Update on rifampin, rifabutin, and rifapentine drug interactions

Abstract

Background:

Rifampin is a potent inducer of both cytochrome P-450 oxidative enzymes and the P-glycoprotein transport system. Among numerous well documented, clinically significant interactions, examples include warfarin, oral contraceptives, itraconazole, digoxin, verapamil, simvastatin, and human immunodeficiency virus-related protease inhibitors. Rifabutin reduces serum concentrations of antiretroviral agents, but less so than rifampin. Rifapentine is also an inducer of drug metabolism.

Methods:

A literature search of English language journals from 2008 to March 2012 was completed using several databases, including PubMed, EMBASE, and SCOPUS. Search terms included rifampin, rifabutin, rifapentine AND drug interactions.

Findings:

Examples of clinically relevant interactions with rifampin demonstrated by recent reports include posaconazole, voriconazole, oxycodone, risperidone, mirodenafil, and ebastine.

Conclusions:

To avoid a reduced therapeutic response, therapeutic failure, or toxic reactions when rifampin, rifabutin, or rifapentine are added to or discontinued from medication regimens, clinicians need to be aware of these interactions. Recent studies have indicated that other transporter systems play a role in these drug interactions. As reports of rifampin drug interactions continue to grow, this review is a reminder to clinicians to be vigilant.

Key words::

• Drug interactions
• Rifabutin
• Rifampin
• Rifapentine

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Corrigendum

Transparency

Declaration of funding

There was no funding associated with this article.

Declaration of financial/other relationships

A.M.B. has disclosed that she owns drug company stocks via mutual funds. C.R.C. has disclosed that he has no significant relationships with or financial interests in any commercial companies related to this study or article. C.K.F. has disclosed that he is on the GlaxoSmithKline Speakers Bureau, and has an investigator-initiated grant with Medicines Co. T.H.S. owns drug company stocks via mutual funds.

CMRO peer reviewers may have received honoraria for their review work. The peer reviewers on this manuscript have disclosed that they have no relevant financial relationships.