Drug interactions
Paracetamol + Rifampin
Severity: Moderate
Paracetamol and Rifampin: moderate 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 induces hepatic enzymes and can reduce paracetamol levels while increasing formation of the toxic metabolite NAPQI. Hepatotoxicity risk may be higher, particularly with high doses, fasting or pre-existing liver disease, and rifampin itself is hepatotoxic.
What this interaction means in plain words
Paracetamol and Rifampin can affect each other. The combination is often manageable, but it may need a change of dose, a change of timing, or extra checks while both are taken.
Why it happens
Rifampin induces CYP enzymes and glucuronidation, shifting paracetamol metabolism toward oxidative toxic pathways.
What to do
Keep paracetamol doses low and avoid prolonged high-dose use during rifampin therapy. Monitor liver function, and consider reduced dose ceilings in patients with additional hepatic risk factors.
What to ask your pharmacist
- Should I take them at different times of day?
- Does the dose of either medicine need to change?
- Is there anything I should avoid, such as alcohol or certain foods, while on both?
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Other interactions of Paracetamol
- Ethanol + Paracetamol Major
- Busulfan + Paracetamol Moderate
- Carbamazepine + Paracetamol Moderate
- Cholestyramine + Paracetamol Moderate
- Felbamate + Paracetamol Moderate
- Fosphenytoin + Paracetamol Moderate
Frequently asked questions
Can I take Paracetamol with Rifampin?
MediHelp rates the interaction as moderate. Paracetamol and Rifampin can affect each other. The combination is often manageable, but it may need a change of dose, a change of timing, or extra checks while both are taken. Rifampin induces hepatic enzymes and can reduce paracetamol levels while increasing formation of the toxic metabolite NAPQI. Hepatotoxicity risk may be higher, particularly with high doses, fasting or pre-existing liver disease, and rifampin itself is hepatotoxic.
How serious is the interaction between Paracetamol and Rifampin?
MediHelp rates it moderate, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Keep paracetamol doses low and avoid prolonged high-dose use during rifampin therapy. Monitor liver function, and consider reduced dose ceilings in patients with additional hepatic risk factors.
What other medicines interact with Paracetamol?
MediHelp also lists interactions of Paracetamol with, for example, Ethanol, Busulfan, Carbamazepine. The full list is on the Paracetamol page.
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