with a strong CYP3A4 inducers, abiraterone frequency may increased to twice daily. See full mono for details. Risk D: Consider Therapy Modification
Abrocitinib: CYP2C19 Inducers (Strong) may decrease serum concentration of Abrocitinib. Risk X: Avoid
Acalabrutinib: CYP3A4 Inducers (Strong) may decrease serum concentration of Acalabrutinib. Management: Avoid co-administration of strong CYP3A inducers in patients taking acalabrutinib. If strong CYP3A inducers cannot be avoided, increase the dose of acalabrutinib to 200 mg twice daily. Risk D: Consider Therapy Modification
Acetaminophen: RifAMPin may increase hepatotoxic effects of Acetaminophen. RifAMPin may decrease serum concentration of Acetaminophen. Risk C: Monitor
Acoramidis: UGT1A1 Inducers may decrease serum concentration of Acoramidis. Risk X: Avoid
Adagrasib: CYP3A4 Inducers (Strong) may decrease serum concentration of Adagrasib. Risk X: Avoid
Afatinib: P-glycoprotein/ABCB1 Inducers may decrease serum concentration of Afatinib. Management: Increase the afatinib dose by 10 mg as tolerated in patients requiring chronic coadministration of P-gp inducers with afatinib. Reduce afatinib dose back to the original afatinib dose 2 to 3 days after discontinuation of the P-gp inducer. Risk D: Consider Therapy Modification
Agomelatine: RifAMPin may decrease serum concentration of Agomelatine. Risk C: Monitor
Alfacalcidol: CYP3A4 Inducers (Strong) may decrease serum concentration of Alfacalcidol. Risk C: Monitor
ALfentanil: CYP3A4 Inducers (Strong) may decrease serum concentration of ALfentanil. Management: If concomitant use of alfentanil and strong CYP3A4 inducers is necessary, consider dosage increase of alfentanil until stable drug effects are achieved. Monitor patients for signs of opioid withdrawal. Risk D: Consider Therapy Modification
Aliskiren: P-glycoprotein/ABCB1 Inducers may decrease serum concentration of Aliskiren. Risk C: Monitor
Alpelisib: CYP3A4 Inducers (Strong) may decrease serum concentration of Alpelisib. Risk X: Avoid
ALPRAZolam: CYP3A4 Inducers (Strong) may decrease serum concentration of ALPRAZolam. Risk C: Monitor
Amiodarone: CYP3A4 Inducers (Strong) may decrease active metabolite exposure of Amiodarone. CYP3A4 Inducers (Strong) may decrease serum concentration of Amiodarone. Risk C: Monitor
Amitriptyline: RifAMPin may decrease serum concentration of Amitriptyline. RifAMPin may decrease active metabolite exposure of Amitriptyline. Specifically, concentrations of nortriptyline may be reduced. Risk C: Monitor
AmLODIPine: CYP3A4 Inducers (Strong) may decrease serum concentration of AmLODIPine. Risk C: Monitor
Amodiaquine: CYP2C8 Inducers (Moderate) may decrease serum concentration of Amodiaquine. Management: Monitor for reduced amodiaquine efficacy if combined with moderate CYP2C8 inducers. Consider increasing artensunate/amodiaquine treatment duration to 5 days if coadministration with enzyme inducing drugs is required. Risk D: Consider Therapy Modification
Antihepaciviral Combination Products: CYP3A4 Inducers (Strong) may decrease serum concentration of Antihepaciviral Combination Products. Risk X: Avoid
Apixaban: Inducers of CYP3A4 (Strong) and P-glycoprotein may decrease serum concentration of Apixaban. Risk X: Avoid
Apremilast: CYP3A4 Inducers (Strong) may decrease serum concentration of Apremilast. Risk X: Avoid
Aprepitant: CYP3A4 Inducers (Strong) may decrease serum concentration of Aprepitant. Risk X: Avoid
ARIPiprazole Lauroxil: CYP3A4 Inducers (Strong) may decrease active metabolite exposure of ARIPiprazole Lauroxil. Management: Patients taking the 441 mg dose of aripiprazole lauroxil increase their dose to 662 mg if used with a strong CYP3A4 inducer for more than 14 days. No dose adjustment is necessary for patients using the higher doses of aripiprazole lauroxil. Risk D: Consider Therapy Modification
ARIPiprazole: CYP3A4 Inducers (Strong) may decrease serum concentration of ARIPiprazole. Management: For indications other than major depressive disorder: double the oral aripiprazole dose over 1 to 2 weeks and closely monitor. Avoid use of strong CYP3A4 inducers for more than 14 days with extended-release injectable aripiprazole. Risk D: Consider Therapy Modification
Artemether and Lumefantrine: CYP3A4 Inducers (Strong) may decrease serum concentration of Artemether and Lumefantrine. CYP3A4 Inducers (Strong) may decrease active metabolite exposure of Artemether and Lumefantrine. Specifically, concentrations of dihydroartemisinin (DHA), the active metabolite of artemether may be decreased. Risk X: Avoid
Artesunate: RifAMPin may decrease active metabolite exposure of Artesunate. Risk C: Monitor
Ataluren: RifAMPin may decrease serum concentration of Ataluren. Risk C: Monitor
Atazanavir: RifAMPin may decrease serum concentration of Atazanavir. Risk X: Avoid
Atogepant: RifAMPin may decrease serum concentration of Atogepant. Specifically, atogepant concentrations may be reduced with daily dosing of rifampin. RifAMPin may increase serum concentration of Atogepant. Specifically, increases in atogepant exposure may occur with single dose of rifampin or at the initiation of rifampin therapy. Management: Episodic migraine: atogepant dose should be 10 mg or 30 mg once daily with single dose rifampin, or 30 mg or 60 mg once daily with daily rifampin. Chronic migraine: avoid atogepant with daily rifampin; with single dose rifampin, use atogepant 30 mg daily. Risk D: Consider Therapy Modification
Atorvastatin: RifAMPin may increase serum concentration of Atorvastatin. RifAMPin may decrease serum concentration of Atorvastatin. Management: Administer atorvastatin and rifampin simultaneously if using both. Monitor atorvastatin response closely. Risk D: Consider Therapy Modification
Atovaquone: May increase serum concentration of RifAMPin. RifAMPin may decrease serum concentration of Atovaquone. Risk X: Avoid
Atrasentan: CYP3A4 Inducers (Strong) may decrease serum concentration of Atrasentan. Risk X: Avoid
Avacopan: CYP3A4 Inducers (Strong) may decrease serum concentration of Avacopan. Risk X: Avoid
Avanafil: CYP3A4 Inducers (Strong) may decrease serum concentration of Avanafil. Risk X: Avoid
Avapritinib: CYP3A4 Inducers (Strong) may decrease serum concentration of Avapritinib. Risk X: Avoid
Avatrombopag: RifAMPin may decrease serum concentration of Avatrombopag. Management: For chronic immune thrombocytopenia, increase initial avatrombopag dose to 40 mg daily. No dosage adjustment needed for patients with chronic liver disease-associated thrombocytopenia using altrombopag prior to a procedure. Risk D: Consider Therapy Modification
Axitinib: CYP3A4 Inducers (Strong) may decrease serum concentration of Axitinib. Risk X: Avoid
Bacillus clausii: Antibiotics may decrease therapeutic effects of Bacillus clausii. Management: Bacillus clausii should be taken in between antibiotic doses during concomitant therapy. Risk D: Consider Therapy Modification
Barnidipine: CYP3A4 Inducers (Strong) may decrease serum concentration of Barnidipine. Risk C: Monitor
Bazedoxifene: RifAMPin may decrease serum concentration of Bazedoxifene. This may lead to loss of efficacy or, if bazedoxifene is combined with estrogen therapy, an increased risk of endometrial hyperplasia. Risk C: Monitor
BCG (Intravesical): Antibiotics may decrease therapeutic effects of BCG (Intravesical). Risk X: Avoid
BCG Vaccine (Immunization): Antibiotics may decrease therapeutic effects of BCG Vaccine (Immunization). Risk C: Monitor
Bedaquiline: CYP3A4 Inducers (Strong) may decrease serum concentration of Bedaquiline. CYP3A4 Inducers (Strong) may decrease active metabolite exposure of Bedaquiline. Risk X: Avoid
Belumosudil: CYP3A4 Inducers (Strong) may decrease serum concentration of Belumosudil. Management: Increase the dose of belumosudil to 200 mg twice daily when coadministered with strong CYP3A4 inducers. Risk D: Consider Therapy Modification
Benidipine: CYP3A4 Inducers (Strong) may decrease serum concentration of Benidipine. Risk C: Monitor
Benperidol: CYP3A4 Inducers (Strong) may decrease serum concentration of Benperidol. Risk C: Monitor
Benzhydrocodone: CYP3A4 Inducers (Strong) may decrease serum concentration of Benzhydrocodone. Specifically, the serum concentrations of hydrocodone may be reduced. Risk C: Monitor
Berotralstat: P-glycoprotein/ABCB1 Inducers may decrease serum concentration of Berotralstat. Risk X: Avoid
Beta-Acetyldigoxin: P-glycoprotein/ABCB1 Inducers may decrease serum concentration of Beta-Acetyldigoxin. Risk C: Monitor
Betamethasone (Systemic): CYP3A4 Inducers (Strong) may decrease serum concentration of Betamethasone (Systemic). Risk C: Monitor
Bexagliflozin: UGT1A9 Inducers may decrease serum concentration of Bexagliflozin. Risk C: Monitor
Bictegravir: RifAMPin may decrease serum concentration of Bictegravir. Risk X: Avoid
Bisoprolol: CYP3A4 Inducers (Strong) may decrease serum concentration of Bisoprolol. Risk C: Monitor
Blonanserin: CYP3A4 Inducers (Strong) may decrease serum concentration of Blonanserin. Risk C: Monitor
Bortezomib: CYP3A4 Inducers (Strong) may decrease serum concentration of Bortezomib. Risk X: Avoid
Bosentan: RifAMPin may decrease serum concentration of Bosentan. Following the initial week of concurrent rifampin, this effect is most likely. RifAMPin may increase serum concentration of Bosentan. This effect is most likely to be observed within the initial few days of concurrent therapy (and may be greatest immediately following initiation of the combination). Risk C: Monitor
Bosutinib: CYP3A4 Inducers (Strong) may decrease serum concentration of Bosutinib. Risk X: Avoid
Brentuximab Vedotin: CYP3A4 Inducers (Strong) may decrease serum concentration of Brentuximab Vedotin. Specifically, concentrations of the active monomethyl auristatin E (MMAE) component may be decreased. Risk C: Monitor
Brexpiprazole: CYP3A4 Inducers (Strong) may decrease serum concentration of Brexpiprazole. Management: If brexpiprazole is used together with a strong CYP3A4 inducer, the brexpiprazole dose should gradually be doubled over the course of 1 to 2 weeks. Decrease brexpiprazole to original dose over 1 to 2 weeks if the strong CYP3A4 inducer is discontinued. Risk D: Consider Therapy Modification
Brigatinib: CYP3A4 Inducers (Strong) may decrease serum concentration of Brigatinib. Risk X: Avoid
Brincidofovir: OATP1B1/1B3 (SLCO1B1/1B3) Inhibitors may increase serum concentration of Brincidofovir. Management: Consider alternatives to OATP1B/1B3 inhibitors in patients treated with brincidofovir. If coadministration is required, administer OATP1B1/1B3 inhibitors at least 3 hours after brincidofovir and increase monitoring for brincidofovir adverse reactions. Risk D: Consider Therapy Modification
Brivaracetam: CYP2C19 Inducers (Strong) may decrease serum concentration of Brivaracetam. Management: Increase the brivaracetam dose by up to 100% (ie, double the dose) if used with rifampin and consider the same dose adjustment if used with other strong CYP2C19 inducers. Monitor for reduced brivaracetam efficacy. Risk D: Consider Therapy Modification
Bromocriptine: CYP3A4 Inducers (Strong) may decrease serum concentration of Bromocriptine. Risk C: Monitor
Bromperidol: CYP3A4 Inducers (Strong) may decrease serum concentration of Bromperidol. Risk C: Monitor
Brotizolam: CYP3A4 Inducers (Strong) may decrease serum concentration of Brotizolam. Risk C: Monitor
Buprenorphine: CYP3A4 Inducers (Strong) may decrease serum concentration of Buprenorphine. Risk C: Monitor
BuPROPion: CYP2B6 Inducers (Moderate) may decrease serum concentration of BuPROPion. Risk C: Monitor
BusPIRone: CYP3A4 Inducers (Strong) may decrease serum concentration of BusPIRone. Management: Consider alternatives to this combination. If coadministration of these agents is deemed necessary, monitor patients for reduced buspirone effects and increase buspirone doses as needed. Risk D: Consider Therapy Modification
Butorphanol: CYP3A4 Inducers (Strong) may decrease serum concentration of Butorphanol. Risk C: Monitor
Cabazitaxel: CYP3A4 Inducers (Strong) may decrease serum concentration of Cabazitaxel. Risk C: Monitor
Cabotegravir: UGT1A1 Inducers may decrease serum concentration of Cabotegravir. Risk X: Avoid
Cabozantinib: CYP3A4 Inducers (Strong) may decrease serum concentration of Cabozantinib. Management: Avoid use of strong CYP3A4 inducers with cabozantinib if possible. If combined, increase cabozantinib capsules (Cometriq) by 40 mg from previous dose, max 180 mg daily. Increase cabozantinib tablets (Cabometyx) by 20 mg from previous dose, max 80 mg daily Risk D: Consider Therapy Modification
Calcifediol: CYP3A4 Inducers (Strong) may increase serum concentration of Calcifediol. Risk C: Monitor
Calcitriol (Systemic): CYP3A4 Inducers (Strong) may decrease serum concentration of Calcitriol (Systemic). Risk C: Monitor
Canagliflozin: RifAMPin may decrease serum concentration of Canagliflozin. Management: Consider increasing canagliflozin dose to 200 mg/day in patients tolerating 100 mg/day. A further increase to 300 mg/day can be considered in patients with an estimated glomerular filtration rate (GFR) of 60 mL/min/1.73 m2 or greater. Risk D: Consider Therapy Modification
Cannabidiol: CYP2C19 Inducers (Strong) may decrease serum concentration of Cannabidiol. CYP2C19 Inducers (Strong) may decrease active metabolite exposure of Cannabidiol. Risk C: Monitor
Cannabis: CYP3A4 Inducers (Strong) may decrease serum concentration of Cannabis. More specifically, tetrahydrocannabinol and cannabidiol serum concentrations may be decreased. Risk C: Monitor
Capivasertib: CYP3A4 Inducers (Strong) may decrease serum concentration of Capivasertib. Risk X: Avoid
Capmatinib: CYP3A4 Inducers (Strong) may decrease serum concentration of Capmatinib. Risk X: Avoid
CarBAMazepine: CYP3A4 Inducers (Strong) may decrease serum concentration of CarBAMazepine. Risk C: Monitor
Cariprazine: CYP3A4 Inducers (Strong) may decrease serum concentration of Cariprazine. Risk X: Avoid
Carisoprodol: CYP2C19 Inducers (Strong) may decrease serum concentration of Carisoprodol. CYP2C19 Inducers (Strong) may increase active metabolite exposure of Carisoprodol. Risk C: Monitor
Carvedilol: RifAMPin may decrease serum concentration of Carvedilol. Risk C: Monitor
Caspofungin: RifAMPin may decrease serum concentration of Caspofungin. Management: Caspofungin prescribing information recommends using a dose of 70 mg daily in adults (or 70 mg/m2, up to a maximum of 70 mg, daily in pediatric patients) who are also receiving rifampin. Risk D: Consider Therapy Modification
CeFAZolin: May increase adverse/toxic effects of RifAMPin. Specifically, the risk for bleeding may be increased. Management: Avoid concomitant use of rifampin with cefazolin when possible. If combined, closely monitor prothrombin time or other coagulation tests and administer vitamin K as needed. Risk D: Consider Therapy Modification
Celecoxib: CYP2C9 Inducers (Moderate) may decrease serum concentration of Celecoxib. Risk C: Monitor
Celiprolol: P-glycoprotein/ABCB1 Inducers may decrease serum concentration of Celiprolol. Risk C: Monitor
Cephalosporins (N-methylthiotetrazole [NMTT] Side Chain Containing): May increase adverse/toxic effects of RifAMPin. Specifically, the risk for bleeding may be increased. Management: Avoid concomitant use of rifampin with cephalosporins that contain an N-methylthiotetrazole (NMTT) side chain when possible. If combined, closely monitor prothrombin time or other coagulation tests and administer vitamin K as needed. Risk D: Consider Therapy Modification
Ceritinib: CYP3A4 Inducers (Strong) may decrease serum concentration of Ceritinib. Risk X: Avoid
Charcoal, Activated: May decrease absorption of RifAMPin. Risk C: Monitor
Chloramphenicol (Systemic): RifAMPin may increase metabolism of Chloramphenicol (Systemic). Risk C: Monitor
ChlorproPAMIDE: CYP3A4 Inducers (Strong) may decrease serum concentration of ChlorproPAMIDE. Risk C: Monitor
Cholera Vaccine: Antibiotics may decrease therapeutic effects of Cholera Vaccine. Management: Avoid cholera vaccine in patients receiving systemic antibiotics, and within 14 days following the use of oral or parenteral antibiotics. Risk X: Avoid
Cilnidipine: CYP3A4 Inducers (Strong) may decrease serum concentration of Cilnidipine. Risk C: Monitor
Citalopram: CYP3A4 Inducers (Strong) may decrease serum concentration of Citalopram. Risk C: Monitor
Cladribine: BCRP/ABCG2 Inducers may decrease serum concentration of Cladribine. Risk C: Monitor
Cladribine: P-glycoprotein/ABCB1 Inducers may decrease serum concentration of Cladribine. Risk C: Monitor
Clarithromycin: CYP3A4 Inducers (Strong) may increase active metabolite exposure of Clarithromycin. CYP3A4 Inducers (Strong) may decrease serum concentration of Clarithromycin. Management: Consider alternative antimicrobial therapy for patients receiving a CYP3A4 inducer. Drugs that enhance the metabolism of clarithromycin into 14-hydroxyclarithromycin may alter the clinical activity of clarithromycin and may impair clarithromycin efficacy. Risk D: Consider Therapy Modification
ClonazePAM: CYP3A4 Inducers (Strong) may decrease serum concentration of ClonazePAM. Risk C: Monitor
Clopidogrel: CYP2C19 Inducers (Strong) may increase active metabolite exposure of Clopidogrel. Management: Consider alternatives to this combination when possible. If combined, monitor for increased clopidogrel effects and toxicities (eg, bleeding) if clopidogrel is combined with a strong CYP2C19 inducer. Risk D: Consider Therapy Modification
CloZAPine: CYP3A4 Inducers (Strong) may decrease serum concentration of CloZAPine. Management: Avoid use with strong CYP3A4 inducers when possible. If combined, monitor patients closely and consider clozapine dose increases. Clozapine dose reduction and further monitoring may be required when strong CYP3A4 inducers are discontinued. Risk D: Consider Therapy Modification
Cobicistat: RifAMPin may decrease serum concentration of Cobicistat. Risk X: Avoid
Cobimetinib: CYP3A4 Inducers (Strong) may decrease serum concentration of Cobimetinib. Risk X: Avoid
Codeine: CYP3A4 Inducers (Strong) may decrease active metabolite exposure of Codeine. Risk C: Monitor
Colchicine: CYP3A4 Inducers (Strong) may decrease serum concentration of Colchicine. Risk C: Monitor
Copanlisib: CYP3A4 Inducers (Strong) may decrease serum concentration of Copanlisib. Risk X: Avoid
Crinecerfont: CYP3A4 Inducers (Strong) may decrease serum concentration of Crinecerfont. Management: Double the morning and evening doses of crinecerfont during coadministration with strong CYP3A4 inducers. See full interaction monograph for details. Risk D: Consider Therapy Modification
Crizotinib: CYP3A4 Inducers (Strong) may decrease serum concentration of Crizotinib. Risk X: Avoid
CycloPHOSphamide: CYP2B6 Inducers (Moderate) may increase active metabolite exposure of CycloPHOSphamide. Risk C: Monitor
CycloSPORINE (Systemic): CYP3A4 Inducers (Strong) may decrease serum concentration of CycloSPORINE (Systemic). Management: Monitor closely for reduced cyclosporine concentrations when combined with strong CYP3A4 inducers. Cyclosporine dose increases will likely be required to maintain adequate serum concentrations. Risk D: Consider Therapy Modification
Cyproterone: CYP3A4 Inducers (Strong) may decrease serum concentration of Cyproterone. Risk C: Monitor
Dabigatran Etexilate: P-glycoprotein/ABCB1 Inducers may decrease serum concentration of Dabigatran Etexilate. Management: Avoid concurrent use of dabigatran with P-glycoprotein inducers whenever possible. Risk X: Avoid
Daclatasvir: CYP3A4 Inducers (Strong) may decrease serum concentration of Daclatasvir. Risk X: Avoid
Daprodustat: CYP2C8 Inducers (Moderate) may decrease serum concentration of Daprodustat. Risk C: Monitor
Dapsone (Systemic): May increase adverse/toxic effects of CYP3A4 Inducers (Strong). CYP3A4 Inducers (Strong) may decrease serum concentration of Dapsone (Systemic). Management: Consider alternatives to this combination when possible. Monitor for decreased dapsone efficacy if combined with strong CYP3A4 inducers. Risk D: Consider Therapy Modification
Daridorexant: CYP3A4 Inducers (Strong) may decrease serum concentration of Daridorexant. Risk X: Avoid
Darolutamide: Inducers of CYP3A4 (Strong) and P-glycoprotein may decrease serum concentration of Darolutamide. Risk X: Avoid
Darunavir: RifAMPin may decrease serum concentration of Darunavir. Risk X: Avoid
Dasabuvir: CYP3A4 Inducers (Strong) may decrease serum concentration of Dasabuvir. Risk X: Avoid
Dasatinib: CYP3A4 Inducers (Strong) may decrease serum concentration of Dasatinib. Management: Avoid concurrent use of dasatinib with strong CYP3A4 inducers when possible. If such a combination cannot be avoided, consider increasing dasatinib dose and monitor clinical response and toxicity closely. Risk D: Consider Therapy Modification
Deferasirox: UGT1A1 Inducers may decrease serum concentration of Deferasirox. Management: Avoid concomitant use of deferasirox and UGT1A1 inducers when possible. If combined, consider a 50% increase in the initial deferasirox dose, with monitoring of serum ferritin concentrations and clinical response to guide further dosing. Risk D: Consider Therapy Modification
Deflazacort: CYP3A4 Inducers (Strong) may decrease active metabolite exposure of Deflazacort. Risk X: Avoid
Delamanid: CYP3A4 Inducers (Strong) may decrease serum concentration of Delamanid. Risk X: Avoid
Deuruxolitinib: CYP2C9 Inducers (Moderate) may decrease serum concentration of Deuruxolitinib. Risk X: Avoid
Deuruxolitinib: CYP3A4 Inducers (Strong) may decrease serum concentration of Deuruxolitinib. Risk X: Avoid
DexAMETHasone (Systemic): CYP3A4 Inducers (Strong) may decrease serum concentration of DexAMETHasone (Systemic). Management: Avoid coadministration of dexamethasone and strong CYP3A4 inducers. If concomitant use cannot be avoided, consider dexamethasone dose increases. Risk D: Consider Therapy Modification
Dexlansoprazole: CYP2C19 Inducers (Strong) may decrease serum concentration of Dexlansoprazole. Risk X: Avoid
Diamorphine: RifAMPin may decrease active metabolite exposure of Diamorphine. Risk C: Monitor
DiazePAM: CYP3A4 Inducers (Strong) may decrease serum concentration of DiazePAM. Risk C: Monitor
Diazoxide Choline: RifAMPin may decrease serum concentration of Diazoxide Choline. Risk X: Avoid
Diclofenac (Systemic): CYP2C9 Inducers (Moderate) may decrease serum concentration of Diclofenac (Systemic). Risk C: Monitor
Dienogest: CYP3A4 Inducers (Strong) may decrease serum concentration of Dienogest. Risk C: Monitor
Digitoxin: CYP3A4 Inducers (Strong) may decrease serum concentration of Digitoxin. Risk C: Monitor
Digitoxin: P-glycoprotein/ABCB1 Inducers may decrease serum concentration of Digitoxin. Risk C: Monitor
Digoxin: P-glycoprotein/ABCB1 Inducers may decrease serum concentration of Digoxin. Risk C: Monitor
DilTIAZem: CYP3A4 Inducers (Strong) may decrease serum concentration of DilTIAZem. Management: Consider alternatives to this combination when possible. If combined, monitor for decreased diltiazem efficacy. Risk D: Consider Therapy Modification
Disopyramide: CYP3A4 Inducers (Strong) may decrease serum concentration of Disopyramide. Risk C: Monitor
DOCEtaxel: CYP3A4 Inducers (Strong) may decrease serum concentration of DOCEtaxel. Risk C: Monitor
Dolutegravir: RifAMPin may decrease serum concentration of Dolutegravir. Management: Increase dolutegravir to 50 mg twice/day in adults. Increase weight-based dose to twice daily in pediatric patients. Specific recommendations vary for combination products; see interaction monograph for details. Risk D: Consider Therapy Modification
Domperidone: CYP3A4 Inducers (Strong) may decrease serum concentration of Domperidone. Risk C: Monitor
Doravirine: CYP3A4 Inducers (Strong) may decrease serum concentration of Doravirine. Risk X: Avoid
Doxercalciferol: CYP3A4 Inducers (Strong) may increase active metabolite exposure of Doxercalciferol. Risk C: Monitor
DOXOrubicin (Conventional): CYP3A4 Inducers (Strong) may decrease serum concentration of DOXOrubicin (Conventional). Risk X: Avoid
DOXOrubicin (Conventional): P-glycoprotein/ABCB1 Inducers may decrease serum concentration of DOXOrubicin (Conventional). Risk X: Avoid
Doxycycline: RifAMPin may decrease serum concentration of Doxycycline. Risk C: Monitor
DroNABinol: CYP3A4 Inducers (Strong) may decrease serum concentration of DroNABinol. Risk C: Monitor
Dronedarone: CYP3A4 Inducers (Strong) may decrease serum concentration of Dronedarone. Risk X: Avoid
Duvelisib: CYP3A4 Inducers (Strong) may decrease serum concentration of Duvelisib. Risk X: Avoid
Dydrogesterone: CYP3A4 Inducers (Strong) may decrease serum concentration of Dydrogesterone. Risk C: Monitor
Ebastine: CYP3A4 Inducers (Strong) may decrease serum concentration of Ebastine. CYP3A4 Inducers (Strong) may decrease active metabolite exposure of Ebastine. Risk C: Monitor
Edoxaban: RifAMPin may decrease serum concentration of Edoxaban. Risk X: Avoid
Efavirenz: RifAMPin may decrease serum concentration of Efavirenz. Efavirenz may decrease serum concentration of RifAMPin. Management: Monitor for reduced response to efavirenz and rifampin. Guidelines suggest no efavirenz dose adjustments are required when combined, while labeling recommends an efavirenz dose increase to 800 mg daily in adults weighing more than 50 kg. Risk C: Monitor
Elacestrant: CYP3A4 Inducers (Strong) may decrease serum concentration of Elacestrant. Risk X: Avoid
Elafibranor: RifAMPin may decrease serum concentration of Elafibranor. Risk C: Monitor
Elagolix, Estradiol, and Norethindrone: May increase serum concentration of RifAMPin. Specifically, rifampin may increase elagolix concentrations and decrease estradiol and norethindrone concentrations. Risk X: Avoid
Elagolix: RifAMPin may increase serum concentration of Elagolix. Management: Use of the elagolix 200 mg twice daily dose with rifampin is not recommended. Limit combined use of the elagolix 150 mg once daily dose with rifampin to a maximum of 6 months. Risk D: Consider Therapy Modification
Elbasvir and Grazoprevir: RifAMPin may increase serum concentration of Elbasvir and Grazoprevir. RifAMPin may decrease serum concentration of Elbasvir and Grazoprevir. Risk X: Avoid
Elexacaftor, Tezacaftor, and Ivacaftor: CYP3A4 Inducers (Strong) may decrease serum concentration of Elexacaftor, Tezacaftor, and Ivacaftor. Risk X: Avoid
Eliglustat: CYP3A4 Inducers (Strong) may decrease serum concentration of Eliglustat. Risk X: Avoid
Eluxadoline: OATP1B1/1B3 (SLCO1B1/1B3) Inhibitors may increase serum concentration of Eluxadoline. Management: Decrease the eluxadoline dose to 75 mg twice daily if combined with OATP1B1/1B3 inhibitors and monitor patients for increased eluxadoline effects/toxicities. Risk D: Consider Therapy Modification
Encorafenib: CYP3A4 Inducers (Strong) may decrease serum concentration of Encorafenib. Risk X: Avoid
Enfortumab Vedotin: CYP3A4 Inducers (Strong) may decrease serum concentration of Enfortumab Vedotin. Specifically, concentrations of the active monomethyl auristatin E (MMAE) component may be decreased. Risk C: Monitor
Ensartinib: CYP3A4 Inducers (Strong) may decrease serum concentration of Ensartinib. Risk X: Avoid
Entrectinib: CYP3A4 Inducers (Strong) may decrease serum concentration of Entrectinib. Risk X: Avoid
Enzalutamide: CYP3A4 Inducers (Strong) may decrease serum concentration of Enzalutamide. CYP3A4 Inducers (Strong) may decrease active metabolite exposure of Enzalutamide. Management: Consider using an alternative agent that has no or minimal CYP3A4 induction potential when possible. If this combination cannot be avoided, increase the dose of enzalutamide from 160 mg daily to 240 mg daily. Risk D: Consider Therapy Modification
Eplerenone: CYP3A4 Inducers (Strong) may decrease serum concentration of Eplerenone. Risk C: Monitor
Eravacycline: CYP3A4 Inducers (Strong) may decrease serum concentration of Eravacycline. Management: Increase the eravacycline dose to 1.5 mg/kg every 12 hours when combined with strong CYP3A4 inducers. Risk D: Consider Therapy Modification
Erdafitinib: CYP3A4 Inducers (Strong) may decrease serum concentration of Erdafitinib. Risk X: Avoid
Erlotinib: CYP3A4 Inducers (Strong) may decrease serum concentration of Erlotinib. Management: Avoid the combination of erlotinib and strong CYP3A4 inducers whenever possible. If this combination must be used, increase erlotinib dose by 50 mg increments every 2 weeks as tolerated, to a maximum of 450 mg/day. Risk D: Consider Therapy Modification
Escitalopram: CYP3A4 Inducers (Strong) may decrease serum concentration of Escitalopram. Risk C: Monitor
Esketamine (Injection): CYP3A4 Inducers (Strong) may decrease serum concentration of Esketamine (Injection). Risk C: Monitor
Esomeprazole: CYP2C19 Inducers (Strong) may decrease serum concentration of Esomeprazole. Risk X: Avoid
Estazolam: CYP3A4 Inducers (Strong) may decrease serum concentration of Estazolam. Risk C: Monitor
Estrogen Derivatives: CYP3A4 Inducers (Strong) may decrease serum concentration of Estrogen Derivatives. Risk C: Monitor
Eszopiclone: CYP3A4 Inducers (Strong) may decrease serum concentration of Eszopiclone. Risk C: Monitor
Ethosuximide: CYP3A4 Inducers (Strong) may decrease serum concentration of Ethosuximide. Risk C: Monitor
Etizolam: CYP3A4 Inducers (Strong) may decrease serum concentration of Etizolam. Risk C: Monitor
Etoposide Phosphate: CYP3A4 Inducers (Strong) may decrease serum concentration of Etoposide Phosphate. Management: When possible, seek alternatives to strong CYP3A4-inducing medications in patients receiving etoposide phosphate. If these combinations cannot be avoided, monitor patients closely for diminished etoposide phosphate response. Risk D: Consider Therapy Modification
Etoposide: CYP3A4 Inducers (Strong) may decrease serum concentration of Etoposide. Management: When possible, seek alternatives to strong CYP3A4-inducing medications in patients receiving etoposide. If combined, monitor patients closely for diminished etoposide response and need for etoposide dose increases. Risk D: Consider Therapy Modification
Etoricoxib: CYP3A4 Inducers (Strong) may decrease serum concentration of Etoricoxib. Risk C: Monitor
Etrasimod: RifAMPin may decrease serum concentration of Etrasimod. Risk X: Avoid
Etravirine: CYP3A4 Inducers (Strong) may decrease serum concentration of Etravirine. Risk X: Avoid
Everolimus: Inducers of CYP3A4 (Strong) and P-glycoprotein may decrease serum concentration of Everolimus. Management: Afinitor: Double the everolimus daily dose, using increments of 5 mg or less, with careful monitoring; multiple increments may be necessary. Zortress: Avoid if possible and monitor for decreased everolimus concentrations if combined. Risk D: Consider Therapy Modification
Evogliptin: CYP3A4 Inducers (Strong) may decrease serum concentration of Evogliptin. Risk C: Monitor
Exemestane: CYP3A4 Inducers (Strong) may decrease serum concentration of Exemestane. Management: Increase the exemestane dose to 50 mg once daily in patients receiving concurrent strong CYP3A4 inducers. Monitor patients closely for evidence of toxicity or inadequate clinical response. Risk D: Consider Therapy Modification
Fecal Microbiota (Live) (Oral): May decrease therapeutic effects of Antibiotics. Risk X: Avoid
Fecal Microbiota (Live) (Rectal): Antibiotics may decrease therapeutic effects of Fecal Microbiota (Live) (Rectal). Risk X: Avoid
Fedratinib: CYP3A4 Inducers (Strong) may decrease serum concentration of Fedratinib. Risk X: Avoid
Felbamate: CYP3A4 Inducers (Strong) may decrease serum concentration of Felbamate. Risk C: Monitor
Felodipine: CYP3A4 Inducers (Strong) may decrease serum concentration of Felodipine. Management: Consider alternatives to this combination when possible. If combined, monitor for reduced felodipine efficacy and the need for felodipine dose increases. Risk D: Consider Therapy Modification
Fenfluramine: RifAMPin may decrease serum concentration of Fenfluramine. Management: Avoid concurrent use of rifampin with fenfluramine when possible. If combined use cannot be avoided, consider increasing the fenfluramine dose, but do not exceed the fenfluramine maximum daily dose. Risk D: Consider Therapy Modification
FentaNYL: CYP3A4 Inducers (Strong) may decrease serum concentration of FentaNYL. Risk C: Monitor
Fesoterodine: CYP3A4 Inducers (Strong) may decrease active metabolite exposure of Fesoterodine. Risk C: Monitor
Fexinidazole: CYP3A4 Inducers (Strong) may increase active metabolite exposure of Fexinidazole. Risk X: Avoid
Fexofenadine: RifAMPin may decrease serum concentration of Fexofenadine. RifAMPin may increase serum concentration of Fexofenadine. Risk C: Monitor
Fimasartan: RifAMPin may increase serum concentration of Fimasartan. Risk X: Avoid
Finerenone: CYP3A4 Inducers (Strong) may decrease serum concentration of Finerenone. Risk X: Avoid
Flibanserin: CYP3A4 Inducers (Strong) may decrease serum concentration of Flibanserin. Risk X: Avoid
Fluconazole: RifAMPin may decrease serum concentration of Fluconazole. Fluconazole may increase serum concentration of RifAMPin. Management: Consider increasing the dose of fluconazole when used concurrently with rifampin. When combined, monitor for both reduced clinical efficacy of fluconazole and increased rifampin toxicities. Risk D: Consider Therapy Modification
Fludrocortisone: CYP3A4 Inducers (Strong) may decrease serum concentration of Fludrocortisone. Risk C: Monitor
Fluvastatin: RifAMPin may decrease serum concentration of Fluvastatin. Specifically, this occurs with prolonged coadministration. RifAMPin may increase serum concentration of Fluvastatin. Specifically, this occurs upon rifampin initiation. Risk C: Monitor
Fosamprenavir: RifAMPin may decrease serum concentration of Fosamprenavir. Specifically, concentrations of amprenavir (active metabolite) may be decreased. Risk X: Avoid
Fosaprepitant: CYP3A4 Inducers (Strong) may decrease serum concentration of Fosaprepitant. Specifically, CYP3A4 Inducers (Strong) may decrease serum concentrations of the active metabolite aprepitant. Risk X: Avoid
Fosnetupitant: CYP3A4 Inducers (Strong) may decrease active metabolite exposure of Fosnetupitant. Risk X: Avoid
Fosphenytoin-Phenytoin: CYP2C19 Inducers (Strong) may decrease serum concentration of Fosphenytoin-Phenytoin. Risk C: Monitor
Fostamatinib: CYP3A4 Inducers (Strong) may decrease active metabolite exposure of Fostamatinib. Risk X: Avoid
Fostemsavir: CYP3A4 Inducers (Strong) may decrease active metabolite exposure of Fostemsavir. Risk X: Avoid
Fruquintinib: CYP3A4 Inducers (Strong) may decrease serum concentration of Fruquintinib. Risk X: Avoid
Futibatinib: Inducers of CYP3A4 (Strong) and P-glycoprotein may decrease serum concentration of Futibatinib. Risk X: Avoid
Ganaxolone: CYP3A4 Inducers (Strong) may decrease serum concentration of Ganaxolone. Management: Avoid concomitant use of ganaxolone and strong CYP3A4 inducers whenever possible. If combined, consider increasing the dose of ganaxolone, but do not exceed the maximum recommended daily dose. Risk D: Consider Therapy Modification
Gefitinib: CYP3A4 Inducers (Strong) may decrease serum concentration of Gefitinib. Management: In the absence of severe adverse reactions, increase the gefitinib dose to 500 mg daily in patients receiving strong CYP3A4 inducers; resume 250 mg dose 7 days after discontinuation of the strong inducer. Carefully monitor clinical response. Risk D: Consider Therapy Modification
Gemigliptin: CYP3A4 Inducers (Strong) may decrease serum concentration of Gemigliptin. CYP3A4 Inducers (Strong) may decrease active metabolite exposure of Gemigliptin. Risk X: Avoid
Gepirone: CYP3A4 Inducers (Strong) may decrease serum concentration of Gepirone. Risk X: Avoid
Gepotidacin: CYP3A4 Inducers (Strong) may decrease serum concentration of Gepotidacin. Risk X: Avoid
Gestrinone: RifAMPin may decrease serum concentration of Gestrinone. Risk C: Monitor
Gilteritinib: Inducers of CYP3A4 (Strong) and P-glycoprotein may decrease serum concentration of Gilteritinib. Risk X: Avoid
Glasdegib: CYP3A4 Inducers (Strong) may decrease serum concentration of Glasdegib. Risk X: Avoid
Glecaprevir and Pibrentasvir: RifAMPin may decrease serum concentration of Glecaprevir and Pibrentasvir. RifAMPin may increase serum concentration of Glecaprevir and Pibrentasvir. Specifically, a single dose of rifampin may increase glecaprevir/pibrentasvir concentrations, while chronic daily use of rifampin may decrease glecaprevir/pibrentasvir concentrations. Risk X: Avoid
GuanFACINE: CYP3A4 Inducers (Strong) may decrease serum concentration of GuanFACINE. Management: Increase extended-release guanfacine dose by up to double when initiating guanfacine in patients taking CYP3A4 inducers or if initiating a CYP3A4 inducer in a patient already taking extended-release guanfacine. Monitor for reduced guanfacine efficacy. Risk D: Consider Therapy Modification
Haloperidol: CYP3A4 Inducers (Strong) may decrease serum concentration of Haloperidol. Risk C: Monitor
Hormonal Contraceptives: CYP3A4 Inducers (Strong) may decrease serum concentration of Hormonal Contraceptives. Management: Advise patients to use an alternative method of contraception or a back-up method during coadministration, and to continue back-up contraception for 28 days after discontinuing a strong CYP3A4 inducer to ensure contraceptive reliability. Risk D: Consider Therapy Modification
HYDROcodone: CYP3A4 Inducers (Strong) may decrease serum concentration of HYDROcodone. Risk C: Monitor
Hydrocortisone (Systemic): CYP3A4 Inducers (Strong) may decrease serum concentration of Hydrocortisone (Systemic). Risk C: Monitor
Hydroxychloroquine: RifAMPin may decrease therapeutic effects of Hydroxychloroquine. Risk X: Avoid
Ibrexafungerp: CYP3A4 Inducers (Strong) may decrease serum concentration of Ibrexafungerp. Risk X: Avoid
Ibrutinib: CYP3A4 Inducers (Strong) may decrease serum concentration of Ibrutinib. Risk X: Avoid
Idelalisib: CYP3A4 Inducers (Strong) may decrease serum concentration of Idelalisib. Risk X: Avoid
Ifosfamide: CYP3A4 Inducers (Strong) may increase active metabolite exposure of Ifosfamide. CYP3A4 Inducers (Strong) may decrease active metabolite exposure of Ifosfamide. Risk C: Monitor
Imatinib: CYP3A4 Inducers (Strong) may decrease serum concentration of Imatinib. Management: Avoid use of imatinib and strong CYP3A4 inducers when possible. If such a combination must be used, increase imatinib dose by at least 50% and monitor the patient's clinical response closely. Doses up to 1200 mg/day (600 mg twice daily) have been used. Risk D: Consider Therapy Modification
Immune Checkpoint Inhibitors (Anti-PD-1, -PD-L1, and -CTLA4 Therapies): Antibiotics may decrease therapeutic effects of Immune Checkpoint Inhibitors (Anti-PD-1, -PD-L1, and -CTLA4 Therapies). Risk C: Monitor
Indinavir: RifAMPin may decrease serum concentration of Indinavir. Risk X: Avoid
Iptacopan: CYP2C8 Inducers (Moderate) may decrease serum concentration of Iptacopan. Risk C: Monitor
Irinotecan Products: CYP3A4 Inducers (Strong) may decrease serum concentration of Irinotecan Products. CYP3A4 Inducers (Strong) may decrease active metabolite exposure of Irinotecan Products. Specifically, serum concentrations of SN-38 may be reduced. Management: Avoid administration of strong CYP3A4 inducers during irinotecan treatment, and substitute non-CYP3A4 inducing agents at least 2 weeks prior to irinotecan initiation, whenever possible. If combined, monitor for reduced irinotecan efficacy. Risk D: Consider Therapy Modification
Isavuconazonium Sulfate: CYP3A4 Inducers (Strong) may decrease active metabolite exposure of Isavuconazonium Sulfate. Specifically, CYP3A4 Inducers (Strong) may decrease isavuconazole serum concentrations. Risk X: Avoid
Isoniazid: May increase hepatotoxic effects of RifAMPin. RifAMPin may decrease serum concentration of Isoniazid. Risk C: Monitor
Isradipine: CYP3A4 Inducers (Strong) may decrease serum concentration of Isradipine. Risk C: Monitor
Istradefylline: CYP3A4 Inducers (Strong) may decrease serum concentration of Istradefylline. Risk X: Avoid
Itraconazole: CYP3A4 Inducers (Strong) may decrease serum concentration of Itraconazole. CYP3A4 Inducers (Strong) may decrease active metabolite exposure of Itraconazole. Risk X: Avoid
Ivabradine: CYP3A4 Inducers (Strong) may decrease serum concentration of Ivabradine. Risk X: Avoid
Ivacaftor: CYP3A4 Inducers (Strong) may decrease serum concentration of Ivacaftor. Risk X: Avoid
Ivosidenib: CYP3A4 Inducers (Strong) may decrease serum concentration of Ivosidenib. Risk X: Avoid
Ixabepilone: CYP3A4 Inducers (Strong) may decrease serum concentration of Ixabepilone. Management: Avoid this combination whenever possible. If this combination must be used, a gradual increase in ixabepilone dose from 40 mg/m2 to 60 mg/m2 (given as a 4-hour infusion), as tolerated, should be considered. Risk D: Consider Therapy Modification
Ixazomib: CYP3A4 Inducers (Strong) may decrease serum concentration of Ixazomib. Risk X: Avoid
Ketamine: CYP3A4 Inducers (Strong) may decrease serum concentration of Ketamine. Risk C: Monitor
Ketoconazole (Systemic): CYP3A4 Inducers (Strong) may decrease serum concentration of Ketoconazole (Systemic). Management: The use of ketoconazole concurrently with or within 2 weeks of a strong CYP3A4 inducer is not recommended. If such a combination cannot be avoided, monitor patients closely for evidence of diminished clinical response to ketoconazole. Risk D: Consider Therapy Modification
Lacidipine: CYP3A4 Inducers (Strong) may decrease serum concentration of Lacidipine. Risk C: Monitor
Lactobacillus and Estriol: Antibiotics may decrease therapeutic effects of Lactobacillus and Estriol. Risk C: Monitor
LamoTRIgine: RifAMPin may decrease serum concentration of LamoTRIgine. Management: For patients taking rifampin without valproate, lamotrigine dose adjustments are recommended for lamotrigine initiation. Recommendations vary based on lamotrigine indication and age. See full interact monograph for details. Risk D: Consider Therapy Modification
Lansoprazole: CYP2C19 Inducers (Strong) may decrease serum concentration of Lansoprazole. Risk X: Avoid
Lapatinib: CYP3A4 Inducers (Strong) may decrease serum concentration of Lapatinib. Management: If concomitant use cannot be avoided, titrate lapatinib gradually from 1,250 mg/day up to 4,500 mg/day (HER2 positive metastatic breast cancer) or 1,500 mg/day up to 5,500 mg/day (hormone receptor/HER2 positive breast cancer) as tolerated. Risk D: Consider Therapy Modification
Larotrectinib: CYP3A4 Inducers (Strong) may decrease serum concentration of Larotrectinib. Management: Avoid use of strong CYP3A4 inducers with larotrectinib. If this combination cannot be avoided, double the larotrectinib dose. Reduced to previous dose after stopping the inducer after a period of 3 to 5 times the inducer's half-life. Risk D: Consider Therapy Modification
Lazertinib: CYP3A4 Inducers (Strong) may decrease serum concentration of Lazertinib. Risk X: Avoid
Ledipasvir: P-glycoprotein/ABCB1 Inducers may decrease serum concentration of Ledipasvir. Risk X: Avoid
Lefamulin (Intravenous): CYP3A4 Inducers (Strong) may decrease serum concentration of Lefamulin (Intravenous). Management: Avoid concomitant use of lefamulin intravenous infusion with strong CYP3A4 inducers unless the benefits outweigh the risks. Risk D: Consider Therapy Modification
Lefamulin (Intravenous): P-glycoprotein/ABCB1 Inducers may decrease serum concentration of Lefamulin (Intravenous). Management: Avoid concomitant use of lefamulin (intravenous) with P-glycoprotein/ABCB1 inducers unless the benefits outweigh the risks. Risk D: Consider Therapy Modification
Lefamulin: CYP3A4 Inducers (Strong) may decrease serum concentration of Lefamulin. Management: Avoid concomitant use of lefamulin with strong CYP3A4 inducers unless the benefits outweigh the risks. Risk D: Consider Therapy Modification
Lefamulin: P-glycoprotein/ABCB1 Inducers may decrease serum concentration of Lefamulin. Management: Avoid concomitant use of lefamulin with P-glycoprotein/ABCB1 inducers unless the benefits outweigh the risks. Risk D: Consider Therapy Modification
Leflunomide: RifAMPin may increase active metabolite exposure of Leflunomide. Risk C: Monitor
Lemborexant: CYP3A4 Inducers (Strong) may decrease serum concentration of Lemborexant. Risk X: Avoid
Lenacapavir: CYP3A4 Inducers (Strong) may decrease serum concentration of Lenacapavir. Risk X: Avoid
Leniolisib: CYP3A4 Inducers (Strong) may decrease serum concentration of Leniolisib. Risk X: Avoid
Lercanidipine: CYP3A4 Inducers (Strong) may decrease serum concentration of Lercanidipine. Risk C: Monitor
Letermovir: P-glycoprotein/ABCB1 Inducers may decrease serum concentration of Letermovir. Risk X: Avoid
Letermovir: UGT1A1 Inducers may decrease serum concentration of Letermovir. Risk X: Avoid
Leuprolide and Norethindrone: CYP3A4 Inducers (Strong) may decrease serum concentration of Leuprolide and Norethindrone. Specifically, norethindrone concentrations may be decreased. Risk C: Monitor
Levamlodipine: CYP3A4 Inducers (Strong) may decrease serum concentration of Levamlodipine. Risk C: Monitor
Levoketoconazole: CYP3A4 Inducers (Strong) may decrease serum concentration of Levoketoconazole. Risk X: Avoid
Levomethadone: CYP3A4 Inducers (Strong) may decrease serum concentration of Levomethadone. Risk C: Monitor
Levonorgestrel (IUD): CYP3A4 Inducers (Strong) may decrease therapeutic effects of Levonorgestrel (IUD). CYP3A4 Inducers (Strong) may decrease serum concentration of Levonorgestrel (IUD). Risk C: Monitor
Lidocaine (Systemic): CYP3A4 Inducers (Strong) may decrease serum concentration of Lidocaine (Systemic). Risk C: Monitor
LinaGLIPtin: CYP3A4 Inducers (Strong) may decrease serum concentration of LinaGLIPtin. Management: Strongly consider using an alternative to any strong CYP3A4 inducer in patients who are being treated with linagliptin. If this combination is used, monitor patients closely for evidence of reduced linagliptin effectiveness. Risk D: Consider Therapy Modification
LinaGLIPtin: P-glycoprotein/ABCB1 Inducers may decrease serum concentration of LinaGLIPtin. Management: Strongly consider using an alternative to any P-glycoprotein inducer in patients who are being treated with linagliptin. If this combination is used, monitor patients closely for evidence of reduced linagliptin effectiveness. Risk D: Consider Therapy Modification
Lonafarnib: CYP3A4 Inducers (Strong) may decrease serum concentration of Lonafarnib. Risk X: Avoid
Lopinavir: RifAMPin may increase adverse/toxic effects of Lopinavir. Specifically, the risk of hepatocellular toxicity may be increased. RifAMPin may decrease serum concentration of Lopinavir. Risk X: Avoid
Lorlatinib: CYP3A4 Inducers (Strong) may increase hepatotoxic effects of Lorlatinib. CYP3A4 Inducers (Strong) may decrease serum concentration of Lorlatinib. Risk X: Avoid
Lornoxicam: CYP2C9 Inducers (Moderate) may decrease serum concentration of Lornoxicam. Risk C: Monitor
Lovastatin: CYP3A4 Inducers (Strong) may decrease serum concentration of Lovastatin. Risk C: Monitor
Lumacaftor and Ivacaftor: CYP3A4 Inducers (Strong) may decrease serum concentration of Lumacaftor and Ivacaftor. Specifically, the serum concentration of ivacaftor may be decreased. Risk X: Avoid
Lumateperone: CYP3A4 Inducers (Strong) may decrease serum concentration of Lumateperone. Risk X: Avoid
Lurasidone: CYP3A4 Inducers (Strong) may decrease serum concentration of Lurasidone. Risk X: Avoid
Lurbinectedin: CYP3A4 Inducers (Strong) may decrease serum concentration of Lurbinectedin. Risk X: Avoid
Macimorelin: CYP3A4 Inducers (Strong) may decrease serum concentration of Macimorelin. Risk X: Avoid
Macitentan: CYP3A4 Inducers (Strong) may decrease serum concentration of Macitentan. Risk X: Avoid
Manidipine: CYP3A4 Inducers (Strong) may decrease serum concentration of Manidipine. Management: Consider avoiding concomitant use of manidipine and strong CYP3A4 inducers. If combined, monitor closely for decreased manidipine effects and loss of efficacy. Increased manidipine doses may be required. Risk D: Consider Therapy Modification
Maraviroc: CYP3A4 Inducers (Strong) may decrease serum concentration of Maraviroc. Management: Increase maraviroc adult dose to 600 mg twice/day, but only if not receiving a strong CYP3A4 inhibitor. Not recommended for pediatric patients not also receiving a strong CYP3A4 inhibitor. Contraindicated in patients with CrCl less than 30 mL/min. Risk D: Consider Therapy Modification
Maribavir: CYP3A4 Inducers (Strong) may decrease serum concentration of Maribavir. Risk X: Avoid
Mavacamten: CYP3A4 Inducers (Strong) may decrease serum concentration of Mavacamten. Risk X: Avoid
Mavorixafor: CYP3A4 Inducers (Strong) may decrease serum concentration of Mavorixafor. Risk X: Avoid
Mefloquine: CYP3A4 Inducers (Strong) may decrease serum concentration of Mefloquine. Risk C: Monitor
Meperidine: CYP3A4 Inducers (Strong) may decrease serum concentration of Meperidine. CYP3A4 Inducers (Strong) may increase active metabolite exposure of Meperidine. Specifically, concentrations of normeperidine, the CNS stimulating metabolite, may be increased. Risk C: Monitor
Methadone: CYP3A4 Inducers (Strong) may decrease serum concentration of Methadone. Risk C: Monitor
Methotrexate: RifAMPin may increase serum concentration of Methotrexate. Risk C: Monitor
Methoxyflurane: CYP2B6 Inducers (Moderate) may increase metabolism of Methoxyflurane. Specifically, this increased metabolism may lead to increased production of nephrotoxic metabolites. Risk X: Avoid
Methylergonovine: CYP3A4 Inducers (Strong) may decrease serum concentration of Methylergonovine. Risk C: Monitor
MethylPREDNISolone: CYP3A4 Inducers (Strong) may decrease serum concentration of MethylPREDNISolone. Management: Consider methylprednisolone dose increases in patients receiving strong CYP3A4 inducers and monitor closely for reduced steroid efficacy. Risk D: Consider Therapy Modification
Metoprolol: RifAMPin may decrease serum concentration of Metoprolol. Risk C: Monitor
Mexiletine: RifAMPin may decrease serum concentration of Mexiletine. Risk C: Monitor
Mianserin: CYP3A4 Inducers (Strong) may decrease serum concentration of Mianserin. Risk C: Monitor
Midazolam: CYP3A4 Inducers (Strong) may decrease serum concentration of Midazolam. Risk C: Monitor
Midostaurin: CYP3A4 Inducers (Strong) may decrease serum concentration of Midostaurin. Risk X: Avoid
MiFEPRIStone: CYP3A4 Inducers (Strong) may decrease serum concentration of MiFEPRIStone. Management: Avoid combined use in patients treated for Cushing's disease. When used for pregnancy termination, mifepristone efficacy may be reduced and an alternative pregnancy termination procedure may be warranted. Ensure a follow-up assessment after combined use. Risk D: Consider Therapy Modification
Mirabegron: CYP3A4 Inducers (Strong) may decrease serum concentration of Mirabegron. Risk C: Monitor
Mirodenafil: CYP3A4 Inducers (Strong) may decrease serum concentration of Mirodenafil. Management: Consider avoiding the concomitant use of mirodenafil and strong CYP3A4 inducers. If combined, monitor for decreased mirodenafil effects. Mirodenafil dose increases may be required to achieve desired effects. Risk D: Consider Therapy Modification
Mirtazapine: CYP3A4 Inducers (Strong) may decrease serum concentration of Mirtazapine. Risk C: Monitor
Mitapivat: CYP3A4 Inducers (Strong) may decrease serum concentration of Mitapivat. Risk X: Avoid
Mobocertinib: CYP3A4 Inducers (Strong) may decrease serum concentration of Mobocertinib. CYP3A4 Inducers (Strong) may decrease active metabolite exposure of Mobocertinib. Risk X: Avoid
Momelotinib: OATP1B1/1B3 (SLCO1B1/1B3) Inhibitors may increase serum concentration of Momelotinib. Risk C: Monitor
Montelukast: CYP3A4 Inducers (Strong) may decrease serum concentration of Montelukast. Risk C: Monitor
Morphine (Systemic): RifAMPin may decrease serum concentration of Morphine (Systemic). Risk C: Monitor
Moxifloxacin (Systemic): RifAMPin may decrease serum concentration of Moxifloxacin (Systemic). Risk C: Monitor
Mycophenolate: RifAMPin may decrease active metabolite exposure of Mycophenolate. Specifically, concentrations of mycophenolic acid (MPA) may be decreased. Management: Avoid concurrent use of rifampin and mycophenolate when possible. If used together, closely monitor mycophenolic acid levels and clinical response. Mycophenolate doses may need to be increased. Risk D: Consider Therapy Modification
Naldemedine: CYP3A4 Inducers (Strong) may decrease serum concentration of Naldemedine. Risk X: Avoid
Naloxegol: CYP3A4 Inducers (Strong) may decrease serum concentration of Naloxegol. Risk X: Avoid
Nateglinide: CYP3A4 Inducers (Strong) may decrease serum concentration of Nateglinide. Risk C: Monitor
Nelfinavir: RifAMPin may decrease serum concentration of Nelfinavir. Risk X: Avoid
Neratinib: CYP3A4 Inducers (Strong) may decrease serum concentration of Neratinib. Risk X: Avoid
Netupitant: CYP3A4 Inducers (Strong) may decrease serum concentration of Netupitant. Risk X: Avoid
Nevirapine: RifAMPin may decrease serum concentration of Nevirapine. Risk X: Avoid
NiCARdipine: CYP3A4 Inducers (Strong) may decrease serum concentration of NiCARdipine. Risk C: Monitor
NIFEdipine (Topical): CYP3A4 Inducers (Strong) may decrease serum concentration of NIFEdipine (Topical). Risk C: Monitor
NIFEdipine: CYP3A4 Inducers (Strong) may decrease serum concentration of NIFEdipine. Management: Avoid coadministration of nifedipine with strong CYP3A4 inducers when possible and if combined, monitor patients closely for clinical signs of diminished nifedipine response. Risk D: Consider Therapy Modification
Nilotinib: CYP3A4 Inducers (Strong) may decrease serum concentration of Nilotinib. Risk X: Avoid
Nilvadipine: CYP3A4 Inducers (Strong) may decrease serum concentration of Nilvadipine. Risk C: Monitor
NiMODipine: CYP3A4 Inducers (Strong) may decrease serum concentration of NiMODipine. Risk X: Avoid
Nintedanib: Inducers of CYP3A4 (Strong) and P-glycoprotein may decrease serum concentration of Nintedanib. Risk X: Avoid
Nirmatrelvir and Ritonavir: CYP3A4 Inducers (Strong) may decrease serum concentration of Nirmatrelvir and Ritonavir. Risk X: Avoid
Nirogacestat: CYP3A4 Inducers (Strong) may decrease serum concentration of Nirogacestat. Risk X: Avoid
Nisoldipine: CYP3A4 Inducers (Strong) may decrease serum concentration of Nisoldipine. Risk X: Avoid
Nitrazepam: CYP3A4 Inducers (Strong) may decrease serum concentration of Nitrazepam. Risk C: Monitor
Nortriptyline: RifAMPin may decrease serum concentration of Nortriptyline. Risk C: Monitor
OLANZapine: RifAMPin may decrease serum concentration of OLANZapine. Risk C: Monitor
Olaparib: CYP3A4 Inducers (Strong) may decrease serum concentration of Olaparib. Risk X: Avoid
Oliceridine: CYP3A4 Inducers (Strong) may decrease serum concentration of Oliceridine. Risk C: Monitor
Olmutinib: CYP3A4 Inducers (Strong) may decrease serum concentration of Olmutinib. Risk C: Monitor
Olutasidenib: CYP3A4 Inducers (Strong) may decrease serum concentration of Olutasidenib. Risk X: Avoid
Omaveloxolone: CYP3A4 Inducers (Strong) may decrease serum concentration of Omaveloxolone. Risk X: Avoid
Omeprazole: CYP2C19 Inducers (Strong) may decrease serum concentration of Omeprazole. Risk X: Avoid
Ondansetron: CYP3A4 Inducers (Strong) may decrease serum concentration of Ondansetron. Risk C: Monitor
Ornidazole: RifAMPin may decrease serum concentration of Ornidazole. Risk C: Monitor
Osilodrostat: CYP3A4 Inducers (Strong) may decrease serum concentration of Osilodrostat. Risk C: Monitor
Osimertinib: CYP3A4 Inducers (Strong) may decrease serum concentration of Osimertinib. Management: Avoid coadministration of osimertinib and strong CYP3A4 inducers if possible. If coadministration is unavoidable, increase osimertinib to 160 mg daily. Reduce osimertinib to 80 mg daily 3 weeks after discontinuation of the strong CYP3A4 inducer. Risk D: Consider Therapy Modification
Ospemifene: RifAMPin may decrease serum concentration of Ospemifene. Risk C: Monitor
OXcarbazepine: CYP3A4 Inducers (Strong) may decrease serum concentration of OXcarbazepine. Specifically, the concentrations of the 10-monohydroxy active metabolite of oxcarbazepine may be decreased. Risk C: Monitor
OxyCODONE: CYP3A4 Inducers (Strong) may decrease serum concentration of OxyCODONE. Risk C: Monitor
Ozanimod: CYP2C8 Inducers (Moderate) may decrease active metabolite exposure of Ozanimod. CYP2C8 Inducers (Moderate) may decrease serum concentration of Ozanimod. Risk X: Avoid
PACLitaxel (Conventional): CYP3A4 Inducers (Strong) may decrease serum concentration of PACLitaxel (Conventional). Risk C: Monitor
PACLitaxel (Protein Bound): CYP3A4 Inducers (Strong) may decrease serum concentration of PACLitaxel (Protein Bound). Risk C: Monitor
Pacritinib: CYP3A4 Inducers (Strong) may decrease serum concentration of Pacritinib. Risk X: Avoid
Palbociclib: CYP3A4 Inducers (Strong) may decrease serum concentration of Palbociclib. Risk X: Avoid
Paliperidone: P-glycoprotein/ABCB1 Inducers may decrease serum concentration of Paliperidone. Management: Avoid coadministration of extended-release injectable paliperidone and P-gp inducers. If coadministration is required, consider use of paliperidone extended-release tablets, monitor for reduced paliperidone effects, and increase the dose as needed. Risk D: Consider Therapy Modification
Palovarotene: CYP3A4 Inducers (Strong) may decrease serum concentration of Palovarotene. Risk X: Avoid
Panobinostat: CYP3A4 Inducers (Strong) may decrease serum concentration of Panobinostat. Risk X: Avoid
PAZOPanib: CYP3A4 Inducers (Strong) may decrease serum concentration of PAZOPanib. Risk X: Avoid
Pefloxacin: RifAMPin may decrease serum concentration of Pefloxacin. Pefloxacin may increase serum concentration of RifAMPin. Risk C: Monitor
Pemigatinib: CYP3A4 Inducers (Strong) may decrease serum concentration of Pemigatinib. Risk X: Avoid
Perampanel: CYP3A4 Inducers (Strong) may decrease serum concentration of Perampanel. Management: Increase perampanel starting dose to 4 mg/day if used with strong CYP3A4 inducers. Increase perampanel dose by 2 mg/day no more than once weekly based on response and tolerability. Dose adjustments may be needed if the inducer is discontinued. Risk D: Consider Therapy Modification
Perazine: CYP3A4 Inducers (Strong) may decrease serum concentration of Perazine. Risk C: Monitor
Pexidartinib: CYP3A4 Inducers (Strong) may decrease serum concentration of Pexidartinib. Risk X: Avoid
PHENobarbital: CYP2C19 Inducers (Strong) may decrease serum concentration of PHENobarbital. Risk C: Monitor
Pimavanserin: CYP3A4 Inducers (Strong) may decrease serum concentration of Pimavanserin. Risk X: Avoid
Pioglitazone: CYP2C8 Inducers (Moderate) may decrease serum concentration of Pioglitazone. Risk C: Monitor
Piperaquine: CYP3A4 Inducers (Strong) may decrease serum concentration of Piperaquine. Risk X: Avoid
Pirtobrutinib: CYP3A4 Inducers (Strong) may decrease serum concentration of Pirtobrutinib. Risk X: Avoid
Pitavastatin: RifAMPin may increase serum concentration of Pitavastatin. Management: Limit pitavastatin dose to a maximum of 2 mg/day with concurrent rifampin. Risk D: Consider Therapy Modification
Pitolisant: CYP3A4 Inducers (Strong) may decrease serum concentration of Pitolisant. Management: If on a stable pitolisant dose of 8.9 mg or 17.8 mg/day and starting a strong CYP3A4 inducer, double the pitolisant dose over 7 days (ie, to either 17.8 mg/day or 35.6 mg/day, respectively). Reduce pitolisant dose by 50% when the inducer is discontinued. Risk D: Consider Therapy Modification
Polatuzumab Vedotin: CYP3A4 Inducers (Strong) may decrease serum concentration of Polatuzumab Vedotin. Exposure to unconjugated MMAE, the cytotoxic small molecule component of polatuzumab vedotin, may be decreased. Risk C: Monitor
PONATinib: CYP3A4 Inducers (Strong) may decrease serum concentration of PONATinib. Management: Avoid coadministration of ponatinib with strong CYP3A4 inducers unless the potential benefit of concomitant treatment outweighs the risk of reduced ponatinib exposure. Monitor patients for reduced ponatinib efficacy if combined. Risk D: Consider Therapy Modification
Posaconazole: RifAMPin may decrease serum concentration of Posaconazole. Risk C: Monitor
Pralsetinib: CYP3A4 Inducers (Strong) may decrease serum concentration of Pralsetinib. Management: Avoid concomitant use of pralsetinib with strong CYP3A4 inducers when possible. If combined, increase the starting dose of pralsetinib to double the current pralsetinib dosage starting on day 7 of coadministration. Risk D: Consider Therapy Modification
Pravastatin: RifAMPin may decrease serum concentration of Pravastatin. Risk C: Monitor
Praziquantel: CYP3A4 Inducers (Strong) may decrease serum concentration of Praziquantel. Risk X: Avoid
PrednisoLONE (Systemic): CYP3A4 Inducers (Strong) may decrease serum concentration of PrednisoLONE (Systemic). Risk C: Monitor
PredniSONE: CYP3A4 Inducers (Strong) may decrease serum concentration of PredniSONE. Risk C: Monitor
Pretomanid: CYP3A4 Inducers (Strong) may decrease serum concentration of Pretomanid. Risk X: Avoid
Probenecid: May increase serum concentration of RifAMPin. Risk C: Monitor
Propacetamol: RifAMPin may increase hepatotoxic effects of Propacetamol. RifAMPin may increase metabolism of Propacetamol. . This may 1) diminish the desired effects of propacetamol; and 2) increase the risk of liver damage. Risk C: Monitor
Propafenone: CYP3A4 Inducers (Strong) may decrease serum concentration of Propafenone. Risk C: Monitor
Propofol: RifAMPin may increase hypotensive effects of Propofol. Management: Avoid this combination if possible. Use of propofol in a patient who has been taking rifampin may result in clinically significant hypotension. Risk D: Consider Therapy Modification
Propranolol: RifAMPin may decrease serum concentration of Propranolol. Risk C: Monitor
Prothionamide: RifAMPin may increase hepatotoxic effects of Prothionamide. Management: Avoid concomitant use of prothionamide and rifampin if possible. If combined use is considered necessary, monitor patients closely for signs and symptoms of hepatotoxicity (eg, jaundice, elevations in liver function tests). Risk D: Consider Therapy Modification
Pyrazinamide: May increase hepatotoxic effects of RifAMPin. Severe (even fatal) liver injury has been reported in patients receiving these 2 drugs as a 2-month treatment regimen for latent TB infection. Management: Rifampin-pyrazinamide is generally not preferred for the treatment of latent tuberculosis (TB) due to the risk of hepatotoxicity. However, it is an option for patients at high risk of developing active TB who are unlikely to complete preferred treatment. Risk C: Monitor
Pyrimethamine: CYP3A4 Inducers (Strong) may decrease serum concentration of Pyrimethamine. Risk C: Monitor
QUEtiapine: CYP3A4 Inducers (Strong) may decrease serum concentration of QUEtiapine. Management: An increase in quetiapine dose (as much as 5 times the regular dose) may be required to maintain therapeutic benefit. Reduce the quetiapine dose back to the previous/regular dose within 7 to 14 days of discontinuing the inducer. Risk D: Consider Therapy Modification
QuiNIDine: CYP3A4 Inducers (Strong) may decrease serum concentration of QuiNIDine. Risk C: Monitor
QuiNINE: RifAMPin may decrease serum concentration of QuiNINE. Risk X: Avoid
Quizartinib: CYP3A4 Inducers (Strong) may decrease serum concentration of Quizartinib. Risk X: Avoid
Radotinib: CYP3A4 Inducers (Strong) may decrease serum concentration of Radotinib. Management: Consider alternatives to this combination when possible as the risk of radotinib treatment failure may be increased. Risk D: Consider Therapy Modification
Raltegravir: RifAMPin may decrease serum concentration of Raltegravir. Management: Increase raltegravir dose to 800 mg twice daily (adult dose) when used concomitantly with rifampin. Concurrent use of rifampin with once-daily raltegravir (Isentress HD) is not recommended. Risk D: Consider Therapy Modification
Ramelteon: CYP3A4 Inducers (Strong) may decrease serum concentration of Ramelteon. Risk C: Monitor
Ranolazine: CYP3A4 Inducers (Strong) may decrease serum concentration of Ranolazine. Risk X: Avoid
Reboxetine: CYP3A4 Inducers (Strong) may decrease serum concentration of Reboxetine. Risk C: Monitor
Red Yeast Rice: RifAMPin may decrease serum concentration of Red Yeast Rice. Risk C: Monitor
Regorafenib: CYP3A4 Inducers (Strong) may decrease serum concentration of Regorafenib. CYP3A4 Inducers (Strong) may increase active metabolite exposure of Regorafenib. Risk X: Avoid
Relugolix, Estradiol, and Norethindrone: Inducers of CYP3A4 (Strong) and P-glycoprotein may decrease serum concentration of Relugolix, Estradiol, and Norethindrone. Risk X: Avoid
Relugolix: Inducers of CYP3A4 (Strong) and P-glycoprotein may decrease serum concentration of Relugolix. Management: Avoid use of relugolix with drugs that are both strong CYP3A4 and P-glycoprotein (P-gp) inducer. If combined, increase the dose of relugolix to 240 mg once daily. Reduce back to 120 mg daily once the combined inducer is discontinued. Risk D: Consider Therapy Modification
Repaglinide: RifAMPin may decrease serum concentration of Repaglinide. Risk C: Monitor
Repotrectinib: CYP3A4 Inducers (Strong) may decrease serum concentration of Repotrectinib. Risk X: Avoid
Resmetirom: OATP1B1/1B3 (SLCO1B1/1B3) Inhibitors may increase serum concentration of Resmetirom. Risk X: Avoid
Revefenacin: OATP1B1/1B3 (SLCO1B1/1B3) Inhibitors may increase active metabolite exposure of Revefenacin. Risk X: Avoid
Revumenib: CYP3A4 Inducers (Strong) may decrease serum concentration of Revumenib. Risk X: Avoid
Ribociclib: CYP3A4 Inducers (Strong) may decrease serum concentration of Ribociclib. Risk X: Avoid
Rifabutin: CYP3A4 Inducers (Strong) may decrease serum concentration of Rifabutin. Risk C: Monitor
Rilpivirine: RifAMPin may decrease serum concentration of Rilpivirine. Risk X: Avoid
Rimegepant: CYP3A4 Inducers (Strong) may decrease serum concentration of Rimegepant. Risk X: Avoid
Riociguat: CYP3A4 Inducers (Strong) may decrease serum concentration of Riociguat. Risk C: Monitor
Ripretinib: CYP3A4 Inducers (Strong) may decrease serum concentration of Ripretinib. Risk X: Avoid
RisperiDONE: CYP3A4 Inducers (Strong) may decrease serum concentration of RisperiDONE. CYP3A4 Inducers (Strong) may decrease active metabolite exposure of RisperiDONE. Management: Careful monitoring for reduced risperidone efficacy and possible dose adjustment are recommended when combined with strong CYP3A4 inducers. See full interaction monograph for details. Risk D: Consider Therapy Modification
Ritlecitinib: CYP3A4 Inducers (Strong) may decrease serum concentration of Ritlecitinib. Risk X: Avoid
Ritonavir: RifAMPin may decrease serum concentration of Ritonavir. RifAMPin may increase serum concentration of Ritonavir. Risk X: Avoid
Rivaroxaban: Inducers of CYP3A4 (Strong) and P-glycoprotein may decrease serum concentration of Rivaroxaban. Risk X: Avoid
Roflumilast (Systemic): CYP3A4 Inducers (Strong) may decrease serum concentration of Roflumilast (Systemic). CYP3A4 Inducers (Strong) may decrease active metabolite exposure of Roflumilast (Systemic). Risk X: Avoid
Rolapitant: CYP3A4 Inducers (Strong) may decrease serum concentration of Rolapitant. Risk X: Avoid
RomiDEPsin: RifAMPin may increase serum concentration of RomiDEPsin. Risk X: Avoid
Rosiglitazone: CYP2C8 Inducers (Moderate) may decrease serum concentration of Rosiglitazone. Risk C: Monitor
Rosuvastatin: RifAMPin may decrease serum concentration of Rosuvastatin. Risk C: Monitor
Roxadustat: CYP2C8 Inducers (Moderate) may decrease serum concentration of Roxadustat. Risk C: Monitor
Ruxolitinib (Systemic): CYP3A4 Inducers (Strong) may decrease serum concentration of Ruxolitinib (Systemic). CYP3A4 Inducers (Strong) may increase active metabolite exposure of Ruxolitinib (Systemic). Risk C: Monitor
Sacituzumab Govitecan: UGT1A1 Inducers may decrease active metabolite exposure of Sacituzumab Govitecan. Specifically, concentrations of SN-38 may be decreased. Risk X: Avoid
Samidorphan: CYP3A4 Inducers (Strong) may decrease serum concentration of Samidorphan. Risk X: Avoid
Saquinavir: RifAMPin may increase adverse/toxic effects of Saquinavir. Specifically, the risk of hepatocellular toxicity may be increased. RifAMPin may decrease serum concentration of Saquinavir. Risk X: Avoid
SAXagliptin: CYP3A4 Inducers (Strong) may decrease serum concentration of SAXagliptin. Risk C: Monitor
Seladelpar: RifAMPin may decrease serum concentration of Seladelpar. Risk C: Monitor
Selexipag: RifAMPin may decrease active metabolite exposure of Selexipag. Management: Increase the selexipag dose (up to 2-fold) when combined with rifampin. Monitor for decreased selexipag efficacy. Risk D: Consider Therapy Modification
Selpercatinib: CYP3A4 Inducers (Strong) may decrease serum concentration of Selpercatinib. Risk X: Avoid
Selumetinib: CYP3A4 Inducers (Strong) may decrease serum concentration of Selumetinib. Risk X: Avoid
Sertindole: CYP3A4 Inducers (Strong) may decrease serum concentration of Sertindole. Risk C: Monitor
Sertraline: CYP3A4 Inducers (Strong) may decrease serum concentration of Sertraline. Risk C: Monitor
Sildenafil: CYP3A4 Inducers (Strong) may decrease serum concentration of Sildenafil. Risk C: Monitor
Simeprevir: CYP3A4 Inducers (Strong) may decrease serum concentration of Simeprevir. Risk X: Avoid
Simvastatin: CYP3A4 Inducers (Strong) may decrease serum concentration of Simvastatin. Risk C: Monitor
Siponimod: RifAMPin may decrease serum concentration of Siponimod. Risk X: Avoid
Sirolimus (Conventional): CYP3A4 Inducers (Strong) may decrease serum concentration of Sirolimus (Conventional). Management: Avoid concomitant use of strong CYP3A4 inducers and sirolimus if possible. If combined, monitor for reduced serum sirolimus concentrations. Sirolimus dose increases will likely be necessary to prevent subtherapeutic sirolimus levels. Risk D: Consider Therapy Modification
Sirolimus (Protein Bound): CYP3A4 Inducers (Strong) may decrease serum concentration of Sirolimus (Protein Bound). Risk X: Avoid
Sodium Picosulfate: Antibiotics may decrease therapeutic effects of Sodium Picosulfate. Management: Consider using an alternative product for bowel cleansing prior to a colonoscopy in patients who have recently used or are concurrently using an antibiotic. Risk D: Consider Therapy Modification
Sofosbuvir: P-glycoprotein/ABCB1 Inducers may decrease serum concentration of Sofosbuvir. Risk X: Avoid
Solifenacin: CYP3A4 Inducers (Strong) may decrease serum concentration of Solifenacin. Risk C: Monitor
Sonidegib: CYP3A4 Inducers (Strong) may decrease serum concentration of Sonidegib. Risk X: Avoid
SORAfenib: CYP3A4 Inducers (Strong) may decrease serum concentration of SORAfenib. Risk X: Avoid
Sotagliflozin: UGT1A9 Inducers may decrease serum concentration of Sotagliflozin. Risk C: Monitor
Sotorasib: CYP3A4 Inducers (Strong) may decrease serum concentration of Sotorasib. Risk X: Avoid
Sparsentan: CYP3A4 Inducers (Strong) may decrease serum concentration of Sparsentan. Risk X: Avoid
Stiripentol: CYP3A4 Inducers (Strong) may decrease serum concentration of Stiripentol. Management: Avoid concomitant use of stiripentol and strong CYP3A4 inducers when possible. If combined, monitor for reduced stiripentol efficacy and increase the stiripentol dose as needed. Risk D: Consider Therapy Modification
SUFentanil: CYP3A4 Inducers (Strong) may decrease serum concentration of SUFentanil. Management: If a strong CYP3A4 inducer is initiated in a patient on sufentanil, consider a sufentanil dose increase and monitor for decreased sufentanil effects and opioid withdrawal symptoms. Risk D: Consider Therapy Modification
Sulfamethoxazole: RifAMPin may decrease serum concentration of Sulfamethoxazole. Sulfamethoxazole may increase serum concentration of RifAMPin. Risk C: Monitor
Sulfonylureas: CYP2C9 Inducers (Moderate) may decrease serum concentration of Sulfonylureas. Risk C: Monitor
SUNItinib: CYP3A4 Inducers (Strong) may decrease serum concentration of SUNItinib. Management: Avoid when possible. If combined, increase sunitinib dose to a max of 87.5 mg daily when treating GIST or RCC. Increase sunitinib dose to a max of 62.5 mg daily when treating PNET. Monitor patients for both reduced efficacy and increased toxicities. Risk D: Consider Therapy Modification
Suvorexant: CYP3A4 Inducers (Strong) may decrease serum concentration of Suvorexant. Risk C: Monitor
Suzetrigine: CYP3A4 Inducers (Strong) may decrease serum concentration of Suzetrigine. Risk X: Avoid
Tacrolimus (Systemic): CYP3A4 Inducers (Strong) may decrease serum concentration of Tacrolimus (Systemic). Management: Tacrolimus dose increases will likely be needed during concomitant use with strong CYP3A4 inducers. Monitor more closely and frequently for decreased tacrolimus concentrations and effects when combined. Risk D: Consider Therapy Modification
Tadalafil: CYP3A4 Inducers (Strong) may decrease serum concentration of Tadalafil. Management: Erectile dysfunction or benign prostatic hypertrophy: monitor for decreased effectiveness - no standard dose adjustment is recommended. Avoid use of tadalafil for pulmonary arterial hypertension in patients receiving a strong CYP3A4 inducer. Risk D: Consider Therapy Modification
Tamoxifen: CYP3A4 Inducers (Strong) may decrease serum concentration of Tamoxifen. CYP3A4 Inducers (Strong) may decrease active metabolite exposure of Tamoxifen. Risk X: Avoid
Tasimelteon: CYP3A4 Inducers (Strong) may decrease serum concentration of Tasimelteon. Risk X: Avoid
Taurursodiol: OATP1B1/1B3 (SLCO1B1/1B3) Inhibitors may increase serum concentration of Taurursodiol. Risk X: Avoid
Tazemetostat: CYP3A4 Inducers (Strong) may decrease serum concentration of Tazemetostat. Risk X: Avoid
Temsirolimus: CYP3A4 Inducers (Strong) may decrease serum concentration of Temsirolimus. CYP3A4 Inducers (Strong) may decrease active metabolite exposure of Temsirolimus. Specifically, concentrations of sirolimus may be decreased. Management: Avoid concomitant use of temsirolimus and strong CYP3A4 inducers. If coadministration is unavoidable, increase temsirolimus dose to 50 mg per week. Resume previous temsirolimus dose after discontinuation of the strong CYP3A4 inducer. Risk D: Consider Therapy Modification
Teniposide: CYP3A4 Inducers (Strong) may decrease serum concentration of Teniposide. Risk C: Monitor
Tenofovir Alafenamide: RifAMPin may decrease serum concentration of Tenofovir Alafenamide. Risk X: Avoid
Terbinafine (Systemic): RifAMPin may decrease serum concentration of Terbinafine (Systemic). Risk C: Monitor
Tetrahydrocannabinol and Cannabidiol: CYP3A4 Inducers (Strong) may decrease serum concentration of Tetrahydrocannabinol and Cannabidiol. Management: Avoid use of the tetrahydrocannabinol/cannabidiol oromucosal spray and strong CYP3A4 inducers when possible. If combined use is necessary, careful titration is recommended, notably within the two weeks following discontinuation of the inducer. Risk D: Consider Therapy Modification
Tetrahydrocannabinol: CYP3A4 Inducers (Strong) may decrease serum concentration of Tetrahydrocannabinol. Risk C: Monitor
Tezacaftor and Ivacaftor: CYP3A4 Inducers (Strong) may decrease serum concentration of Tezacaftor and Ivacaftor. Risk X: Avoid
Theophylline Derivatives: RifAMPin may decrease serum concentration of Theophylline Derivatives. Risk C: Monitor
Thiotepa: CYP3A4 Inducers (Strong) may increase active metabolite exposure of Thiotepa. CYP3A4 Inducers (Strong) may decrease serum concentration of Thiotepa. Management: Thiotepa prescribing information recommends avoiding concomitant use of thiotepa and strong CYP3A4 inducers. If concomitant use is unavoidable, monitor for adverse effects. Risk D: Consider Therapy Modification
Thyroid Products: RifAMPin may decrease serum concentration of Thyroid Products. Risk C: Monitor
TiaGABine: CYP3A4 Inducers (Strong) may decrease serum concentration of TiaGABine. Risk C: Monitor
Ticagrelor: CYP3A4 Inducers (Strong) may decrease serum concentration of Ticagrelor. CYP3A4 Inducers (Strong) may decrease active metabolite exposure of Ticagrelor. Risk X: Avoid
Tipranavir: RifAMPin may decrease serum concentration of Tipranavir. Risk X: Avoid
Tivozanib: CYP3A4 Inducers (Strong) may decrease serum concentration of Tivozanib. Risk X: Avoid
Tofacitinib: CYP3A4 Inducers (Strong) may decrease serum concentration of Tofacitinib. Risk X: Avoid
Tolvaptan: CYP3A4 Inducers (Strong) may decrease serum concentration of Tolvaptan. Risk X: Avoid
Toremifene: CYP3A4 Inducers (Strong) may decrease serum concentration of Toremifene. CYP3A4 Inducers (Strong) may decrease active metabolite exposure of Toremifene. Risk X: Avoid
Torsemide: CYP2C9 Inducers (Moderate) may decrease serum concentration of Torsemide. Risk C: Monitor
Tovorafenib: CYP2C8 Inducers (Moderate) may decrease serum concentration of Tovorafenib. Risk X: Avoid
Trabectedin: CYP3A4 Inducers (Strong) may decrease serum concentration of Trabectedin. Risk X: Avoid
TraMADol: CYP3A4 Inducers (Strong) may decrease serum concentration of TraMADol. Risk C: Monitor
TraZODone: CYP3A4 Inducers (Strong) may decrease serum concentration of TraZODone. Management: Consider increasing the trazodone dose during coadministration with strong CYP3A4 inducers. Risk D: Consider Therapy Modification
Tretinoin (Systemic): CYP3A4 Inducers (Strong) may decrease serum concentration of Tretinoin (Systemic). Management: Avoid use of tretinoin and strong CYP3A4 inducers when possible. If combined, monitor for reduced tretinoin concentrations and efficacy. Risk D: Consider Therapy Modification
Triamcinolone (Systemic): CYP3A4 Inducers (Strong) may decrease serum concentration of Triamcinolone (Systemic). Risk C: Monitor
Triazolam: CYP3A4 Inducers (Strong) may decrease serum concentration of Triazolam. Management: Consider alternatives to this combination when possible. If combined, monitor for reduced triazolam efficacy. Substantial triazolam dose increases will likely be required. Risk D: Consider Therapy Modification
Trimethoprim: RifAMPin may decrease serum concentration of Trimethoprim. Trimethoprim may increase serum concentration of RifAMPin. Risk C: Monitor
Tropisetron: CYP3A4 Inducers (Strong) may decrease serum concentration of Tropisetron. Risk C: Monitor
Tucatinib: CYP2C8 Inducers (Moderate) may decrease serum concentration of Tucatinib. Risk X: Avoid
Typhoid Vaccine: Antibiotics may decrease therapeutic effects of Typhoid Vaccine. Only the live attenuated Ty21a strain is affected. Management: Avoid use of live attenuated typhoid vaccine (Ty21a) in patients being treated with systemic antibacterial agents. Postpone vaccination until 3 days after cessation of antibiotics and avoid starting antibiotics within 3 days of last vaccine dose. Risk D: Consider Therapy Modification
Ubrogepant: CYP3A4 Inducers (Strong) may decrease serum concentration of Ubrogepant. Risk X: Avoid
Udenafil: CYP3A4 Inducers (Strong) may decrease serum concentration of Udenafil. Risk C: Monitor
Ulipristal: CYP3A4 Inducers (Strong) may decrease serum concentration of Ulipristal. Risk X: Avoid
Upadacitinib: CYP3A4 Inducers (Strong) may decrease serum concentration of Upadacitinib. Risk X: Avoid
Valbenazine: CYP3A4 Inducers (Strong) may decrease serum concentration of Valbenazine. CYP3A4 Inducers (Strong) may decrease active metabolite exposure of Valbenazine. Risk X: Avoid
Valproic Acid and Derivatives: RifAMPin may decrease serum concentration of Valproic Acid and Derivatives. Risk C: Monitor
Vandetanib: CYP3A4 Inducers (Strong) may decrease serum concentration of Vandetanib. CYP3A4 Inducers (Strong) may increase active metabolite exposure of Vandetanib. Risk X: Avoid
Vanzacaftor, Tezacaftor, and Deutivacaftor: CYP3A4 Inducers (Strong) may decrease serum concentration of Vanzacaftor, Tezacaftor, and Deutivacaftor. Risk X: Avoid
Velpatasvir: CYP2B6 Inducers (Moderate) may decrease serum concentration of Velpatasvir. Risk X: Avoid
Velpatasvir: CYP3A4 Inducers (Strong) may decrease serum concentration of Velpatasvir. Risk X: Avoid
Vemurafenib: CYP3A4 Inducers (Strong) may decrease serum concentration of Vemurafenib. Management: Avoid coadministration of vemurafenib and strong CYP3A4 inducers if possible. If coadministration is unavoidable, increase the vemurafenib dose by 240 mg as tolerated. Resume prior vemurafenib dose 2 weeks after discontinuation of strong CYP3A4 inducer. Risk D: Consider Therapy Modification
Venetoclax: CYP3A4 Inducers (Strong) may decrease serum concentration of Venetoclax. Risk X: Avoid
Verapamil: CYP3A4 Inducers (Strong) may decrease serum concentration of Verapamil. Management: Consider alternatives to this combination. If combined, monitor for reduced verapamil efficacy. Verapamil dose increases may be necessary. Risk D: Consider Therapy Modification
Vilazodone: CYP3A4 Inducers (Strong) may decrease serum concentration of Vilazodone. Management: Consider increasing vilazodone dose by as much as 2-fold (do not exceed 80 mg/day), based on response, in patients receiving strong CYP3A4 inducers for > 14 days. Reduce to the original vilazodone dose over 1 to 2 weeks after inducer discontinuation. Risk D: Consider Therapy Modification
VinCRIStine: CYP3A4 Inducers (Strong) may decrease serum concentration of VinCRIStine. Risk X: Avoid
Vinflunine: CYP3A4 Inducers (Strong) may decrease serum concentration of Vinflunine. Risk X: Avoid
Vinorelbine: CYP3A4 Inducers (Strong) may decrease serum concentration of Vinorelbine. Risk C: Monitor
Vitamin K Antagonists: Rifamycin Derivatives may decrease serum concentration of Vitamin K Antagonists. Management: Consider alternatives if possible. If combined, monitor for reduced anticoagulant effects if a rifamycin derivative is initiated in a vitamin K antagonist treated patient. Vitamin K antagonist dose adjustments will likely be required. Risk D: Consider Therapy Modification
Voclosporin: CYP3A4 Inducers (Strong) may decrease serum concentration of Voclosporin. Risk X: Avoid
Vonoprazan: CYP3A4 Inducers (Strong) may decrease serum concentration of Vonoprazan. Risk X: Avoid
Vorapaxar: CYP3A4 Inducers (Strong) may decrease serum concentration of Vorapaxar. Risk X: Avoid
Vorasidenib: RifAMPin may decrease serum concentration of Vorasidenib. Risk X: Avoid
Voriconazole: RifAMPin may decrease serum concentration of Voriconazole. Risk X: Avoid
Vortioxetine: CYP3A4 Inducers (Strong) may decrease serum concentration of Vortioxetine. Management: Consider increasing the vortioxetine dose to no more than 3 times the original dose when used with a strong drug metabolism inducer for more than 14 days. The vortioxetine dose should be returned to normal within 14 days of stopping the strong inducer. Risk D: Consider Therapy Modification
Voxelotor: CYP3A4 Inducers (Strong) may decrease serum concentration of Voxelotor. Management: Avoid concomitant use of voxelotor and strong CYP3A4 inducers. If unavoidable, increase the voxelotor dose to 2,500 mg once daily. For children ages 4 to less than 12 years, weight-based dose adjustments are required. See full monograph for details. Risk D: Consider Therapy Modification
Voxilaprevir: RifAMPin may increase serum concentration of Voxilaprevir. Specifically, a single dose of rifampin may increase voxilaprevir concentrations, while chronic daily use of rifampin may decrease voxilaprevir concentrations. RifAMPin may decrease serum concentration of Voxilaprevir. Risk X: Avoid
Zaleplon: CYP3A4 Inducers (Strong) may decrease serum concentration of Zaleplon. Management: Consider the use of an alternative hypnotic that is not metabolized by CYP3A4 in patients receiving strong CYP3A4 inducers. If zaleplon is combined with a strong CYP3A4 inducer, monitor for decreased effectiveness of zaleplon. Risk D: Consider Therapy Modification
Zanubrutinib: CYP3A4 Inducers (Strong) may decrease serum concentration of Zanubrutinib. Risk X: Avoid
Zavegepant: OATP1B1/1B3 (SLCO1B1/1B3) Inhibitors may increase serum concentration of Zavegepant. Risk X: Avoid
Zidovudine: RifAMPin may decrease serum concentration of Zidovudine. Risk C: Monitor
Ziprasidone: CYP3A4 Inducers (Strong) may decrease serum concentration of Ziprasidone. Risk C: Monitor
Zolpidem: CYP3A4 Inducers (Strong) may decrease serum concentration of Zolpidem. Risk C: Monitor
Zonisamide: CYP3A4 Inducers (Strong) may decrease serum concentration of Zonisamide. Risk C: Monitor
Zopiclone: CYP3A4 Inducers (Strong) may decrease serum concentration of Zopiclone. Risk C: Monitor
Zuclopenthixol: CYP3A4 Inducers (Strong) may decrease serum concentration of Zuclopenthixol. Risk C: Monitor
Zuranolone: CYP3A4 Inducers (Strong) may decrease serum concentration of Zuranolone. Risk X: Avoid
Food decreases the extent of absorption; rifampin concentrations may be decreased if taken with food. Management: Administer on an empty stomach with a glass of water (ie, 1 hour prior to, or 2 hours after meals or antacids).
Rifampin may decrease the effectiveness of hormonal contraceptives. Consult drug interactions database for more detailed information specific to use of rifampin and specific contraceptives.
Rifampin crosses the human placenta. Postnatal hemorrhages have been reported in the infant and mother with administration during the last few weeks of pregnancy.
Rifampin is approved for the treatment of tuberculosis (TB). TB disease (active TB) is associated with adverse fetal outcomes, including intrauterine growth restriction, low birth weight, preterm birth, and perinatal death (Esmail 2018; Miele 2020), as well as adverse maternal outcomes, including increased risks for anemia and cesarean delivery. Placental transmission may rarely occur with active maternal disease (Miele 2020). Due to the risks of untreated TB, rifampin is recommended as part of the initial treatment regimen of drug-susceptible TB disease when the probability of maternal disease is moderate to high (ATS/CDC/IDSA [Nahid 2016]). Rifampin may also be considered for the treatment of TB infection (latent TB) (also known as prophylaxis or preventive therapy) in pregnant patients (WHO 2020). Rifampin may be associated with an increased risk of maternal hepatotoxicity, which may require temporary drug withdrawal in pregnant and postpartum patients (Beck-Friis 2020).
Rifampin is used off-label for the treatment of brucellosis infection. Brucellosis infection may increase the risk of spontaneous abortion; rifampin is recommended for the treatment of brucellosis infection during pregnancy (CDC 2017).
Rifampin may be considered for use as an alternative agent in pregnant patients for the treatment of mild illness due to human anaplasmosis (also known as human granulocytic anaplasmosis); case reports have shown favorable maternal and pregnancy outcomes in small numbers of rifampin-treated pregnant women (CDC [Biggs 2016]).
Liver function (AST, ALT, bilirubin); monitor every 2 to 4 weeks in patients with impaired liver function at baseline. CBC, SCr (CFF/ECFS [Floto 2016]; manufacturer's labeling). Monitor coagulation tests during treatment in patients at risk of vitamin K deficiency.
Leprosy (Hansen Disease): CBC with platelets and comprehensive metabolic panel every 3 months (NHDP/HRSA 2018).
Tuberculosis treatment:
Target peak: ≥8 mg/L (SI: ≥9.7 micromole/L); often obtained at 2 hours postdose (Alsultan 2014; Aruldhas 2019; Chigutsa 2015; Hiruy 2015).
Note: AUC24 has also been suggested as a target pharmacodynamic parameter, though value associated with efficacy has varied (≥13 to 35 mg•hr/L) (Chigutsa 2015; Hiruy 2015; Pasipanodya 2013).
Inhibits bacterial RNA synthesis by binding to the beta subunit of DNA-dependent RNA polymerase, blocking RNA transcription
Duration: ≤24 hours.
Absorption: Oral: Well absorbed; food may delay or slightly reduce peak.
Distribution: Highly lipophilic; crosses blood-brain barrier well.
Vd: Neonates, Infants, Children, and Adolescents: ~1.1 L/kg (Nahata 1990; Smith 2019).
Relative diffusion from blood into CSF: Adequate with or without inflammation (exceeds usual MICs).
CSF:blood level ratio: Inflamed meninges: 25%.
Protein binding: 80%.
Metabolism: Hepatic; undergoes enterohepatic recirculation.
Half-life elimination:
Neonates and Infants <4 months (GA ≥23 weeks): PNA <14 days: Median: 7.1 hours (range: 3 to 23.9 hours); PNA ≥14 days: Median: 3.5 hours (range: 1.9 to 6.5 hours) (Smith 2019).
Infants ≥4 months and Children: ~1 to 4 hours.
Adults: ~2 to 3 hours (steady-state).
Time to peak, serum:
Infants and Children 6 months to <5 years: Oral: 1 hour.
Adults: Oral: ~2 hours (Acocella 1978).
Excretion: Feces (60% to 65%) and urine (≤30%) as unchanged drug.
Altered kidney function: Half-life prolonged from 3.6 hours (GFR >50 mL/minute) to 5 hours (GFR 30 to 50 mL/minute), 7.3 hours (GFR <30 mL/minute) and 11 hours (patients who are anuric) following a single 900 mg dose. No increase in half-life has been observed with doses ≤600 mg/day.
