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Rifampin (rifampicin): Drug information

Rifampin (rifampicin): Drug information
(For additional information see "Rifampin (rifampicin): Patient drug information" and see "Rifampin (rifampicin): Pediatric drug information")

For abbreviations, symbols, and age group definitions used in Lexicomp (show table)
Brand Names: US
  • Rifadin
Brand Names: Canada
  • Rifadin [DSC];
  • Rofact
Pharmacologic Category
  • Antitubercular Agent;
  • Rifamycin
Dosing: Adult
Anaplasmosis, symptomatic

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 (CDC [Biggs 2016]; IDSA [Wormser 2006]).

Oral: 300 mg twice daily for 7 to 10 days (CDC [Biggs 2016]; IDSA [Wormser 2006]).

Bartonella spp. infection

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 (HHS [OI adult] 2022; Rolain 2004; Spach 2022a; Spach 2022b). Some experts do not suggest rifampin as part of the regimen for patients with HIV and bacteremia without endocarditis (HHS [OI adult] 2022).

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 (HHS [OI adult] 2022).

Cat scratch disease, lymphadenitis (alternative agent): Oral: 300 mg twice daily for 7 to 10 days (Spach 2022c).

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 (Rolain 2004; Spach 2022c).

Brucellosis

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 (Alp 2008; Ariza 2007; Bosilkovski 2020; CDC 2017; Jia 2017; Skalsky 2008; Solera 1999; WHO [Corbel 2006]; Zheng 2018).

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 (Bosilkovski 2020; CDC 2017).

Cholestatic pruritus

Cholestatic pruritus (alternative agent) (off-label use):

Note: Avoid use in patients with a baseline bilirubin >2.5 mg/dL (AASLD [Lindor 2019]).

Oral: 150 to 300 mg twice daily (Poupon 2021).

Endocarditis, treatment

Endocarditis, treatment (off-label use):

Staphylococcus spp. or early (<1 year) culture negative (prosthetic valve): 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 (AHA [Baddour 2015]; IDSA [Liu 2011]; Karchmer 2020).

Hidradenitis suppurativa, moderate to severe

Hidradenitis suppurativa, moderate to severe (alternative agent) (off-label use):

Oral: 600 mg/day in 1 or 2 divided doses in combination with clindamycin for 10 to 12 weeks (Alikhan 2019; Dessinioti 2016; Gener 2009; Gulliver 2016; van der Zee 2009).

Leprosy

Leprosy (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 (NHDP/HRSA 2018). Note: Rifampin is given once monthly if coadministered with prednisone (NHDP/HRSA 2018). 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) (WHO 2018).

Meningococcal disease, chemoprophylaxis after close contact with a patient with invasive disease

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) (AAP [Red Book 2015]; ACIP [Bilukha 2005]; ACIP [Cohn 2013]; Gardner 2006).

Mycobacterial infection

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 (ATS/ERS/ESCMID/IDSA [Daley 2020]; BTS [Haworth 2017]).

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 (ATS/ERS/ESCMID/IDSA [Daley 2020]; CFF/ECFS [Floto 2016]).

Duration of therapy: Continue treatment until patient is culture negative on therapy for ≥1 year (ATS/ERS/ESCMID/IDSA [Daley 2020]; BTS [Haworth 2017]; CFF/ECFS [Floto 2016]).

Staphylococcus spp. infections, including bone and joint and CNS

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 (IDSA [Liu 2011]; Zimmerli 1998; Zimmerli 2019).

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 (Baddour 2022; IDSA [Liu 2011]). Some experts suggest delaying initiation of rifampin until several days after initiation of other antistaphylococcal agents (Berbari 2022; Osmon 2020).

Streptococcus chronic carriage

Streptococcus (group A) chronic carriage (off-label use):

Note: Most individuals with chronic carriage do not require antibiotics (IDSA [Shulman 2012]).

Oral: 600 mg/day in 1 or 2 divided doses for the last 4 days of treatment in combination with penicillin V (Chaudhary 1985; IDSA [Shulman 2012]) or for 4 days in combination with single-dose IM benzathine penicillin G (IDSA [Shulman 2012]; Tanz 1985).

Tuberculosis, active

Tuberculosis, active (drug susceptible):

Note: Always administer in combination with other antitubercular drugs (ATS/CDC/IDSA [Nahid 2016]).

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 (ATS/CDC/IDSA [Nahid 2016]).

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) (ATS/CDC/IDSA [Nahid 2016]).

Alternative dosing intervals: Daily or 5-times-weekly dosing is preferred, particularly during the intensive phase. 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 (ATS/CDC/IDSA [Nahid 2016]); 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 (Johnston 2017). Use DOT for <7 days/week dosing (ATS/CDC/IDSA [Nahid 2016]).

Tuberculosis, latent infection

Tuberculosis, latent infection:

Oral: 10 mg/kg (maximum dose: 600 mg) once daily as a single agent for 4 months (HHS [OI adult] 2020; NTCA/CDC [Sterling 2020]) or in combination with isoniazid for 3 months (NTCA/CDC [Sterling 2020]).

Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.

Dosing: Kidney Impairment: Adult

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 (Kenny 1981).

Altered kidney function:

CrCl >15 mL/minute: No dosage adjustment necessary (expert opinion).

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 (Kenny 1981; expert opinion) except when used for meningococcal chemoprophylaxis (no adjustment necessary due to short duration of therapy) (expert opinion).

Hemodialysis, intermittent (thrice weekly): Not significantly dialyzable (Malone 1999); 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 (Kenny 1981; expert opinion) except when used for meningococcal chemoprophylaxis (no adjustment necessary due to short duration of therapy) (expert opinion).

Peritoneal dialysis: Not significantly dialyzable (Ahn 2003); 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 (Kenny 1981; expert opinion) except when used for meningococcal chemoprophylaxis (no adjustment necessary due to short duration of therapy) (expert opinion).

CRRT: No dosage adjustment necessary (expert opinion).

PIRRT (eg, sustained, low-efficiency diafiltration): No dosage adjustment necessary (Strunk 2016; expert opinion).

Dosing: Hepatic Impairment: Adult

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.

Dosing: Pediatric

(For additional information see "Rifampin (rifampicin): Pediatric drug information")

Note: Rifampin monotherapy is rarely indicated; most indications require combination therapy. Dosing presented in mg/kg/dose and mg/kg/day; use caution.

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 (CDC [Biggs 2016]; IDSA [Wormser 2006]).

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 (CDC [Biggs 2016]; IDSA [Wormser 2006]).

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 (Bosilkovski 2015; Bradley 2021; CDC 2017; Red Book [AAP 2018]).

Catheter (peritoneal dialysis); exit-site or tunnel infection: 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 (ISPD [Warady 2012]). Note: Should not be used as monotherapy or routinely used in areas where tuberculosis (TB) is endemic.

Cholestatic pruritus, persistent: Limited data available: Infants ≥4 months, Children, and Adolescents: Oral: 4 to 10 mg/kg/day in 2 divided doses; maximum daily dose: 600 mg/day (Cynamon 1990; El-Karaksy 2007; Gregorio 1993; Yerushalmi 1999). If no response, may increase dose by 2 mg/kg/day every 2 weeks to a maximum dose of 20 mg/kg/day (El-Karaksy 2007).

Endocarditis: Limited data available: Note: Use as part of an appropriate combination regimen.

Empiric therapy or culture-negative endocarditis (prosthetic valve/material) (AHA [Baltimore 2015]):

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 (IDSA [Liu 2011]).

H. 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 (Kliegman 2020; Red Book [AAP 2018]).

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 (NHDP/HRSA 2018).

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 (NHDP/HRSA 2018); in resource-limited settings, the World Health Organization allows for shorter durations of monthly dosing for 6 months (paucibacillary) or 12 months (multibacillary) (WHO 2018).

Meningococcal disease, chemo prophylaxis after close contact with a patient with invasive disease:

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 (BTS [Haworth 2017]; Red Book [AAP 2018]). 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 (Red Book [AAP 2018]).

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 (BTS [Haworth 2017]; CFF/ECFS [Floto 2016]). 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 (CFF/ECFS [Floto 2016]).

Duration of therapy: Continue treatment until patient is culture negative on therapy for ≥1 year (BTS [Haworth 2017]; CFF/ECFS [Floto 2016]).

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 (ISPD [Warady 2012]).

Streptococcus, group A; chronic carriage: Limited data available: Note: Most individuals with chronic carriage do not require antibiotic treatment (IDSA [Shulman 2012]).

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 (IDSA [Shulman 2012]).

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 (IDSA [Shulman 2012]; Tanz 1985).

Tuberculosis, active (drug-susceptible); treatment (ATS/CDC/IDSA [Nahid 2016]):

Note: Always administer in combination with other antitubercular drugs (ATS/CDC/IDSA [Nahid 2016]). Currently recommended doses in guideline, particularly those on the lower end of the range, may not achieve desired exposure (Aruldhas 2019; Hiruy 2015; Kwara 2016; Yang 2018). Doses of 20 to 30 mg/kg/dose have been recommended for infants and young children or for treating disseminated tuberculosis or tuberculous meningitis (Red Book [AAP 2018]).

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, alternatives in order of preference are: Daily (or 5-times-weekly) dosing for the intensive phase followed by 3-times-weekly dosing during the continuation phase; 3-times-weekly dosing for the duration of treatment; and daily dosing for 2 weeks followed by twice-weekly dosing. Twice-weekly dosing should not be used in patients with HIV, who are smear-positive, or who have cavitary disease. Directly observe therapy for any regimen that is <7 days/week dosing.

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 (Diallo 2018; HHS [pediatric OI] 2019; NTCA/CDC [Sterling 2020]; Red Book [AAP 2018]). Higher doses of 20 to 30 mg/kg/dose have been recommended for infants and young children (Red Book [AAP 2018]).

Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.

Dosing: Kidney Impairment: Pediatric

There are no dosage adjustments provided in the manufacturer's labeling; however, based on experience in adults, dosage adjustment is likely unnecessary.

Dosing: Hepatic Impairment: Pediatric

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.

Dosing: Older Adult

Refer to adult dosing.

Dosage Forms: US

Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product

Capsule, Oral:

Rifadin: 150 mg [DSC], 300 mg [DSC] [contains corn starch, fd&c blue #1 (brilliant blue), fd&c red #40 (allura red ac dye)]

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)

Generic Equivalent Available: US

Yes

Dosage Forms: Canada

Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product

Capsule, Oral:

Rifadin: 150 mg [DSC], 300 mg [DSC] [contains fd&c blue #1 (brilliant blue), fd&c red #40 (allura red ac dye)]

Rofact: 150 mg, 300 mg

Administration: Adult

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.

Administration: Pediatric

Oral: Administer on an empty stomach with a 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 (Red Book [AAP 2018]; manufacturer's labeling).

Parenteral: Administer by slow IV infusion over 30 minutes to 3 hours. Do not administer IM or SUBQ. Avoid extravasation.

Use: Labeled Indications

Meningococcal prophylaxis: Treatment of asymptomatic carriers of Neisseria meningitidis to eliminate meningococci from the nasopharynx.

Tuberculosis: Treatment of latent or active tuberculosis (in combination with other agents, when appropriate).

Use: Off-Label: Adult

Anaplasmosis, symptomatic; Bartonella spp. infections; Brucellosis; Cholestatic pruritus; Endocarditis, treatment; Hidradenitis suppurativa, moderate to severe; Leprosy; Meningococcal disease, chemoprophylaxis after close contact with a patient with invasive disease; Mycobacterial (nontuberculous) infection; Staphylococcus spp. infections, including bone and joint and CNS; Streptococcus (group A) chronic carriage

Medication Safety Issues
Sound-alike/look-alike issues:

Rifadin may be confused with Rifater, Ritalin

RifAMPin may be confused with ribavirin, rifabutin, Rifamate, rifapentine, rifAXIMin

Adverse Reactions (Significant): Considerations
Clostridioides difficile infection

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)

Hematologic effects

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

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: Idiosyncratic metabolic products that are either directly toxic or induce an immunologic reaction (Ref) or hypersensitivity (Ref).

Onset: Varied; typically, onset of injury is within the first 1 to 6 weeks of initiation (Ref).

Risk factors:

• Long-term therapy (Ref)

• Age >60 years (Ref)

• Alcohol use disorder (Ref)

• Concurrent use of other hepatotoxic agents (eg, isoniazid, pyrazinamide) (Ref)

• Females (Ref)

• Low body mass index (Ref)

• Malnutrition (Ref)

• Preexisting liver disease (eg, chronic viral hepatitis) (Ref))

• HIV (Ref)

Hypersensitivity reactions (immediate and delayed)

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)

Pulmonary toxicity

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).

Adverse Reactions

The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified.

Postmarketing:

Cardiovascular: Decreased blood pressure, facial edema (Holdiness 1989), flushing, hypersensitivity angiitis (Kim 2010), peripheral edema, shock (Luzzati 2007)

Dermatologic: Acute generalized exanthematous pustulosis (Azad 2006), cutaneous lupus erythematosus (Patel 2001), erythema multiforme, lichenoid eruption (Shahul 2016), pemphigoid reaction, pruritus (Farah 2012), psoriasiform eruption (Feng 2020), skin rash (Farah 2012; Shin 2021), Stevens-Johnson syndrome (Collado-Chagoya 2019), toxic epidermal necrolysis (Collado-Chagoya 2019), urticaria

Endocrine & metabolic: Adrenocortical insufficiency (Denny 2016; Elansary 1983), increased uric acid, menstrual disease

Gastrointestinal: Abdominal cramps, anorexia, cholestasis, Clostridioides difficile-associated diarrhea (Bessaleli 2018), Clostridioides difficile colitis, diarrhea, epigastric discomfort, flatulence, glossalgia, heartburn, nausea, staining of tooth (Ayaslioglu 2005), vomiting

Genitourinary: Hematuria (Covic 2004; Martins 2013), hemoglobinuria (Covic 2004)

Hematologic & oncologic: Acute intravascular hemolysis (Sanwal 2020), agranulocytosis (Andres 2017), decreased hemoglobin (Havey 2012; Sveroni 2018), disorder of hemostatic components of blood (vitamin K-dependent) (Havey 2012), disseminated intravascular coagulation (Havey 2012), eosinophilia, hemolysis (Havey 2012; Sveroni 2018), hemolytic anemia (Havey 2012; Sveroni 2018), hemorrhage (Havey 2012), leukopenia, thrombocytopenia (especially with high-dose therapy) (Forget 2006), thrombotic microangiopathy (including hemolytic-uremic syndrome and thrombotic thrombocytopenic purpura) (Gupta 2005)

Hepatic: Abnormal hepatic function tests (Tostmann 2008), hepatic cirrhosis (Tostmann 2008), hepatic failure (Tostmann 2008), hepatitis (including shock-like syndrome with hepatic involvement) (Tostmann 2008), hepatotoxicity (Nelson 2014), hyperbilirubinemia (Tostmann 2008), jaundice (Tostmann 2008)

Hypersensitivity: Anaphylaxis (Syrigou 2016), angioedema (Farah 2012), fixed drug eruption (Mimouni 1990)

Immunologic: Drug reaction with eosinophilia and systemic symptoms (Brockhaus 2019)

Nervous system: Ataxia, behavioral changes, cerebral hemorrhage (Koboyashi 2002), confusion, dizziness, drowsiness, fatigue, headache, lack of concentration, myasthenia, numbness, psychosis (Salafia 1992), sore mouth

Neuromuscular & skeletal: Limb pain, myopathy (Forget 2006; Jenkins 1981)

Ophthalmic: Conjunctivitis

Renal: Acute interstitial nephritis (Rossert 2001), acute renal injury, increased blood urea nitrogen, renal insufficiency, renal tubular necrosis (Forget 2006)

Respiratory: Acute respiratory distress syndrome (Ashitani 2003), bronchiolitis obliterans organizing pneumonia, eosinophilic pneumonitis, dyspnea, flu-like symptoms (Luzzati 2007), hypersensitivity pneumonitis (Brockhaus 2019), interstitial pulmonary disease, pneumonitis (Ata 2020; Koma 2013), pulmonary fibrosis (Umeki 1988), pulmonary infiltrates, wheezing

Miscellaneous: Fever, paradoxical reaction (recurrence or appearance of new infection symptoms; may be transient)

Contraindications

Hypersensitivity to rifampin, any rifamycins, or any component of the formulation; concurrent use of atazanavir, darunavir, fosamprenavir, praziquantel, ritonavir/saquinavir, saquinavir, or tipranavir.

Canadian labeling: Additional contraindications (not in US labeling): Jaundice associated with reduced bilirubin excretion; premature and newborn infants; breastfeeding women; hepatic function impairment.

Warnings/Precautions

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).

Metabolism/Transport Effects

Substrate of OATP1B1/1B3 (SLCO1B1/1B3), P-glycoprotein/ABCB1 (minor); Note: Assignment of Major/Minor substrate status based on clinically relevant drug interaction potential; Inhibits OATP1B1/1B3 (SLCO1B1/1B3); Induces BCRP/ABCG2, CYP1A2 (weak), CYP2B6 (moderate), CYP2C19 (strong), CYP2C8 (moderate), CYP2C9 (moderate), CYP3A4 (strong), OATP1B1/1B3 (SLCO1B1/1B3), P-glycoprotein/ABCB1, UGT1A1, UGT1A9

Drug Interactions

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 Lexicomp drug interactions program by clicking on the “Launch drug interactions program” link above.

Abemaciclib: CYP3A4 Inducers (Strong) may decrease the serum concentration of Abemaciclib. Risk X: Avoid combination

Abiraterone Acetate: CYP3A4 Inducers (Strong) may decrease the serum concentration of Abiraterone Acetate. Management: Avoid when possible. If the combination cannot be avoided, increase abiraterone acetate dosing frequency from once daily to twice daily during combined use. Reduce abiraterone dose back to the prior dose and frequency once strong inducer is discontinued. Risk D: Consider therapy modification

Abrocitinib: CYP2C19 Inducers (Strong) may decrease the serum concentration of Abrocitinib. Risk X: Avoid combination

Acalabrutinib: CYP3A4 Inducers (Strong) may decrease the serum concentration of Acalabrutinib. Management: Avoid co-administration of strong CYP3A inducers in patients taking acalabrutinib. If strong CYP3A inducers cannot be avoided, increase the dose of acalabrutinib to 200 mg twice daily. Risk D: Consider therapy modification

Acetaminophen: RifAMPin may enhance the hepatotoxic effect of Acetaminophen. RifAMPin may decrease the serum concentration of Acetaminophen. Risk C: Monitor therapy

Afatinib: P-glycoprotein/ABCB1 Inducers may decrease the 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 the serum concentration of Agomelatine. Risk C: Monitor therapy

Alfacalcidol: CYP3A4 Inducers (Strong) may decrease the serum concentration of Alfacalcidol. Risk C: Monitor therapy

Alfentanil: CYP3A4 Inducers (Strong) may decrease the 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 the serum concentration of Aliskiren. Risk C: Monitor therapy

Alpelisib: CYP3A4 Inducers (Strong) may decrease the serum concentration of Alpelisib. Risk X: Avoid combination

ALPRAZolam: CYP3A4 Inducers (Strong) may decrease the serum concentration of ALPRAZolam. Risk C: Monitor therapy

Amiodarone: CYP3A4 Inducers (Strong) may decrease serum concentrations of the active metabolite(s) of Amiodarone. CYP3A4 Inducers (Strong) may decrease the serum concentration of Amiodarone. Risk C: Monitor therapy

Amitriptyline: RifAMPin may decrease serum concentrations of the active metabolite(s) of Amitriptyline. Specifically, concentrations of nortriptyline may be reduced. RifAMPin may decrease the serum concentration of Amitriptyline. Risk C: Monitor therapy

AmLODIPine: CYP3A4 Inducers (Strong) may decrease the serum concentration of AmLODIPine. Risk C: Monitor therapy

Amodiaquine: CYP2C8 Inducers (Moderate) may decrease the 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 the serum concentration of Antihepaciviral Combination Products. Risk X: Avoid combination

Apixaban: Inducers of CYP3A4 (Strong) and P-glycoprotein may decrease the serum concentration of Apixaban. Risk X: Avoid combination

Apremilast: CYP3A4 Inducers (Strong) may decrease the serum concentration of Apremilast. Risk X: Avoid combination

Aprepitant: CYP3A4 Inducers (Strong) may decrease the serum concentration of Aprepitant. Risk X: Avoid combination

ARIPiprazole: CYP3A4 Inducers (Strong) may decrease the 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

ARIPiprazole Lauroxil: CYP3A4 Inducers (Strong) may decrease serum concentrations of the active metabolite(s) of ARIPiprazole Lauroxil. Management: Patients taking the 441 mg dose of aripiprazole lauroxil increase their dose to 662 mg if used with a strong CYP3A4 inducer for more than 14 days. No dose adjustment is necessary for patients using the higher doses of aripiprazole lauroxil. Risk D: Consider therapy modification

Artemether and Lumefantrine: CYP3A4 Inducers (Strong) may decrease serum concentrations of the active metabolite(s) of Artemether and Lumefantrine. Specifically, concentrations of dihydroartemisinin (DHA), the active metabolite of artemether may be decreased. CYP3A4 Inducers (Strong) may decrease the serum concentration of Artemether and Lumefantrine. Risk X: Avoid combination

Artesunate: RifAMPin may decrease serum concentrations of the active metabolite(s) of Artesunate. Risk C: Monitor therapy

Asunaprevir: RifAMPin may decrease the serum concentration of Asunaprevir. This effect is most likely with longer-term coadministration; single-dose rifampin may increase asunaprevir concentrations. RifAMPin may increase the serum concentration of Asunaprevir. This effect is likely following only single-dose or short-term rifampin administration. Longer-term coadministration is likely to result in decreased asunaprevir concentrations. Risk X: Avoid combination

Ataluren: RifAMPin may decrease the serum concentration of Ataluren. Risk C: Monitor therapy

Atazanavir: RifAMPin may decrease the serum concentration of Atazanavir. Risk X: Avoid combination

Atogepant: RifAMPin may decrease the serum concentration of Atogepant. Specifically, atogepant concentrations may be reduced with daily dosing of rifampin. RifAMPin may increase the serum concentration of Atogepant. Specifically, increases in atogepant exposure may occur with single dose of rifampin or at the initiation of rifampin therapy. Management: When administered with single dose rifampin, or at rifampin initiation, the atogepant dose should be 10 mg once daily or 30 mg once daily. When administered with daily dosing of rifampin, the atogepant dose should be 30 mg once daily or 60 mg once daily. Risk D: Consider therapy modification

Atorvastatin: RifAMPin may increase the serum concentration of Atorvastatin. RifAMPin may decrease the 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 the serum concentration of RifAMPin. RifAMPin may decrease the serum concentration of Atovaquone. Risk X: Avoid combination

Avacopan: CYP3A4 Inducers (Strong) may decrease the serum concentration of Avacopan. Risk X: Avoid combination

Avanafil: CYP3A4 Inducers (Strong) may decrease the serum concentration of Avanafil. Risk X: Avoid combination

Avapritinib: CYP3A4 Inducers (Strong) may decrease the serum concentration of Avapritinib. Risk X: Avoid combination

Avatrombopag: RifAMPin may decrease the 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 the serum concentration of Axitinib. Risk X: Avoid combination

Bacillus clausii: Antibiotics may diminish the therapeutic effect 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 the serum concentration of Barnidipine. Risk C: Monitor therapy

Bazedoxifene: RifAMPin may decrease the serum concentration of Bazedoxifene. This may lead to loss of efficacy or, if bazedoxifene is combined with estrogen therapy, an increased risk of endometrial hyperplasia. Risk C: Monitor therapy

BCG (Intravesical): Antibiotics may diminish the therapeutic effect of BCG (Intravesical). Risk X: Avoid combination

BCG Vaccine (Immunization): Antibiotics may diminish the therapeutic effect of BCG Vaccine (Immunization). Risk C: Monitor therapy

Bedaquiline: CYP3A4 Inducers (Strong) may decrease serum concentrations of the active metabolite(s) of Bedaquiline. CYP3A4 Inducers (Strong) may decrease the serum concentration of Bedaquiline. Risk X: Avoid combination

Belumosudil: CYP3A4 Inducers (Strong) may decrease the 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 the serum concentration of Benidipine. Risk C: Monitor therapy

Benperidol: CYP3A4 Inducers (Strong) may decrease the serum concentration of Benperidol. Risk C: Monitor therapy

Benzhydrocodone: CYP3A4 Inducers (Strong) may decrease the serum concentration of Benzhydrocodone. Specifically, the serum concentrations of hydrocodone may be reduced. Risk C: Monitor therapy

Berotralstat: P-glycoprotein/ABCB1 Inducers may decrease the serum concentration of Berotralstat. Risk X: Avoid combination

Betamethasone (Systemic): CYP3A4 Inducers (Strong) may decrease the serum concentration of Betamethasone (Systemic). Risk C: Monitor therapy

Bictegravir: RifAMPin may decrease the serum concentration of Bictegravir. Risk X: Avoid combination

Bisoprolol: CYP3A4 Inducers (Strong) may decrease the serum concentration of Bisoprolol. Risk C: Monitor therapy

Blonanserin: CYP3A4 Inducers (Strong) may decrease the serum concentration of Blonanserin. Risk C: Monitor therapy

Bortezomib: CYP3A4 Inducers (Strong) may decrease the serum concentration of Bortezomib. Risk X: Avoid combination

Bosentan: RifAMPin may decrease the serum concentration of Bosentan. Following the initial week of concurrent rifampin, this effect is most likely. RifAMPin may increase the serum concentration of Bosentan. This effect is most likely to be observed within the initial few days of concurrent therapy (and may be greatest immediately following initiation of the combination). Risk C: Monitor therapy

Bosutinib: CYP3A4 Inducers (Strong) may decrease the serum concentration of Bosutinib. Risk X: Avoid combination

Brentuximab Vedotin: CYP3A4 Inducers (Strong) may decrease the serum concentration of Brentuximab Vedotin. Specifically, concentrations of the active monomethyl auristatin E (MMAE) component may be decreased. Risk C: Monitor therapy

Brexpiprazole: CYP3A4 Inducers (Strong) may decrease the serum concentration of Brexpiprazole. Management: If brexpiprazole is used together with a strong CYP3A4 inducer, the brexpiprazole dose should gradually be doubled over the course of 1 to 2 weeks. 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 the serum concentration of Brigatinib. Risk X: Avoid combination

Brincidofovir: OATP1B1/1B3 (SLCO1B1/1B3) Inhibitors may increase the 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 the 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 the serum concentration of Bromocriptine. Risk C: Monitor therapy

Bromperidol: CYP3A4 Inducers (Strong) may decrease the serum concentration of Bromperidol. Risk C: Monitor therapy

Brotizolam [INT]: CYP3A4 Inducers (Strong) may decrease the serum concentration of Brotizolam [INT]. Risk C: Monitor therapy

Buprenorphine: CYP3A4 Inducers (Strong) may decrease the serum concentration of Buprenorphine. Risk C: Monitor therapy

BuPROPion: CYP2B6 Inducers (Moderate) may decrease the serum concentration of BuPROPion. Risk C: Monitor therapy

BusPIRone: CYP3A4 Inducers (Strong) may decrease the serum concentration of BusPIRone. Management: Consider alternatives to this combination. If coadministration of these agents is deemed necessary, monitor patients for reduced buspirone effects and increase buspirone doses as needed. Risk D: Consider therapy modification

Butorphanol: CYP3A4 Inducers (Strong) may decrease the serum concentration of Butorphanol. Risk C: Monitor therapy

Cabazitaxel: CYP3A4 Inducers (Strong) may decrease the serum concentration of Cabazitaxel. Risk C: Monitor therapy

Cabotegravir: UGT1A1 Inducers may decrease the serum concentration of Cabotegravir. Risk X: Avoid combination

Cabozantinib: CYP3A4 Inducers (Strong) may decrease the 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 decrease the serum concentration of Calcifediol. Risk C: Monitor therapy

Calcitriol (Systemic): CYP3A4 Inducers (Strong) may decrease the serum concentration of Calcitriol (Systemic). Risk C: Monitor therapy

Canagliflozin: RifAMPin may decrease the 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 concentrations of the active metabolite(s) of Cannabidiol. CYP2C19 Inducers (Strong) may decrease the serum concentration of Cannabidiol. Risk C: Monitor therapy

Cannabis: CYP3A4 Inducers (Strong) may decrease the serum concentration of Cannabis. More specifically, tetrahydrocannabinol and cannabidiol serum concentrations may be decreased. Risk C: Monitor therapy

Capmatinib: CYP3A4 Inducers (Strong) may decrease the serum concentration of Capmatinib. Risk X: Avoid combination

CarBAMazepine: CYP3A4 Inducers (Strong) may decrease the serum concentration of CarBAMazepine. Risk C: Monitor therapy

Cariprazine: CYP3A4 Inducers (Strong) may decrease the serum concentration of Cariprazine. Risk X: Avoid combination

Carisoprodol: CYP2C19 Inducers (Strong) may increase serum concentrations of the active metabolite(s) of Carisoprodol. CYP2C19 Inducers (Strong) may decrease the serum concentration of Carisoprodol. Risk C: Monitor therapy

Carvedilol: RifAMPin may decrease the serum concentration of Carvedilol. Risk C: Monitor therapy

Caspofungin: RifAMPin may decrease the serum concentration of Caspofungin. Management: Caspofungin prescribing information recommends using a dose of 70 mg daily in adults (or 70 mg/m2, up to a maximum of 70 mg, daily in pediatric patients) who are also receiving rifampin. Risk D: Consider therapy modification

CeFAZolin: May enhance the adverse/toxic effect of RifAMPin. Specifically, the risk for bleeding may be increased. Management: Avoid concomitant use of rifampin with cefazolin when possible. If combined, closely monitor prothrombin time or other coagulation tests and administer vitamin K as needed. Risk D: Consider therapy modification

Celecoxib: CYP2C9 Inducers (Moderate) may decrease the serum concentration of Celecoxib. Risk C: Monitor therapy

Celiprolol: P-glycoprotein/ABCB1 Inducers may decrease the serum concentration of Celiprolol. Risk C: Monitor therapy

Cephalosporins (N-methylthiotetrazole [NMTT] Side Chain Containing): May enhance the adverse/toxic effect of RifAMPin. Specifically, the risk for bleeding may be increased. Management: Avoid concomitant use of rifampin with cephalosporins that contain an 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 the serum concentration of Ceritinib. Risk X: Avoid combination

Charcoal, Activated: May decrease the absorption of RifAMPin. Risk C: Monitor therapy

Chloramphenicol (Systemic): RifAMPin may increase the metabolism of Chloramphenicol (Systemic). Risk C: Monitor therapy

ChlorproPAMIDE: CYP3A4 Inducers (Strong) may decrease the serum concentration of ChlorproPAMIDE. Risk C: Monitor therapy

Cholera Vaccine: Antibiotics may diminish the therapeutic effect of Cholera Vaccine. Management: Avoid cholera vaccine in patients receiving systemic antibiotics, and within 14 days following the use of oral or parenteral antibiotics. Risk X: Avoid combination

Cilnidipine: CYP3A4 Inducers (Strong) may decrease the serum concentration of Cilnidipine. Risk C: Monitor therapy

Citalopram: CYP3A4 Inducers (Strong) may decrease the serum concentration of Citalopram. Risk C: Monitor therapy

Cladribine: BCRP/ABCG2 Inducers may decrease the serum concentration of Cladribine. Risk C: Monitor therapy

Cladribine: P-glycoprotein/ABCB1 Inducers may decrease the serum concentration of Cladribine. Risk C: Monitor therapy

Clarithromycin: CYP3A4 Inducers (Strong) may increase serum concentrations of the active metabolite(s) of Clarithromycin. CYP3A4 Inducers (Strong) may decrease the 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 the serum concentration of ClonazePAM. Risk C: Monitor therapy

Clopidogrel: CYP2C19 Inducers (Strong) may increase serum concentrations of the active metabolite(s) 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 the 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 the serum concentration of Cobicistat. Risk X: Avoid combination

Cobimetinib: CYP3A4 Inducers (Strong) may decrease the serum concentration of Cobimetinib. Risk X: Avoid combination

Codeine: CYP3A4 Inducers (Strong) may decrease serum concentrations of the active metabolite(s) of Codeine. Risk C: Monitor therapy

Copanlisib: CYP3A4 Inducers (Strong) may decrease the serum concentration of Copanlisib. Risk X: Avoid combination

Crizotinib: CYP3A4 Inducers (Strong) may decrease the serum concentration of Crizotinib. Risk X: Avoid combination

Cyclophosphamide: CYP2B6 Inducers (Moderate) may increase serum concentrations of the active metabolite(s) of Cyclophosphamide. Risk C: Monitor therapy

CycloSPORINE (Systemic): CYP3A4 Inducers (Strong) may decrease the 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 the serum concentration of Cyproterone. Risk C: Monitor therapy

Dabigatran Etexilate: P-glycoprotein/ABCB1 Inducers may decrease the serum concentration of Dabigatran Etexilate. Management: Avoid concurrent use of dabigatran with P-glycoprotein inducers whenever possible. Risk X: Avoid combination

Daclatasvir: CYP3A4 Inducers (Strong) may decrease the serum concentration of Daclatasvir. Risk X: Avoid combination

Dapsone (Systemic): May enhance the adverse/toxic effect of CYP3A4 Inducers (Strong). CYP3A4 Inducers (Strong) may decrease the serum concentration of Dapsone (Systemic). Risk C: Monitor therapy

Daridorexant: CYP3A4 Inducers (Strong) may decrease the serum concentration of Daridorexant. Risk X: Avoid combination

Darolutamide: Inducers of CYP3A4 (Strong) and P-glycoprotein may decrease the serum concentration of Darolutamide. Risk X: Avoid combination

Darunavir: RifAMPin may decrease the serum concentration of Darunavir. Risk X: Avoid combination

Dasabuvir: CYP3A4 Inducers (Strong) may decrease the serum concentration of Dasabuvir. Risk X: Avoid combination

Dasatinib: CYP3A4 Inducers (Strong) may decrease the 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: RifAMPin may decrease the serum concentration of Deferasirox. Management: Avoid combination when possible; if the combination must be used, consider a 50% increase in initial deferasirox dose, with monitoring of serum ferritin concentrations and clinical responses to guide further dosing. Risk D: Consider therapy modification

Deflazacort: CYP3A4 Inducers (Strong) may decrease serum concentrations of the active metabolite(s) of Deflazacort. Risk X: Avoid combination

Delamanid: CYP3A4 Inducers (Strong) may decrease the serum concentration of Delamanid. Risk X: Avoid combination

Delavirdine: RifAMPin may decrease the serum concentration of Delavirdine. Risk X: Avoid combination

DexAMETHasone (Systemic): CYP3A4 Inducers (Strong) may decrease the serum concentration of DexAMETHasone (Systemic). Management: Consider dexamethasone dose increases in patients receiving strong CYP3A4 inducers and monitor closely for reduced dexamethasone efficacy. Consider avoiding this combination when treating life threatening conditions (ie, multiple myeloma). Risk D: Consider therapy modification

Dexlansoprazole: CYP2C19 Inducers (Strong) may decrease the serum concentration of Dexlansoprazole. Risk X: Avoid combination

Diamorphine: RifAMPin may decrease serum concentrations of the active metabolite(s) of Diamorphine. Risk C: Monitor therapy

DiazePAM: CYP3A4 Inducers (Strong) may decrease the serum concentration of DiazePAM. Risk C: Monitor therapy

Diclofenac (Systemic): CYP2C9 Inducers (Moderate) may decrease the serum concentration of Diclofenac (Systemic). Risk C: Monitor therapy

Digoxin: P-glycoprotein/ABCB1 Inducers may decrease the serum concentration of Digoxin. Risk C: Monitor therapy

DilTIAZem: CYP3A4 Inducers (Strong) may decrease the 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 the serum concentration of Disopyramide. Risk C: Monitor therapy

DOCEtaxel: CYP3A4 Inducers (Strong) may decrease the serum concentration of DOCEtaxel. Risk C: Monitor therapy

Dolutegravir: RifAMPin may decrease the 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 the serum concentration of Domperidone. Risk C: Monitor therapy

Doravirine: CYP3A4 Inducers (Strong) may decrease the serum concentration of Doravirine. Risk X: Avoid combination

Doxercalciferol: CYP3A4 Inducers (Strong) may increase serum concentrations of the active metabolite(s) of Doxercalciferol. Risk C: Monitor therapy

DOXOrubicin (Conventional): CYP3A4 Inducers (Strong) may decrease the serum concentration of DOXOrubicin (Conventional). Risk X: Avoid combination

DOXOrubicin (Conventional): P-glycoprotein/ABCB1 Inducers may decrease the serum concentration of DOXOrubicin (Conventional). Risk X: Avoid combination

Doxycycline: RifAMPin may decrease the serum concentration of Doxycycline. Risk C: Monitor therapy

Dronabinol: CYP3A4 Inducers (Strong) may decrease the serum concentration of Dronabinol. Risk C: Monitor therapy

Dronedarone: CYP3A4 Inducers (Strong) may decrease the serum concentration of Dronedarone. Risk X: Avoid combination

Duvelisib: CYP3A4 Inducers (Strong) may decrease the serum concentration of Duvelisib. Risk X: Avoid combination

Dydrogesterone: CYP3A4 Inducers (Strong) may decrease the serum concentration of Dydrogesterone. Risk C: Monitor therapy

Ebastine: CYP3A4 Inducers (Strong) may decrease serum concentrations of the active metabolite(s) of Ebastine. CYP3A4 Inducers (Strong) may decrease the serum concentration of Ebastine. Risk C: Monitor therapy

Edoxaban: RifAMPin may decrease the serum concentration of Edoxaban. Risk X: Avoid combination

Efavirenz: RifAMPin may decrease the serum concentration of Efavirenz. Efavirenz may decrease the 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 therapy

Elagolix: RifAMPin may increase the serum concentration of Elagolix. Management: Use of the elagolix 200 mg twice daily dose with rifampin is not recommended. Limit combined use of the elagolix 150 mg once daily dose with rifampin to a maximum of 6 months. Risk D: Consider therapy modification

Elagolix, Estradiol, and Norethindrone: May increase the serum concentration of RifAMPin. Specifically, rifampin may increase elagolix concentrations and decrease estradiol and norethindrone concentrations. Risk X: Avoid combination

Elbasvir and Grazoprevir: RifAMPin may increase the serum concentration of Elbasvir and Grazoprevir. RifAMPin may decrease the serum concentration of Elbasvir and Grazoprevir. Risk X: Avoid combination

Elexacaftor, Tezacaftor, and Ivacaftor: CYP3A4 Inducers (Strong) may decrease the serum concentration of Elexacaftor, Tezacaftor, and Ivacaftor. Risk X: Avoid combination

Eliglustat: CYP3A4 Inducers (Strong) may decrease the serum concentration of Eliglustat. Risk X: Avoid combination

Eluxadoline: OATP1B1/1B3 (SLCO1B1/1B3) Inhibitors may increase the 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

Elvitegravir: RifAMPin may decrease the serum concentration of Elvitegravir. Risk X: Avoid combination

Encorafenib: CYP3A4 Inducers (Strong) may decrease the serum concentration of Encorafenib. Risk X: Avoid combination

Enfortumab Vedotin: CYP3A4 Inducers (Strong) may decrease the serum concentration of Enfortumab Vedotin. Specifically, concentrations of the active monomethyl auristatin E (MMAE) component may be decreased. Risk C: Monitor therapy

Entrectinib: CYP3A4 Inducers (Strong) may decrease the serum concentration of Entrectinib. Risk X: Avoid combination

Enzalutamide: CYP3A4 Inducers (Strong) may decrease serum concentrations of the active metabolite(s) of Enzalutamide. CYP3A4 Inducers (Strong) may decrease the serum concentration of Enzalutamide. Management: Consider using an alternative agent that has no or minimal CYP3A4 induction potential when possible. If this combination cannot be avoided, increase the dose of enzalutamide from 160 mg daily to 240 mg daily. Risk D: Consider therapy modification

Eplerenone: CYP3A4 Inducers (Strong) may decrease the serum concentration of Eplerenone. Risk C: Monitor therapy

Eravacycline: CYP3A4 Inducers (Strong) may decrease the serum concentration of Eravacycline. Management: Increase the eravacycline dose to 1.5 mg/kg every 12 hours when combined with strong CYP3A4 inducers. Risk D: Consider therapy modification

Erdafitinib: CYP3A4 Inducers (Strong) may decrease the serum concentration of Erdafitinib. Risk X: Avoid combination

Erlotinib: CYP3A4 Inducers (Strong) may decrease the 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 the serum concentration of Escitalopram. Risk C: Monitor therapy

Esomeprazole: CYP2C19 Inducers (Strong) may decrease the serum concentration of Esomeprazole. Risk X: Avoid combination

Estazolam: CYP3A4 Inducers (Strong) may decrease the serum concentration of Estazolam. Risk C: Monitor therapy

Estrogen Derivatives: CYP3A4 Inducers (Strong) may decrease the serum concentration of Estrogen Derivatives. Risk C: Monitor therapy

Eszopiclone: CYP3A4 Inducers (Strong) may decrease the serum concentration of Eszopiclone. Risk C: Monitor therapy

Ethosuximide: CYP3A4 Inducers (Strong) may decrease the serum concentration of Ethosuximide. Risk C: Monitor therapy

Etizolam: CYP3A4 Inducers (Strong) may decrease the serum concentration of Etizolam. Risk C: Monitor therapy

Etoposide: CYP3A4 Inducers (Strong) may decrease the serum concentration of Etoposide. Management: When possible, seek alternatives to strong CYP3A4-inducing medications in patients receiving etoposide. If combined, monitor patients closely for diminished etoposide response and need for etoposide dose increases. Risk D: Consider therapy modification

Etoposide Phosphate: CYP3A4 Inducers (Strong) may decrease the 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

Etoricoxib: CYP3A4 Inducers (Strong) may decrease the serum concentration of Etoricoxib. Risk C: Monitor therapy

Etravirine: CYP3A4 Inducers (Strong) may decrease the serum concentration of Etravirine. Risk X: Avoid combination

Everolimus: Inducers of CYP3A4 (Strong) and P-glycoprotein may decrease the 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 the serum concentration of Evogliptin. Risk C: Monitor therapy

Exemestane: CYP3A4 Inducers (Strong) may decrease the 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

Fedratinib: CYP3A4 Inducers (Strong) may decrease the serum concentration of Fedratinib. Risk X: Avoid combination

Felbamate: CYP3A4 Inducers (Strong) may decrease the serum concentration of Felbamate. Risk C: Monitor therapy

Felodipine: CYP3A4 Inducers (Strong) may decrease the 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 the 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 the serum concentration of FentaNYL. Risk C: Monitor therapy

Fesoterodine: CYP3A4 Inducers (Strong) may decrease serum concentrations of the active metabolite(s) of Fesoterodine. Risk C: Monitor therapy

Fexinidazole: CYP3A4 Inducers (Strong) may increase serum concentrations of the active metabolite(s) of Fexinidazole. Risk X: Avoid combination

Fexofenadine: RifAMPin may decrease the serum concentration of Fexofenadine. RifAMPin may increase the serum concentration of Fexofenadine. Risk C: Monitor therapy

Fimasartan: RifAMPin may increase the serum concentration of Fimasartan. Risk X: Avoid combination

Finerenone: CYP3A4 Inducers (Strong) may decrease the serum concentration of Finerenone. Risk X: Avoid combination

Flibanserin: CYP3A4 Inducers (Strong) may decrease the serum concentration of Flibanserin. Risk X: Avoid combination

Fluconazole: RifAMPin may decrease the serum concentration of Fluconazole. Fluconazole may increase the 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

Fluvastatin: RifAMPin may decrease the serum concentration of Fluvastatin. Specifically, this occurs with prolonged coadministration. RifAMPin may increase the serum concentration of Fluvastatin. Specifically, this occurs upon rifampin initiation. Risk C: Monitor therapy

Fosamprenavir: RifAMPin may decrease the serum concentration of Fosamprenavir. Specifically, concentrations of amprenavir (active metabolite) may be decreased. Risk X: Avoid combination

Fosaprepitant: CYP3A4 Inducers (Strong) may decrease the serum concentration of Fosaprepitant. Specifically, CYP3A4 Inducers (Strong) may decrease serum concentrations of the active metabolite aprepitant. Risk X: Avoid combination

Fosnetupitant: CYP3A4 Inducers (Strong) may decrease serum concentrations of the active metabolite(s) of Fosnetupitant. Risk X: Avoid combination

Fosphenytoin-Phenytoin: CYP2C19 Inducers (Strong) may decrease the serum concentration of Fosphenytoin-Phenytoin. Risk C: Monitor therapy

Fostamatinib: CYP3A4 Inducers (Strong) may decrease serum concentrations of the active metabolite(s) of Fostamatinib. Risk X: Avoid combination

Fostemsavir: CYP3A4 Inducers (Strong) may decrease serum concentrations of the active metabolite(s) of Fostemsavir. Risk X: Avoid combination

Futibatinib: Inducers of CYP3A4 (Strong) and P-glycoprotein may decrease the serum concentration of Futibatinib. Risk X: Avoid combination

Ganaxolone: CYP3A4 Inducers (Strong) may decrease the 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 the 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 concentrations of the active metabolite(s) of Gemigliptin. CYP3A4 Inducers (Strong) may decrease the serum concentration of Gemigliptin. Risk X: Avoid combination

Gestrinone: RifAMPin may decrease the serum concentration of Gestrinone. Risk C: Monitor therapy

Gilteritinib: Inducers of CYP3A4 (Strong) and P-glycoprotein may decrease the serum concentration of Gilteritinib. Risk X: Avoid combination

Glasdegib: CYP3A4 Inducers (Strong) may decrease the serum concentration of Glasdegib. Risk X: Avoid combination

Glecaprevir and Pibrentasvir: RifAMPin may decrease the serum concentration of Glecaprevir and Pibrentasvir. RifAMPin may increase the serum concentration of Glecaprevir and Pibrentasvir. Specifically, a single dose of rifampin may increase glecaprevir/pibrentasvir concentrations, while chronic daily use of rifampin may decrease glecaprevir/pibrentasvir concentrations. Risk X: Avoid combination

GuanFACINE: CYP3A4 Inducers (Strong) may decrease the 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 the serum concentration of Haloperidol. Risk C: Monitor therapy

Hormonal Contraceptives: CYP3A4 Inducers (Strong) may decrease the 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 the serum concentration of HYDROcodone. Risk C: Monitor therapy

Hydrocortisone (Systemic): CYP3A4 Inducers (Strong) may decrease the serum concentration of Hydrocortisone (Systemic). Risk C: Monitor therapy

Ibrexafungerp: CYP3A4 Inducers (Strong) may decrease the serum concentration of Ibrexafungerp. Risk X: Avoid combination

Ibrutinib: CYP3A4 Inducers (Strong) may decrease the serum concentration of Ibrutinib. Risk X: Avoid combination

Idelalisib: CYP3A4 Inducers (Strong) may decrease the serum concentration of Idelalisib. Risk X: Avoid combination

Ifosfamide: CYP3A4 Inducers (Strong) may increase serum concentrations of the active metabolite(s) of Ifosfamide. CYP3A4 Inducers (Strong) may decrease serum concentrations of the active metabolite(s) of Ifosfamide. Risk C: Monitor therapy

Imatinib: CYP3A4 Inducers (Strong) may decrease the 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: Antibiotics may diminish the therapeutic effect of Immune Checkpoint Inhibitors. Risk C: Monitor therapy

Indinavir: RifAMPin may decrease the serum concentration of Indinavir. Risk X: Avoid combination

Infigratinib: CYP3A4 Inducers (Strong) may decrease serum concentrations of the active metabolite(s) of Infigratinib. CYP3A4 Inducers (Strong) may decrease the serum concentration of Infigratinib. Risk X: Avoid combination

Irinotecan Products: CYP3A4 Inducers (Strong) may decrease serum concentrations of the active metabolite(s) of Irinotecan Products. Specifically, serum concentrations of SN-38 may be reduced. CYP3A4 Inducers (Strong) may decrease the serum concentration of Irinotecan Products. 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 serum concentrations of the active metabolite(s) of Isavuconazonium Sulfate. Specifically, CYP3A4 Inducers (Strong) may decrease isavuconazole serum concentrations. Risk X: Avoid combination

Isoniazid: May enhance the hepatotoxic effect of RifAMPin. RifAMPin may decrease the serum concentration of Isoniazid. Risk C: Monitor therapy

Isradipine: CYP3A4 Inducers (Strong) may decrease the serum concentration of Isradipine. Risk C: Monitor therapy

Istradefylline: CYP3A4 Inducers (Strong) may decrease the serum concentration of Istradefylline. Risk X: Avoid combination

Itraconazole: CYP3A4 Inducers (Strong) may decrease serum concentrations of the active metabolite(s) of Itraconazole. CYP3A4 Inducers (Strong) may decrease the serum concentration of Itraconazole. Risk X: Avoid combination

Ivabradine: CYP3A4 Inducers (Strong) may decrease the serum concentration of Ivabradine. Risk X: Avoid combination

Ivacaftor: CYP3A4 Inducers (Strong) may decrease the serum concentration of Ivacaftor. Risk X: Avoid combination

Ivosidenib: CYP3A4 Inducers (Strong) may decrease the serum concentration of Ivosidenib. Risk X: Avoid combination

Ixabepilone: CYP3A4 Inducers (Strong) may decrease the serum concentration of Ixabepilone. Management: Avoid this combination whenever possible. If this combination must be used, a gradual increase in ixabepilone dose from 40 mg/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 the serum concentration of Ixazomib. Risk X: Avoid combination

Ketamine: CYP3A4 Inducers (Strong) may decrease the serum concentration of Ketamine. Risk C: Monitor therapy

Ketoconazole (Systemic): CYP3A4 Inducers (Strong) may decrease the 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 the serum concentration of Lacidipine. Risk C: Monitor therapy

Lactobacillus and Estriol: Antibiotics may diminish the therapeutic effect of Lactobacillus and Estriol. Risk C: Monitor therapy

LamoTRIgine: RifAMPin may decrease the 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 the serum concentration of Lansoprazole. Risk X: Avoid combination

Lapatinib: CYP3A4 Inducers (Strong) may decrease the 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 the serum concentration of Larotrectinib. Management: Avoid use of strong CYP3A4 inducers with larotrectinib. If this combination cannot be avoided, double the larotrectinib dose. Reduced to previous dose after stopping the inducer after a period of 3 to 5 times the inducer's half-life. Risk D: Consider therapy modification

Ledipasvir: P-glycoprotein/ABCB1 Inducers may decrease the serum concentration of Ledipasvir. Risk X: Avoid combination

Lefamulin: CYP3A4 Inducers (Strong) may decrease the serum concentration of Lefamulin. Management: Avoid concomitant use of lefamulin with strong CYP3A4 inducers unless the benefits outweigh the risks. Risk D: Consider therapy modification

Lefamulin: P-glycoprotein/ABCB1 Inducers may decrease the serum concentration of Lefamulin. Management: Avoid concomitant use of lefamulin with P-glycoprotein/ABCB1 inducers unless the benefits outweigh the risks. Risk D: Consider therapy modification

Lefamulin (Intravenous): CYP3A4 Inducers (Strong) may decrease the serum concentration of Lefamulin (Intravenous). Management: Avoid concomitant use of lefamulin intravenous infusion with strong CYP3A4 inducers unless the benefits outweigh the risks. Risk D: Consider therapy modification

Lefamulin (Intravenous): P-glycoprotein/ABCB1 Inducers may decrease the serum concentration of Lefamulin (Intravenous). Management: Avoid concomitant use of lefamulin (intravenous) with P-glycoprotein/ABCB1 inducers unless the benefits outweigh the risks. Risk D: Consider therapy modification

Leflunomide: RifAMPin may increase serum concentrations of the active metabolite(s) of Leflunomide. Risk C: Monitor therapy

Lemborexant: CYP3A4 Inducers (Strong) may decrease the serum concentration of Lemborexant. Risk X: Avoid combination

Lercanidipine: CYP3A4 Inducers (Strong) may decrease the serum concentration of Lercanidipine. Risk C: Monitor therapy

Lesinurad: CYP2C9 Inducers (Moderate) may decrease the serum concentration of Lesinurad. Risk C: Monitor therapy

Letermovir: P-glycoprotein/ABCB1 Inducers may decrease the serum concentration of Letermovir. Risk X: Avoid combination

Letermovir: May increase the serum concentration of UGT1A1 Inducers. Risk X: Avoid combination

Leuprolide and Norethindrone: CYP3A4 Inducers (Strong) may decrease the serum concentration of Leuprolide and Norethindrone. Specifically, norethindrone concentrations may be decreased. Risk C: Monitor therapy

Levamlodipine: CYP3A4 Inducers (Strong) may decrease the serum concentration of Levamlodipine. Risk C: Monitor therapy

Levoketoconazole: CYP3A4 Inducers (Strong) may decrease the serum concentration of Levoketoconazole. Risk X: Avoid combination

Levomethadone: CYP3A4 Inducers (Strong) may decrease the serum concentration of Levomethadone. Risk C: Monitor therapy

Levonorgestrel (IUD): CYP3A4 Inducers (Strong) may diminish the therapeutic effect of Levonorgestrel (IUD). CYP3A4 Inducers (Strong) may decrease the serum concentration of Levonorgestrel (IUD). Risk C: Monitor therapy

Lidocaine (Systemic): CYP3A4 Inducers (Strong) may decrease the serum concentration of Lidocaine (Systemic). Risk C: Monitor therapy

LinaGLIPtin: CYP3A4 Inducers (Strong) may decrease the serum concentration of LinaGLIPtin. Management: Strongly consider using an alternative to any strong CYP3A4 inducer in patients who are being treated with linagliptin. If this combination is used, monitor patients closely for evidence of reduced linagliptin effectiveness. Risk D: Consider therapy modification

LinaGLIPtin: P-glycoprotein/ABCB1 Inducers may decrease the 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 the serum concentration of Lonafarnib. Risk X: Avoid combination

Lopinavir: RifAMPin may enhance the adverse/toxic effect of Lopinavir. Specifically, the risk of hepatocellular toxicity may be increased. RifAMPin may decrease the serum concentration of Lopinavir. Risk X: Avoid combination

Lorlatinib: CYP3A4 Inducers (Strong) may enhance the hepatotoxic effect of Lorlatinib. CYP3A4 Inducers (Strong) may decrease the serum concentration of Lorlatinib. Risk X: Avoid combination

Lornoxicam: CYP2C9 Inducers (Moderate) may decrease the serum concentration of Lornoxicam. Risk C: Monitor therapy

Lovastatin: CYP3A4 Inducers (Strong) may decrease the serum concentration of Lovastatin. Risk C: Monitor therapy

Lumacaftor and Ivacaftor: CYP3A4 Inducers (Strong) may decrease the serum concentration of Lumacaftor and Ivacaftor. Specifically, the serum concentration of ivacaftor may be decreased. Risk X: Avoid combination

Lumateperone: CYP3A4 Inducers (Strong) may decrease the serum concentration of Lumateperone. Risk X: Avoid combination

Lurasidone: CYP3A4 Inducers (Strong) may decrease the serum concentration of Lurasidone. Risk X: Avoid combination

Lurbinectedin: CYP3A4 Inducers (Strong) may decrease the serum concentration of Lurbinectedin. Risk X: Avoid combination

Macimorelin: CYP3A4 Inducers (Strong) may decrease the serum concentration of Macimorelin. Risk X: Avoid combination

Macitentan: CYP3A4 Inducers (Strong) may decrease the serum concentration of Macitentan. Risk X: Avoid combination

Manidipine: CYP3A4 Inducers (Strong) may decrease the serum concentration of Manidipine. Management: Consider avoiding concomitant use of manidipine and strong CYP3A4 inducers. If combined, monitor closely for decreased manidipine effects and loss of efficacy. Increased manidipine doses may be required. Risk D: Consider therapy modification

Maraviroc: CYP3A4 Inducers (Strong) may decrease the 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 the serum concentration of Maribavir. Risk X: Avoid combination

Mavacamten: CYP3A4 Inducers (Strong) may decrease the serum concentration of Mavacamten. Risk X: Avoid combination

Mefloquine: CYP3A4 Inducers (Strong) may decrease the serum concentration of Mefloquine. Risk C: Monitor therapy

Meperidine: CYP3A4 Inducers (Strong) may decrease the serum concentration of Meperidine. Risk C: Monitor therapy

Methadone: CYP3A4 Inducers (Strong) may decrease the serum concentration of Methadone. Risk C: Monitor therapy

Methylergonovine: CYP3A4 Inducers (Strong) may decrease the serum concentration of Methylergonovine. Risk C: Monitor therapy

MethylPREDNISolone: CYP3A4 Inducers (Strong) may decrease the serum concentration of MethylPREDNISolone. Management: Consider methylprednisolone dose increases in patients receiving strong CYP3A4 inducers and monitor closely for reduced steroid efficacy. Risk D: Consider therapy modification

Metoprolol: RifAMPin may decrease the serum concentration of Metoprolol. Risk C: Monitor therapy

Mexiletine: RifAMPin may decrease the serum concentration of Mexiletine. Risk C: Monitor therapy

Mianserin: CYP3A4 Inducers (Strong) may decrease the serum concentration of Mianserin. Risk C: Monitor therapy

Midazolam: CYP3A4 Inducers (Strong) may decrease the serum concentration of Midazolam. Risk C: Monitor therapy

Midostaurin: CYP3A4 Inducers (Strong) may decrease the serum concentration of Midostaurin. Risk X: Avoid combination

MiFEPRIStone: CYP3A4 Inducers (Strong) may decrease the serum concentration of MiFEPRIStone. Risk X: Avoid combination

Mirabegron: CYP3A4 Inducers (Strong) may decrease the serum concentration of Mirabegron. Risk C: Monitor therapy

Mirodenafil: CYP3A4 Inducers (Strong) may decrease the serum concentration of Mirodenafil. Management: Consider avoiding the concomitant use of mirodenafil and strong CYP3A4 inducers. If combined, monitor for decreased mirodenafil effects. Mirodenafil dose increases may be required to achieve desired effects. Risk D: Consider therapy modification

Mirtazapine: CYP3A4 Inducers (Strong) may decrease the serum concentration of Mirtazapine. Risk C: Monitor therapy

Mitapivat: CYP3A4 Inducers (Strong) may decrease the serum concentration of Mitapivat. Risk X: Avoid combination

Mobocertinib: CYP3A4 Inducers (Strong) may decrease serum concentrations of the active metabolite(s) of Mobocertinib. CYP3A4 Inducers (Strong) may decrease the serum concentration of Mobocertinib. Risk X: Avoid combination

Morphine (Systemic): RifAMPin may decrease the serum concentration of Morphine (Systemic). Risk C: Monitor therapy

Moxifloxacin (Systemic): RifAMPin may decrease the serum concentration of Moxifloxacin (Systemic). Risk C: Monitor therapy

Mycophenolate: RifAMPin may decrease serum concentrations of the active metabolite(s) 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 the serum concentration of Naldemedine. Risk X: Avoid combination

Naloxegol: CYP3A4 Inducers (Strong) may decrease the serum concentration of Naloxegol. Risk X: Avoid combination

Nateglinide: CYP3A4 Inducers (Strong) may decrease the serum concentration of Nateglinide. Risk C: Monitor therapy

Nelfinavir: RifAMPin may decrease the serum concentration of Nelfinavir. Risk X: Avoid combination

Neratinib: CYP3A4 Inducers (Strong) may decrease the serum concentration of Neratinib. Risk X: Avoid combination

Netupitant: CYP3A4 Inducers (Strong) may decrease the serum concentration of Netupitant. Risk X: Avoid combination

Nevirapine: RifAMPin may decrease the serum concentration of Nevirapine. Risk X: Avoid combination

NiCARdipine: CYP3A4 Inducers (Strong) may decrease the serum concentration of NiCARdipine. Risk C: Monitor therapy

NIFEdipine: CYP3A4 Inducers (Strong) may decrease the 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 the serum concentration of Nilotinib. Risk X: Avoid combination

Nilvadipine: CYP3A4 Inducers (Strong) may decrease the serum concentration of Nilvadipine. Risk C: Monitor therapy

NiMODipine: CYP3A4 Inducers (Strong) may decrease the serum concentration of NiMODipine. Risk X: Avoid combination

Nintedanib: Inducers of CYP3A4 (Strong) and P-glycoprotein may decrease the serum concentration of Nintedanib. Risk X: Avoid combination

Nirmatrelvir and Ritonavir: CYP3A4 Inducers (Strong) may decrease the serum concentration of Nirmatrelvir and Ritonavir. Risk X: Avoid combination

Nisoldipine: CYP3A4 Inducers (Strong) may decrease the serum concentration of Nisoldipine. Risk X: Avoid combination

Nitrazepam: CYP3A4 Inducers (Strong) may decrease the serum concentration of Nitrazepam. Risk C: Monitor therapy

Nitrendipine: CYP3A4 Inducers (Strong) may decrease the serum concentration of Nitrendipine. Risk C: Monitor therapy

Nortriptyline: RifAMPin may decrease the serum concentration of Nortriptyline. Risk C: Monitor therapy

OLANZapine: RifAMPin may decrease the serum concentration of OLANZapine. Risk C: Monitor therapy

Olaparib: CYP3A4 Inducers (Strong) may decrease the serum concentration of Olaparib. Risk X: Avoid combination

Oliceridine: CYP3A4 Inducers (Strong) may decrease the serum concentration of Oliceridine. Risk C: Monitor therapy

Olmutinib: CYP3A4 Inducers (Strong) may decrease the serum concentration of Olmutinib. Risk C: Monitor therapy

Omeprazole: CYP2C19 Inducers (Strong) may decrease the serum concentration of Omeprazole. Risk X: Avoid combination

Ondansetron: CYP3A4 Inducers (Strong) may decrease the serum concentration of Ondansetron. Risk C: Monitor therapy

Ornidazole: RifAMPin may decrease the serum concentration of Ornidazole. Risk C: Monitor therapy

Osilodrostat: CYP3A4 Inducers (Strong) may decrease the serum concentration of Osilodrostat. Risk C: Monitor therapy

Osimertinib: CYP3A4 Inducers (Strong) may decrease the 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 the serum concentration of Ospemifene. Risk C: Monitor therapy

OXcarbazepine: CYP3A4 Inducers (Strong) may decrease the serum concentration of OXcarbazepine. Specifically, the concentrations of the 10-monohydroxy active metabolite of oxcarbazepine may be decreased. Risk C: Monitor therapy

OxyCODONE: CYP3A4 Inducers (Strong) may decrease the serum concentration of OxyCODONE. Risk C: Monitor therapy

Ozanimod: CYP2C8 Inducers (Moderate) may decrease serum concentrations of the active metabolite(s) of Ozanimod. CYP2C8 Inducers (Moderate) may decrease the serum concentration of Ozanimod. Risk X: Avoid combination

PACLitaxel (Conventional): CYP3A4 Inducers (Strong) may decrease the serum concentration of PACLitaxel (Conventional). Risk C: Monitor therapy

PACLitaxel (Protein Bound): CYP3A4 Inducers (Strong) may decrease the serum concentration of PACLitaxel (Protein Bound). Risk C: Monitor therapy

Pacritinib: CYP3A4 Inducers (Strong) may decrease the serum concentration of Pacritinib. Risk X: Avoid combination

Palbociclib: CYP3A4 Inducers (Strong) may decrease the serum concentration of Palbociclib. Risk X: Avoid combination

Paliperidone: Inducers of CYP3A4 (Strong) and P-glycoprotein may decrease the serum concentration of Paliperidone. Management: Monitor for reduced paliperidone effects when combined with strong inducers of both CYP3A4 and P-gp. Avoid use of these inducers with extended-release injectable paliperidone and instead manage patients with paliperidone extended-release tablets. Risk C: Monitor therapy

Palovarotene: CYP3A4 Inducers (Strong) may decrease the serum concentration of Palovarotene. Risk X: Avoid combination

Panobinostat: CYP3A4 Inducers (Strong) may decrease the serum concentration of Panobinostat. Risk X: Avoid combination

PAZOPanib: CYP3A4 Inducers (Strong) may decrease the serum concentration of PAZOPanib. Risk X: Avoid combination

Pemigatinib: CYP3A4 Inducers (Strong) may decrease the serum concentration of Pemigatinib. Risk X: Avoid combination

Perampanel: CYP3A4 Inducers (Strong) may decrease the 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

Pexidartinib: CYP3A4 Inducers (Strong) may decrease the serum concentration of Pexidartinib. Risk X: Avoid combination

Pimavanserin: CYP3A4 Inducers (Strong) may decrease the serum concentration of Pimavanserin. Risk X: Avoid combination

Pioglitazone: CYP2C8 Inducers (Moderate) may decrease the serum concentration of Pioglitazone. Risk C: Monitor therapy

Piperaquine: CYP3A4 Inducers (Strong) may decrease the serum concentration of Piperaquine. Risk X: Avoid combination

Pitavastatin: RifAMPin may increase the 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 the 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 the serum concentration of Polatuzumab Vedotin. Exposure to unconjugated MMAE, the cytotoxic small molecule component of polatuzumab vedotin, may be decreased. Risk C: Monitor therapy

PONATinib: CYP3A4 Inducers (Strong) may decrease the 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

Ponesimod: UGT1A1 Inducers may decrease the serum concentration of Ponesimod. Risk X: Avoid combination

Posaconazole: RifAMPin may decrease the serum concentration of Posaconazole. Risk C: Monitor therapy

Pralsetinib: CYP3A4 Inducers (Strong) may decrease the 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 the serum concentration of Pravastatin. Risk C: Monitor therapy

Praziquantel: RifAMPin may decrease the serum concentration of Praziquantel. Risk X: Avoid combination

PrednisoLONE (Systemic): CYP3A4 Inducers (Strong) may decrease the serum concentration of PrednisoLONE (Systemic). Risk C: Monitor therapy

PredniSONE: CYP3A4 Inducers (Strong) may decrease the serum concentration of PredniSONE. Risk C: Monitor therapy

Pretomanid: CYP3A4 Inducers (Strong) may decrease the serum concentration of Pretomanid. Risk X: Avoid combination

Probenecid: May increase the serum concentration of RifAMPin. Risk C: Monitor therapy

Propacetamol: RifAMPin may enhance the hepatotoxic effect of Propacetamol. RifAMPin may increase the metabolism of Propacetamol. . This may 1) diminish the desired effects of propacetamol; and 2) increase the risk of liver damage. Risk C: Monitor therapy

Propafenone: CYP3A4 Inducers (Strong) may decrease the serum concentration of Propafenone. Risk C: Monitor therapy

Propofol: RifAMPin may enhance the hypotensive effect 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 the serum concentration of Propranolol. Risk C: Monitor therapy

Prothionamide: RifAMPin may enhance the hepatotoxic effect of Prothionamide. Management: Avoid concomitant use of prothionamide and rifampin if possible. If combined use is considered necessary, monitor patients closely for signs and symptoms of hepatotoxicity (eg, jaundice, elevations in liver function tests). Risk D: Consider therapy modification

Pyrazinamide: May enhance the hepatotoxic effect of RifAMPin. Severe (even fatal) liver injury has been reported in patients receiving these 2 drugs as a 2-month treatment regimen for latent TB infection. 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 therapy

QUEtiapine: CYP3A4 Inducers (Strong) may decrease the serum concentration of QUEtiapine. Management: An increase in quetiapine dose (as much as 5 times the regular dose) may be required to maintain therapeutic benefit. Reduce the quetiapine dose back to the previous/regular dose within 7 to 14 days of discontinuing the inducer. Risk D: Consider therapy modification

QuiNIDine: CYP3A4 Inducers (Strong) may decrease the serum concentration of QuiNIDine. Risk C: Monitor therapy

QuiNINE: RifAMPin may decrease the serum concentration of QuiNINE. Risk X: Avoid combination

Radotinib: CYP3A4 Inducers (Strong) may decrease the serum concentration of Radotinib. Management: Consider alternatives to this combination when possible as the risk of radotinib treatment failure may be increased. Risk D: Consider therapy modification

Raltegravir: RifAMPin may decrease the serum concentration of Raltegravir. Management: Increase raltegravir dose to 800 mg twice daily (adult dose) when used concomitantly with rifampin. Concurrent use of rifampin with once-daily raltegravir (Isentress HD) is not recommended. Risk D: Consider therapy modification

Ramelteon: CYP3A4 Inducers (Strong) may decrease the serum concentration of Ramelteon. Risk C: Monitor therapy

Ranolazine: CYP3A4 Inducers (Strong) may decrease the serum concentration of Ranolazine. Risk X: Avoid combination

Reboxetine: CYP3A4 Inducers (Strong) may decrease the serum concentration of Reboxetine. Risk C: Monitor therapy

Red Yeast Rice: RifAMPin may decrease the serum concentration of Red Yeast Rice. Risk C: Monitor therapy

Regorafenib: CYP3A4 Inducers (Strong) may increase serum concentrations of the active metabolite(s) of Regorafenib. CYP3A4 Inducers (Strong) may decrease the serum concentration of Regorafenib. Risk X: Avoid combination

Relugolix: Inducers of CYP3A4 (Strong) and P-glycoprotein may decrease the 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

Relugolix, Estradiol, and Norethindrone: Inducers of CYP3A4 (Strong) and P-glycoprotein may decrease the serum concentration of Relugolix, Estradiol, and Norethindrone. Risk X: Avoid combination

Repaglinide: RifAMPin may decrease the serum concentration of Repaglinide. Risk C: Monitor therapy

Revefenacin: OATP1B1/1B3 (SLCO1B1/1B3) Inhibitors may increase serum concentrations of the active metabolite(s) of Revefenacin. Risk X: Avoid combination

Ribociclib: CYP3A4 Inducers (Strong) may decrease the serum concentration of Ribociclib. Risk X: Avoid combination

Rifabutin: CYP3A4 Inducers (Strong) may decrease the serum concentration of Rifabutin. Risk C: Monitor therapy

Rilpivirine: RifAMPin may decrease the serum concentration of Rilpivirine. Risk X: Avoid combination

Rimegepant: CYP3A4 Inducers (Strong) may decrease the serum concentration of Rimegepant. Risk X: Avoid combination

Riociguat: CYP3A4 Inducers (Strong) may decrease the serum concentration of Riociguat. Risk C: Monitor therapy

Ripretinib: CYP3A4 Inducers (Strong) may decrease the serum concentration of Ripretinib. Risk X: Avoid combination

RisperiDONE: CYP3A4 Inducers (Strong) may decrease serum concentrations of the active metabolite(s) of RisperiDONE. CYP3A4 Inducers (Strong) may decrease the serum concentration 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

Ritonavir: RifAMPin may increase the serum concentration of Ritonavir. RifAMPin may decrease the serum concentration of Ritonavir. Risk X: Avoid combination

Rivaroxaban: Inducers of CYP3A4 (Strong) and P-glycoprotein may decrease the serum concentration of Rivaroxaban. Risk X: Avoid combination

Roflumilast (Systemic): CYP3A4 Inducers (Strong) may decrease serum concentrations of the active metabolite(s) of Roflumilast (Systemic). CYP3A4 Inducers (Strong) may decrease the serum concentration of Roflumilast (Systemic). Risk X: Avoid combination

Rolapitant: CYP3A4 Inducers (Strong) may decrease the serum concentration of Rolapitant. Risk X: Avoid combination

RomiDEPsin: RifAMPin may increase the serum concentration of RomiDEPsin. Risk X: Avoid combination

Rosiglitazone: CYP2C8 Inducers (Moderate) may decrease the serum concentration of Rosiglitazone. Risk C: Monitor therapy

Rosuvastatin: RifAMPin may decrease the serum concentration of Rosuvastatin. Risk C: Monitor therapy

Ruxolitinib (Systemic): CYP3A4 Inducers (Strong) may increase serum concentrations of the active metabolite(s) of Ruxolitinib (Systemic). CYP3A4 Inducers (Strong) may decrease the serum concentration of Ruxolitinib (Systemic). Risk C: Monitor therapy

Sacituzumab Govitecan: UGT1A1 Inducers may decrease serum concentrations of the active metabolite(s) of Sacituzumab Govitecan. Specifically, concentrations of SN-38 may be decreased. Risk X: Avoid combination

Samidorphan: CYP3A4 Inducers (Strong) may decrease the serum concentration of Samidorphan. Risk X: Avoid combination

Saquinavir: RifAMPin may enhance the adverse/toxic effect of Saquinavir. Specifically, the risk of hepatocellular toxicity may be increased. RifAMPin may decrease the serum concentration of Saquinavir. Risk X: Avoid combination

SAXagliptin: CYP3A4 Inducers (Strong) may decrease the serum concentration of SAXagliptin. Risk C: Monitor therapy

Selexipag: RifAMPin may decrease serum concentrations of the active metabolite(s) 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 the serum concentration of Selpercatinib. Risk X: Avoid combination

Selumetinib: CYP3A4 Inducers (Strong) may decrease the serum concentration of Selumetinib. Risk X: Avoid combination

Sertindole: CYP3A4 Inducers (Strong) may decrease the serum concentration of Sertindole. Risk C: Monitor therapy

Sertraline: CYP3A4 Inducers (Strong) may decrease the serum concentration of Sertraline. Risk C: Monitor therapy

Sildenafil: CYP3A4 Inducers (Strong) may decrease the serum concentration of Sildenafil. Risk C: Monitor therapy

Simeprevir: CYP3A4 Inducers (Strong) may decrease the serum concentration of Simeprevir. Risk X: Avoid combination

Simvastatin: CYP3A4 Inducers (Strong) may decrease the serum concentration of Simvastatin. Risk C: Monitor therapy

Siponimod: RifAMPin may decrease the serum concentration of Siponimod. Risk X: Avoid combination

Sirolimus (Conventional): CYP3A4 Inducers (Strong) may decrease the 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 the serum concentration of Sirolimus (Protein Bound). Risk X: Avoid combination

Sodium Picosulfate: Antibiotics may diminish the therapeutic effect of Sodium Picosulfate. Management: Consider using an alternative product for bowel cleansing prior to a colonoscopy in patients who have recently used or are concurrently using an antibiotic. Risk D: Consider therapy modification

Sofosbuvir: P-glycoprotein/ABCB1 Inducers may decrease the serum concentration of Sofosbuvir. Risk X: Avoid combination

Solifenacin: CYP3A4 Inducers (Strong) may decrease the serum concentration of Solifenacin. Risk C: Monitor therapy

Sonidegib: CYP3A4 Inducers (Strong) may decrease the serum concentration of Sonidegib. Risk X: Avoid combination

SORAfenib: CYP3A4 Inducers (Strong) may decrease the serum concentration of SORAfenib. Risk X: Avoid combination

Sotorasib: CYP3A4 Inducers (Strong) may decrease the serum concentration of Sotorasib. Risk X: Avoid combination

Stiripentol: CYP3A4 Inducers (Strong) may decrease the 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 the 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: May increase the serum concentration of RifAMPin. RifAMPin may decrease the serum concentration of Sulfamethoxazole. Risk C: Monitor therapy

Sulfonylureas: CYP2C9 Inducers (Moderate) may decrease the serum concentration of Sulfonylureas. Risk C: Monitor therapy

SUNItinib: CYP3A4 Inducers (Strong) may decrease the 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 the serum concentration of Suvorexant. Risk C: Monitor therapy

Tacrolimus (Systemic): CYP3A4 Inducers (Strong) may decrease the serum concentration of Tacrolimus (Systemic). Management: Monitor for decreased tacrolimus concentrations and effects when combined with strong CYP3A4 inducers. Tacrolimus dose increases will likely be needed during concomitant use. Risk D: Consider therapy modification

Tadalafil: CYP3A4 Inducers (Strong) may decrease the 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 concentrations of the active metabolite(s) of Tamoxifen. CYP3A4 Inducers (Strong) may decrease the serum concentration of Tamoxifen. Risk X: Avoid combination

Tasimelteon: CYP3A4 Inducers (Strong) may decrease the serum concentration of Tasimelteon. Risk X: Avoid combination

Taurursodiol: OATP1B1/1B3 (SLCO1B1/1B3) Inhibitors may increase the serum concentration of Taurursodiol. Risk X: Avoid combination

Tazemetostat: CYP3A4 Inducers (Strong) may decrease the serum concentration of Tazemetostat. Risk X: Avoid combination

Telithromycin: CYP3A4 Inducers (Strong) may decrease the serum concentration of Telithromycin. Risk X: Avoid combination

Temsirolimus: CYP3A4 Inducers (Strong) may decrease serum concentrations of the active metabolite(s) of Temsirolimus. Specifically, concentrations of sirolimus may be decreased. CYP3A4 Inducers (Strong) may decrease the serum concentration of Temsirolimus. 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 the serum concentration of Teniposide. Risk C: Monitor therapy

Tenofovir Alafenamide: RifAMPin may decrease the serum concentration of Tenofovir Alafenamide. Risk X: Avoid combination

Tepotinib: CYP3A4 Inducers (Strong) may decrease the serum concentration of Tepotinib. Risk X: Avoid combination

Terbinafine (Systemic): RifAMPin may decrease the serum concentration of Terbinafine (Systemic). Risk C: Monitor therapy

Tertatolol: RifAMPin may decrease the serum concentration of Tertatolol. Risk C: Monitor therapy

Tetrahydrocannabinol: CYP3A4 Inducers (Strong) may decrease the serum concentration of Tetrahydrocannabinol. Risk C: Monitor therapy

Tetrahydrocannabinol and Cannabidiol: CYP3A4 Inducers (Strong) may decrease the 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

Tezacaftor and Ivacaftor: CYP3A4 Inducers (Strong) may decrease the serum concentration of Tezacaftor and Ivacaftor. Risk X: Avoid combination

Theophylline Derivatives: RifAMPin may decrease the serum concentration of Theophylline Derivatives. Risk C: Monitor therapy

Thiotepa: CYP3A4 Inducers (Strong) may increase serum concentrations of the active metabolite(s) of Thiotepa. CYP3A4 Inducers (Strong) may decrease the serum concentration of Thiotepa. Management: Thiotepa prescribing information recommends avoiding concomitant use of thiotepa and strong CYP3A4 inducers. If concomitant use is unavoidable, monitor for adverse effects. Risk D: Consider therapy modification

Thyroid Products: RifAMPin may decrease the serum concentration of Thyroid Products. Risk C: Monitor therapy

TiaGABine: CYP3A4 Inducers (Strong) may decrease the serum concentration of TiaGABine. Risk C: Monitor therapy

Ticagrelor: CYP3A4 Inducers (Strong) may decrease serum concentrations of the active metabolite(s) of Ticagrelor. CYP3A4 Inducers (Strong) may decrease the serum concentration of Ticagrelor. Risk X: Avoid combination

Tipranavir: RifAMPin may decrease the serum concentration of Tipranavir. Risk X: Avoid combination

Tivozanib: CYP3A4 Inducers (Strong) may decrease the serum concentration of Tivozanib. Risk X: Avoid combination

Tofacitinib: CYP3A4 Inducers (Strong) may decrease the serum concentration of Tofacitinib. Risk X: Avoid combination

Tolvaptan: CYP3A4 Inducers (Strong) may decrease the serum concentration of Tolvaptan. Risk X: Avoid combination

Toremifene: CYP3A4 Inducers (Strong) may decrease serum concentrations of the active metabolite(s) of Toremifene. CYP3A4 Inducers (Strong) may decrease the serum concentration of Toremifene. Risk X: Avoid combination

Torsemide: CYP2C9 Inducers (Moderate) may decrease the serum concentration of Torsemide. Risk C: Monitor therapy

Trabectedin: CYP3A4 Inducers (Strong) may decrease the serum concentration of Trabectedin. Risk X: Avoid combination

TraMADol: CYP3A4 Inducers (Strong) may decrease the serum concentration of TraMADol. Risk C: Monitor therapy

TraZODone: CYP3A4 Inducers (Strong) may decrease the serum concentration of TraZODone. Management: Consider increasing the trazodone dose during coadministration with strong CYP3A4 inducers. Risk D: Consider therapy modification

Triamcinolone (Systemic): CYP3A4 Inducers (Strong) may decrease the serum concentration of Triamcinolone (Systemic). Risk C: Monitor therapy

Triazolam: CYP3A4 Inducers (Strong) may decrease the 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: May increase the serum concentration of RifAMPin. RifAMPin may decrease the serum concentration of Trimethoprim. Risk C: Monitor therapy

Tropisetron: CYP3A4 Inducers (Strong) may decrease the serum concentration of Tropisetron. Risk C: Monitor therapy

Tucatinib: CYP2C8 Inducers (Moderate) may decrease the serum concentration of Tucatinib. Risk X: Avoid combination

Typhoid Vaccine: Antibiotics may diminish the therapeutic effect 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 the serum concentration of Ubrogepant. Risk X: Avoid combination

Udenafil: CYP3A4 Inducers (Strong) may decrease the serum concentration of Udenafil. Risk C: Monitor therapy

Ulipristal: CYP3A4 Inducers (Strong) may decrease the serum concentration of Ulipristal. Risk X: Avoid combination

Upadacitinib: CYP3A4 Inducers (Strong) may decrease the serum concentration of Upadacitinib. Risk X: Avoid combination

Valbenazine: CYP3A4 Inducers (Strong) may decrease serum concentrations of the active metabolite(s) of Valbenazine. CYP3A4 Inducers (Strong) may decrease the serum concentration of Valbenazine. Risk X: Avoid combination

Valproate Products: RifAMPin may decrease the serum concentration of Valproate Products. Risk C: Monitor therapy

Vandetanib: CYP3A4 Inducers (Strong) may increase serum concentrations of the active metabolite(s) of Vandetanib. CYP3A4 Inducers (Strong) may decrease the serum concentration of Vandetanib. Risk X: Avoid combination

Velpatasvir: CYP2B6 Inducers (Moderate) may decrease the serum concentration of Velpatasvir. Risk X: Avoid combination

Velpatasvir: CYP3A4 Inducers (Strong) may decrease the serum concentration of Velpatasvir. Risk X: Avoid combination

Vemurafenib: CYP3A4 Inducers (Strong) may decrease the 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 the serum concentration of Venetoclax. Risk X: Avoid combination

Verapamil: CYP3A4 Inducers (Strong) may decrease the 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 the serum concentration of Vilazodone. Management: Consider increasing vilazodone dose by as much as 2-fold (do not exceed 80 mg/day), based on response, in patients receiving strong CYP3A4 inducers for > 14 days. Reduce to the original vilazodone dose over 1 to 2 weeks after inducer discontinuation. Risk D: Consider therapy modification

VinCRIStine: CYP3A4 Inducers (Strong) may decrease the serum concentration of VinCRIStine. Risk C: Monitor therapy

VinCRIStine (Liposomal): CYP3A4 Inducers (Strong) may decrease the serum concentration of VinCRIStine (Liposomal). Risk X: Avoid combination

VinCRIStine (Liposomal): P-glycoprotein/ABCB1 Inducers may decrease the serum concentration of VinCRIStine (Liposomal). Risk X: Avoid combination

Vinflunine: CYP3A4 Inducers (Strong) may decrease the serum concentration of Vinflunine. Risk X: Avoid combination

Vinorelbine: CYP3A4 Inducers (Strong) may decrease the serum concentration of Vinorelbine. Risk C: Monitor therapy

Vitamin K Antagonists (eg, warfarin): Rifamycin Derivatives may decrease the 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 the serum concentration of Voclosporin. Risk X: Avoid combination

Vonoprazan: CYP3A4 Inducers (Strong) may decrease the serum concentration of Vonoprazan. Risk X: Avoid combination

Vorapaxar: CYP3A4 Inducers (Strong) may decrease the serum concentration of Vorapaxar. Risk X: Avoid combination

Voriconazole: RifAMPin may decrease the serum concentration of Voriconazole. Risk X: Avoid combination

Vortioxetine: CYP3A4 Inducers (Strong) may decrease the serum concentration of Vortioxetine. Management: Consider increasing the vortioxetine dose to no more than 3 times the original dose when used with a strong drug metabolism inducer for more than 14 days. The vortioxetine dose should be returned to normal within 14 days of stopping the strong inducer. Risk D: Consider therapy modification

Voxelotor: CYP3A4 Inducers (Strong) may decrease the 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 the serum concentration of Voxilaprevir. Specifically, a single dose of rifampin may increase voxilaprevir concentrations, while chronic daily use of rifampin may decrease voxilaprevir concentrations. RifAMPin may decrease the serum concentration of Voxilaprevir. Risk X: Avoid combination

Zaleplon: CYP3A4 Inducers (Strong) may decrease the serum concentration of Zaleplon. Management: Consider the use of an alternative hypnotic that is not metabolized by CYP3A4 in patients receiving strong CYP3A4 inducers. If 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 the serum concentration of Zanubrutinib. Risk X: Avoid combination

Zidovudine: RifAMPin may decrease the serum concentration of Zidovudine. Risk C: Monitor therapy

Ziprasidone: CYP3A4 Inducers (Strong) may decrease the serum concentration of Ziprasidone. Risk C: Monitor therapy

Zolpidem: CYP3A4 Inducers (Strong) may decrease the serum concentration of Zolpidem. Risk C: Monitor therapy

Zonisamide: CYP3A4 Inducers (Strong) may decrease the serum concentration of Zonisamide. Risk C: Monitor therapy

Zopiclone: CYP3A4 Inducers (Strong) may decrease the serum concentration of Zopiclone. Risk C: Monitor therapy

Zuclopenthixol: CYP3A4 Inducers (Strong) may decrease the serum concentration of Zuclopenthixol. Risk C: Monitor therapy

Food Interactions

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).

Reproductive Considerations

Rifampin may decrease the effectiveness of hormonal contraceptives. Consult drug interactions database for more detailed information specific to use of rifampin and specific contraceptives.

Pregnancy Considerations

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. Active tuberculosis infection 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 tuberculosis, rifampin is recommended as part of the initial treatment regimen of drug-susceptible active tuberculosis when the probability of maternal disease is moderate to high (ATS/CDC/IDSA [Nahid 2016]). Rifampin may also be considered for the treatment of latent tuberculosis infection (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]).

Breastfeeding Considerations

Rifampin is present in breast milk (Vorherr 1974).

Due to the potential for serious adverse reactions in the breastfeeding infant, the manufacturer recommends a decision be made whether to discontinue breastfeeding or to discontinue the drug, considering the importance of treatment to the mother. Breastfeeding is not a contraindication during therapy for drug-susceptible tuberculosis in patients deemed noninfectious who are treated with first-line agents (ie, rifampin). Exposure to rifampin via breast milk should not be considered effective treatment for the breastfeeding infant (ATS/CDC/IDSA [Nahid 2016]).

Monitoring Parameters

Baseline LFTs (AST, ALT, bilirubin), serum creatinine, CBC; periodic (every 2 to 4 weeks during therapy) monitoring of liver function in patients with preexisting hepatic impairment and periodic monitoring of serum creatinine and CBC in patients with baseline abnormalities. Monitor for signs/symptoms of liver injury (especially in prolonged therapy or with concurrent hepatotoxic drugs). Monitor mental status, sputum culture, chest X-ray 2 to 3 months into treatment, and for signs/symptoms of hypersensitivity (eg, fever, lymphadenopathy, eosinophilia, neutropenia, rash, hypotension, acute bronchospasm, conjunctivitis, flu-like syndrome). Monitor coagulation tests during treatment in patients at risk of vitamin K deficiency (eg, chronic liver disease, poor nutritional status, prolonged use of antibacterial agents or anticoagulants). Check platelets, renal function tests, serum lactate dehydrogenase, blood film for schistocytes (erythrocyte fragmentation), ADAMTS13 activity, and anti-ADAMTS13-antibody determination in patients with suspected thrombotic microangiopathy or hemolytic uremic syndrome. Monitor for symptoms of interstitial lung disease/pneumonitis.

Reference Range

TB treatment: Target peak: ≥8 mcg/mL at 2 and 6 hours post-dose (Alsultan 2014)

Mechanism of Action

Inhibits bacterial RNA synthesis by binding to the beta subunit of DNA-dependent RNA polymerase, blocking RNA transcription

Pharmacokinetics

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 and Children 6 months to <5 years: ~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.

Pharmacokinetics: Additional Considerations

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.

Pricing: US

Capsules (rifAMPin Oral)

150 mg (per each): $3.24 - $4.16

300 mg (per each): $4.59 - $5.85

Solution (reconstituted) (Rifadin Intravenous)

600 mg (per each): $214.27

Solution (reconstituted) (rifAMPin Intravenous)

600 mg (per each): $183.60 - $192.63

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Brand Names: International
  • Arficin (HR);
  • Bactromax (CO);
  • Benemicin (CZ, LV, RU, SK);
  • Corifam (ID);
  • Eremfat (AT, CZ, DE);
  • Fuhe (CN);
  • Lyrimpin (VN);
  • Macox (LK);
  • Maficin (PH);
  • Manorifcin (TH);
  • Mycin (BD);
  • Myconil (BD);
  • Oxitrin (PY);
  • R-Cin (ZA);
  • Ramicin (ID);
  • Ricin (HK);
  • Rifacilin (IN);
  • Rifacin (AE, PH, SA);
  • Rifacure (ZW);
  • Rifadex (EC);
  • Rifadin (AE, AR, AU, BB, BF, BJ, CI, CR, CY, DO, ET, GB, GH, GM, GN, GR, GT, HK, HN, IE, IQ, IR, IT, JO, KE, KW, LB, LR, LY, MA, ML, MR, MT, MU, MW, MX, NE, NG, NI, NL, NZ, OM, PA, PK, PT, QA, SA, SC, SD, SE, SL, SN, SV, SY, TN, TR, TW, TZ, UG, YE, ZA, ZM);
  • Rifadine (BE, FR, LU, VN);
  • Rifaldin (BR, CL, ES);
  • Rifalep (AR);
  • Rifamcin (TH);
  • Rifamed (HU);
  • Rifampicin Labatec (CH);
  • Rifampin (KR);
  • Rifapin (AE, CY, IQ, IR, JO, KW, LB, LY, OM, SA, SY, YE);
  • Rifarad (AE, BF, BJ, CI, CY, ET, GH, GM, GN, IQ, IR, JO, KE, KW, LB, LR, LY, MA, ML, MR, MU, MW, NE, NG, OM, SA, SC, SD, SL, SN, SY, TN, TZ, UG, YE, ZA, ZM);
  • Rifaren (MT, SG, TR);
  • Rifarm (FI);
  • Rifasynt (CY, JO, MY);
  • Rifatan (BD);
  • Rifocina (PE);
  • Rifocina Spray (CO);
  • Rifodex (KR);
  • Rifoldin (AT);
  • Rifoldine (CH);
  • Rimactan (BG, CH, DK, ES, FR, HR, IS, LU, MX, NO, SE, SI, UY, VE, VN);
  • Rimactane (BD, BF, BJ, BM, BS, BZ, CI, ET, GB, GH, GM, GN, GY, ID, IN, JM, KE, LR, MA, ML, MR, MU, MW, MY, NE, NG, SA, SC, SD, SL, SN, SR, TN, TT, TZ, UG, ZA, ZM);
  • Rimactan[inj.] (CH);
  • Rimafed (PH);
  • Rimapen (FI);
  • Rimecin (TH);
  • Rimpacin (AE, BF, BJ, CI, CY, ET, GH, GM, GN, IQ, IR, JO, KE, KW, LB, LR, LY, MA, ML, MR, MU, MW, NE, NG, OM, SA, SC, SD, SL, SN, SY, TN, TZ, UG, YE, ZA, ZM);
  • Rimpin (IN);
  • Rimycin (AU);
  • Ripin (TW);
  • Shu Lan Xin (CN);
  • Stririfa (ZW);
  • Tubocin (HU)


For country code abbreviations (show table)
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