Drug interactions
Cyclosporin + Rifabutin
Severity: Major
Cyclosporin and Rifabutin: major interaction.
Last updated Sources: US FDA label
For healthcare professionals — reference only. This page is a brief summary, not medical advice and not a substitute for official labeling or clinical judgement. Always verify before prescribing or dispensing.
Summary
Rifabutin induces cyclosporine metabolism and can substantially lower blood concentrations, risking transplant rejection or loss of efficacy. The inducing effect is weaker than with rifampicin but is still clinically relevant.
What this interaction means in plain words
Cyclosporin and Rifabutin can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for.
Cyclosporin belongs to Miscellaneous; Rifabutin belongs to Anti Bacterial.
Why it happens
Rifabutin induces CYP3A4 and P-glycoprotein, increasing cyclosporine clearance.
What to do
Measure cyclosporine trough levels frequently and increase the dose as needed, then lower it again after rifabutin is stopped. Consider an alternative antimycobacterial if possible.
What to ask your pharmacist
- Does the benefit of taking both outweigh the risk in my case?
- Do I need any blood test, ECG or other check while on both?
- What early warning signs should I watch for, and what should I do if they appear?
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References
Other interactions of Cyclosporin
- Adenovirus types 4 and 7 live + Cyclosporin Contraindicated
- Aliskiren + Cyclosporin Contraindicated
- Bcg vaccine live + Cyclosporin Contraindicated
- Bosentan + Cyclosporin Contraindicated
- Cidofovir + Cyclosporin Contraindicated
- Cyclosporin + Dengue vaccine Contraindicated
Other interactions of Rifabutin
- Cabotegravir + Rifabutin Contraindicated
- Lorlatinib + Rifabutin Contraindicated
- Rifabutin + Voriconazole Contraindicated
- Apixaban + Rifabutin Major
- Axitinib + Rifabutin Major
- Brexpiprazole + Rifabutin Major
Frequently asked questions
Can I take Cyclosporin with Rifabutin?
MediHelp rates the interaction as major. Cyclosporin and Rifabutin can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for. Rifabutin induces cyclosporine metabolism and can substantially lower blood concentrations, risking transplant rejection or loss of efficacy. The inducing effect is weaker than with rifampicin but is still clinically relevant.
How serious is the interaction between Cyclosporin and Rifabutin?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Measure cyclosporine trough levels frequently and increase the dose as needed, then lower it again after rifabutin is stopped. Consider an alternative antimycobacterial if possible.
What other medicines interact with Cyclosporin?
MediHelp also lists interactions of Cyclosporin with, for example, Adenovirus types 4 and 7 live, Aliskiren, Bcg vaccine live. The full list is on the Cyclosporin page.
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