Drug interactions
Hydrocortisone + Rifampin
Severity: Major
Hydrocortisone and Rifampin: major interaction.
Last updated
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
Rifampin strongly induces hepatic and intestinal enzymes and lowers hydrocortisone concentrations. This can cause loss of glucocorticoid effect and may precipitate adrenal crisis in patients on replacement therapy.
What this interaction means in plain words
Hydrocortisone and Rifampin 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.
Why it happens
Rifampin induces CYP3A4 (and other enzymes), accelerating hydrocortisone metabolism.
What to do
Monitor clinical response and increase the hydrocortisone dose as needed, particularly in adrenal insufficiency. Reassess the dose when rifampin is stopped.
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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Other interactions of Hydrocortisone
- Hydrocortisone + Mifepristone Contraindicated
- Hydrocortisone + Poliovirus vaccine live oral trivalent Contraindicated
- Hydrocortisone + Smallpox vaccine live Contraindicated
- Adenovirus types 4 and 7 live + Hydrocortisone Major
- Aldesleukin + Hydrocortisone Major
- Aspirin + Hydrocortisone Major
Frequently asked questions
Can I take Hydrocortisone with Rifampin?
MediHelp rates the interaction as major. Hydrocortisone and Rifampin 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. Rifampin strongly induces hepatic and intestinal enzymes and lowers hydrocortisone concentrations. This can cause loss of glucocorticoid effect and may precipitate adrenal crisis in patients on replacement therapy.
How serious is the interaction between Hydrocortisone and Rifampin?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Monitor clinical response and increase the hydrocortisone dose as needed, particularly in adrenal insufficiency. Reassess the dose when rifampin is stopped.
What other medicines interact with Hydrocortisone?
MediHelp also lists interactions of Hydrocortisone with, for example, Mifepristone, Poliovirus vaccine live oral trivalent, Smallpox vaccine live. The full list is on the Hydrocortisone page.
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