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Rifampin and Rifabutin Drug Interactions
An Update
Christopher K. Finch, PharmD;
Cary R. Chrisman, PharmD;
Anne M. Baciewicz, PharmD, MBA;
Timothy H. Self, PharmD
Arch Intern Med. 2002;162:985-992.
Rifampin is a potent inducer of cytochrome P-450 oxidative enzymes.
A few examples of well-documented clinically significant interactions include
interactions with warfarin, oral contraceptives, cyclosporine, glucocorticoids,
ketoconazole or itraconazole, theophylline, quinidine sulfate, digitoxin or
digoxin, verapamil hydrochloride, human immunodeficiency virus–related
protease inhibitors, zidovudine, delavirdine mesylate, nifedipine, and midazolam.
Recent reports have demonstrated clinically relevant interactions with numerous
other drugs, such as buspirone hydrochloride, zolpidem tartrate, simvastatin,
propafenone hydrochloride, tacrolimus, ondansetron hydrochloride, and opiates.
Rifabutin reduces serum concentrations of antiretroviral agents, but less
so than rifampin. To avoid a reduced therapeutic response, therapeutic failure,
or toxic reactions when rifampin is added to or discontinued from medication
regimens, clinicians need to be cognizant of these interactions. Enhanced
knowledge of known interactions will continue to develop, including research
on the induction of specific cytochrome P-450 isoenzymes and on the importance
of the P-glycoprotein transport system. New rifampin and rifabutin interactions
will be discovered with further investigations.
From the Department of Clinical Pharmacy, University of Tennessee,
Memphis (Drs Finch and Self); Secure Pharmacy, Franklin, Tenn (Dr Chrisman);
and Department of Pharmacy Services, University Hospitals of Cleveland, Cleveland,
Ohio (Dr Baciewicz). Dr Finch is now with the Department of Pharmacy Practice,
Auburn University, Auburn, Ala, and Dr Chrisman is now with the Department
of Pharmacy, Methodist Medical Center of Oak Ridge, Oak Ridge, Tenn. Dr Chrisman
has no type of investment of involvement with any pharmaceutical companies
via stock or mutual funds. He has consultant arrangements for which he receives
no compensation, financial or otherwise, with the following pharmaceutical
companies: Merck & Co, Inc, Whitehouse Station, NJ; Roche, Nutley, NJ;
Bristol-Myers Squibb, Wallingford, Conn; and Agouron Pharmaceuticals, Inc,
La Jolla, Calif. Dr Baciewicz owns drug company stocks (including stocks for
GlaxoSmithKline, Research Triangle Park, NC; Merck & Co, Inc; Pfizer Inc,
New York, NY; and Bristol-Myers Squibb) in addition to drug company stocks
via mutual funds. Dr Self receives standard speaking/consulting honoraria
from GlaxoSmithKline; Merck & Co, Inc; and other pharmaceutical companies
related to his expertise on asthma therapy. (These companies may have products
discussed in this review.) Dr Self has received investigator-initiated grants
from GlaxoSmithKline for asthma clinical investigations. He also owns stock
in several pharmaceutical companies, primarily via mutual funds.
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