COMMENT:: Review of this area is important since in many parts of the world, rifampin is the only drug available for the treatment of TB. There are some notable problems in this review. The protease inhibitors and rifampin are reviewed from the point of view of the effect on the PIs, but the effect of the PIs on rifampin is not considered, Several PIs increase rifampin levels and therefore cannot be used together. This is not discussed in the article. What is extremely valuable are the tables in the article that summarize clinical points.
ABSTRACT:Am J Med Sci. 2008 Feb;335(2):126-136.Update on Rifampin and Rifabutin Drug Interactions. Baciewicz AM, Chrisman CR, Finch CK, Self TH.
Rifampin is a potent inducer of cytochrome P-450 oxidative enzymes as well as the P-glycoprotein transport system. Several examples of well-documented clinically significant interactions include warfarin, oral contraceptives, cyclosporine, itraconazole, digoxin, verapamil, nifedipine, simvastatin, midazolam, and human immunodeficiency virus-related protease inhibitors. Rifabutin reduces serum concentrations of antiretroviral agents, but less so than rifampin. Examples of clinically relevant interactions demonstrated by recent reports include everolimus, atorvastatin, rosiglitazone/ pioglitazone, celecoxib, clarithromycin, caspofungin, and lorazepam.To avoid a decreased 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. Studies and cases of rifampin drug interactions continue to increase rapidly. This review is a timely reminder to clinicians to be vigilant. PMID: 18277121