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| Interactions: | Amiodarone
Adverse Effect: decreased amiodarone plasma concentrations Clinical Management: Concurrent administration of amiodarone and rifampin should be avoided. If concurrent administration is clinically necessary, the patients cardiac status should be carefully monitored.
Amlodipine
Adverse Effect: Decreased amlodipine efficacy
Betamethasone
Adverse Effect: decreased betamethasone effectiveness Clinical Management: Monitor for decreased corticosteroid effectiveness and increase the dose if necessary; a dose reduction may be necessary if rifampin is discontinued.
Buspirone
Adverse Effect: reduced anxiolytic effects of buspirone Clinical Management: Monitor patients receiving rifampin and buspirone for buspirone efficacy. Doses of buspirone may need to be increased when rifampin is coadministered.
Carbamazepine
Adverse Effect: Elevated carbamazepine levels and toxicity (ataxia, nystagmus, diplopia, headache, vomiting, apnea, seizures, coma) Clinical Management: Monitor the patient for signs of carbamazepine toxicity, including ataxia, nystagmus, diplopia, headache, vomiting, apnea, seizures, and coma. A carbamazepine plasma concentration may be helpful in diagnosing carbamazepine toxicity.
Carvedilol
Adverse Effect: Decreased therapeutic response to carvedilol Clinical Management: Monitor patient response (blood pressure, signs/symptoms of hepatic dysfunction) with concomitant use of carvedilol and rifampin. Adjust carvedilol dosage as needed.
Chloramphenicol
Adverse Effect: decreased chloramphenicol effectiveness Clinical Management: Monitor chloramphenicol concentration and adjust the chloramphenicol dose accordingly.
Chlorpropamide
Adverse Effect: decreased chlorpropamide effectiveness Clinical Management: Monitor the patients blood glucose during concurrent therapy with chlorpropamide and rifampin. The dosage of chlorpropamide may need to be increased after initiation of rifampin therapy and decreased when rifampin is discontinued.
Clozapine
Adverse Effect: Subtherapeutic concentrations of clozapine Clinical Management: Monitor clozapine levels when rifampin therapy is added, changed, or discontinued.
Cyclosporin
Adverse Effect: Decreases Cyclosporine concentrations and reduces its efficacy #Clinical Management: Monitor Cyclosporine concentrations and adjust the dosage accordingly.
Dapsone
Adverse Effect: decreased dapsone effectiveness Clinical Management: Monitor decreased dapsone efficacy; adjust the dose if needed.
Dexamethasone
Adverse Effect: decreased dexamethasone effectiveness Clinical Management: Monitor patient for decreased corticosteroid effectiveness and increase Dexamethasone dose if necessary; a dose reduction may be necessary if rifampin is discontinued.
Diazepam
Adverse Effect: decreased diazepam effectiveness Clinical Management: If concurrent therapy is required, a dosage adjustment for diazepam may be required in order to maintain or achieve a therapeutic effect.
Digoxin
Adverse Effect: Decreased digoxin effectiveness Clinical Management: Monitor digoxin levels within three to five days of adding or deleting rifampin, and adjust digoxin doses accordingly.
Diltiazem
Adverse Effect: Decreased diltiazem effectiveness Clinical Management: Monitor patient for loss of calcium channel blocker effects, including clinical signs of symptoms of hypertension or angina. Dose increases may be required. Other categories of antihypertensive agents (ACE inhibitors, beta-blockers) are also subject to this interaction and could only be substituted with continued monitoring for effectiveness.
Disopyramide
Adverse Effect: Decreased disopyramide effectiveness Clinical Management: Monitor disopyramide levels within two weeks of starting or discontinuing rifampin; adjust the disopyramide dose as needed.
Doxycycline
Adverse Effect: reduced doxycycline serum concentrations and potential loss of doxycycline efficacy Clinical Management: Monitor patient response to combined rifampin and doxycycline treatment as lowered doxycycline effectiveness should be anticipated. Alternatively, consider administering doxycycline in combination with streptomycin.
Dydrogesterone
Enhance the clearance of progesterone and the progestogens
Efavirenz
Adverse Effect: Decrease in plasma concentration of Efavirenz # Clinical Management: Clinical effects is not known, increase the dose of Efavirenz if required.
Enalapril
Adverse Effect: Decreased enalapril effectiveness Clinical Management: Monitor for continuing blood pressure control after the addition or withdrawal of rifampin, adjusting the enalapril dose to regain control. Substitution of an alternative ACE inhibitor or a different class of antihypertensive agent may be required for blood pressure control.
Ethionamide
Adverse Effect: hepatotoxicity Clinical Management: Combined rifampin and ethionamide therapy should only be administered to patients found to have normal baseline liver function. Regular liver function tests should be performed in patients receiving this combination of agents. Patients with diabetes mellitus are more likely to experience hepatitis and have more difficulty with diabetic management; these patients need close monitoring. Ethionamide should be withdrawn if significant alterations in liver tests are observed.
Felodipine
Adverse Effect: Decreased felodipine efficacy
Fluconazole
Adverse Effect: Decreased fluconazole effectiveness Clinical Management: Monitor antifungal efficacy. Consider increasing the fluconazole dose when it is used concomitantly with rifampin.
Fludrocortisone acetate
Adverse Effect: Increased metabolic clearance of Fludrocortisone acetate due to the induction of hepatic enzymes # Clinical Management: Monitor for the possible diminished effect of Fludrocortisone acetate and increase the dosage accordingly.
Flunarizine
Adverse Effect: Decreased flunarizine efficacy
Haloperidol
Adverse Effect: Decreased haloperidol effectiveness Clinical Management: Monitor the patient for a decreased clinical response to haloperidol when rifampin is added to the drug therapy. The haloperidol dose may need to be increased while receiving rifampin and decreased when rifampin is discontinued.
Hydrocortisone
Adverse Effect: decreased hydrocortisone effectiveness Clinical Management: Monitor Hydrocortisone effect and increase the dose if necessary; a dose reduction may be necessary if rifampin is discontinued.
INH
Adverse Effect: hepatotoxicity Clinical Management: For patients on concurrent isoniazid and rifampin, monitor liver function tests, especially in children and in adults with predisposing risk factors. Monitor the patient for clinical symptoms of liver toxicity.
Indinavir
Adverse Effect: decrease in the Plasma concentration of Indinavir markedly # Clinical Management: Avoid the concomitant use if possible.
Itraconazole
Adverse Effect: Loss of itraconazole efficacy Clinical Management: Monitor itraconazole effectiveness and adjust the dose as needed; larger itraconazole doses may be required in some situations.
Ketoconazole
Adverse Effect: Decreased ketoconazole and rifampin effectiveness Clinical Management: If concurrent therapy is required, a dosage adjustment may be required for both drugs in order to maintain or achieve a therapeutic effect.
Lacidipine
Adverse Effect: Decreased lacidipine efficacy
Lefulnomide
Adverse Effect: Significant increase in the plasma concentration of Lefulnomide # Clinical Management: Concomitant administration should be done with caution.
Levonorgestrel
Adverse Effect: Reduced efficacy of Levonorgestrel due to the increased metabolism of the drug by induction of hepatic microsomal enzymes by Rifampicin # Clinical Management: Women receiving concomitant administration should be warned of reduced efficacy and those receiving long-term therapy with hepatic enzyme inducers, another method of contraception should be considered.
Losartan
Adverse Effect: Reduced losartan efficacy Clinical Management: In patients receiving rifampin and losartan, monitor blood pressure and adjust the dose of losartan accordingly.
Metoprolol
Adverse Effect: Decreased metoprolol effectiveness Clinical Management: If concurrent therapy is required, monitor blood pressure carefully. A dosage increase for metoprolol may be required.
Mexiletine
Adverse Effect: Decreased mexiletine effectiveness Clinical Management: This combination should be avoided unless mexiletine serum concentrations can be determined and the dosage adjusted pharmacokinetically. Monitor ECG and serum mexiletine concentrations during and after rifampin therapy.
Mifepristone
Adverse Effect: Induction of Mifepristone metabolism resulting in decreased serum levels of Mifepristone # Clinical Management: Monitor for the therapeutic effects and adjust the dose accordingly.
Montelukast
Adverse Effect: Due to the hepatic microsomal induction the AUC of Montelukast is decreased by concomitant administration of Rifampicin # Clinical Management: Monitor for the therapeutic effects and adjust the dose if required.
Morphine
Adverse Effect: loss of morphine efficacy Clinical Management: Patients receiving rifampin and morphine therapy should be monitored for adequate pain control. Doses of morphine may need to be increased when rifampin is present and should be reevaluated when rifampin is discontinued.
Nevirapine
Adverse Effect: Steady-state nevirapine trough plasma concentrations were reduced by 16% and 37% in patients, who received Rifabutin /Rifampin # Clinical Management: Rifampin/ Rifabutin should only be used in combination with Nevirapine if clearly indicated and with careful monitoring.
Nifedipine
Adverse Effect: Decreased nifedipine effectiveness Clinical Management: Monitor patient for loss of Nifedipine effects, including clinical signs or symptoms of hypertension or angina. Dose increases may be required. Other categories of antihypertensive agents (ACE inhibitors, beta-blockers) are also subject to this interaction and could only be substituted with continued monitoring for effectiveness.
Nimodipine
Adverse Effect: Decreased nimodipine efficacy
Nitrazepam
Adverse Effect: Decreased nitrazepam effectiveness Clinical Management: Monitor for signs of Nitrazepam clinical effectiveness. Concurrent use of rifampin and nitrazepam may require higher doses of nitrazepam.
Nitrendipine
Adverse Effect: Decreased nitrendipine efficacy
Omeprazole
Adverse Effect: Concomitant administration results in increased clearance of Olanzapine due to the induction of CYP1A2 or glucuronyl transferase enzyme # Clinical Management: Monitor for the therapeutic effects and adjust the dose accordingly.
Phenytoin
Adverse Effect: Decreased phenytoin effectiveness Clinical Management: Monitor serum phenytoin levels with concomitant use and adjust doses accordingly.
Prednisolone
Adverse Effect: Decreased prednisolone effectiveness Clinical Management: Monitor Prednisolone effect and increase the dose if necessary. A dose reduction may be necessary if rifampin is discontinued.
Probenecid
Adverse Effect: Increased plasma concentrations of rifampin Clinical Management: Rifampin toxicity has not been reported with concurrent probenecid therapy. However, since probenecid may increase the plasma concentration of rifampin, increases in doses of rifampin should be made cautiously and in small increments.
Propafenone
Adverse Effect: Decreased propafenone effectiveness Clinical Management: Rifampin and propafenone should not be used concurrently unless the ability to monitor propafenone plasma concentrations is available for dosage adjustment.
Propranolol
Adverse Effect: Decreased propranolol effectiveness Clinical Management: If concurrent therapy is required, monitor blood pressure carefully. A higher dose of propranolol may be required in patients receiving rifampin for longer than one to two weeks. Beta blockers which are less likely to be affected include atenolol, nadolol, and timolol.
Quinidine
Adverse Effect: Decreased quinidine effectiveness Clinical Management: Combination therapy will probably require an increase in the quinidine dosage: usual therapeutic range 2-6 mg/L. It is also important to consider the possibility of quinidine toxicity after withdrawing concomitant rifampin therapy.
Rofecoxib
Adverse Effect: Decrease in the plasma concentration of Rofecoxib due to the hepatic microsomal induction activity of Rifampicin # Clinical Management: Monitor the therapeutic effects and increase the dose of Rofecoxib if required.
Sertraline
Adverse Effect: Loss of sertraline efficacy Clinical Management: Monitor patients for sertraline efficacy and signs of selective serotonin reuptake inhibitor (SSRI) withdrawal syndrome. Doses of sertraline may need to be increased when rifampin is given concomitantly.
Sildenafil citrate
Adverse Effect: Decrease in plasma levels of sildenafil due to CYP3A4 induction # Clinical Management: Monitor for therapeutic effects and adjust the dose accordingly.
Sodium Valproate
Adverse Effect: reduced valproate levels Clinical Management: Monitor valproate levels and the patient for seizure control. An adjustment in the dose of valproate may be necessary when coadministered with rifampin.
Terbinafine
Adverse Effect: decreased therapeutic response to terbinafine Clinical Management: Monitor patient response and adjust dosage of terbinafine during combined treatment with rifampin.
Theophylline
Adverse Effect: Decreased theophylline effectiveness Clinical Management: Theophylline serum concentrations should be closely monitored when rifampin is added, discontinued, or when dosing changes occur. Dosing adjustments of theophylline may be necessary.
Thyroxine
Adverse Effect: decreased efficacy of levothyroxine Clinical Management: Hypothyroid patients receiving rifampin therapy may need an increase in their levothyroxine dose. Monitor the patient for signs and symptoms of hypothyroidism and monitor the serum thyroxine and TSH levels.
Tolbutamide
Adverse Effect: decreased tolbutamide effectiveness Clinical Management: Monitor the patients glucose more closely, during the first two to three weeks of initiating or discontinuing rifampin. A dosage adjustment for tolbutamide may be required.
Tretinoin
Adverse Effect: decreased efficacy of tretinoin Clinical Management: Monitor patients for signs of tretinoin efficacy. The withdrawal of rifampin therapy may be warranted in some cases.
Triamcinolone
Adverse Effect: decreased triamcinolone effectiveness Clinical Management: Monitor Triamcinolone effects and increase the dose if necessary; a dose reduction may be necessary if rifampin is discontinued.
Warfarin
Adverse Effect: Decreased anticoagulant effectiveness Clinical Management: In patients on warfarin therapy, the prothrombin time ratio or INR (international normalized ratio) should be closely monitored with the addition and withdrawal of treatment with rifampin, and should be reassessed periodically during concurrent therapy. Adjustments of the warfarin dose may be necessary in order to maintain the desired level of anticoagulation.
Zidovudine
Adverse Effect: Decreased zidovudine concentrations Clinical Management: Monitor zidovudine efficacy in patients on combined rifampin and zidovudine and adjust doses accordingly.
Zolpidem
Adverse Effect: decreased plasma concentration and pharmacodynamic effect of zolpidem Clinical Management: If rifampin is given concurrently with zolpidem patients should be monitored for decreased effectiveness of zolpidem.
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