Drug interactions
Prednisone + Rifampin
Severity: Major
Prednisone and Rifampin: 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
Rifampin markedly lowers corticosteroid exposure and can cause loss of disease control or adrenal insufficiency in patients on replacement. Reduced efficacy has been documented in transplant, asthma and autoimmune patients.
What this interaction means in plain words
Prednisone 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 hepatic enzymes, accelerating prednisone and prednisolone clearance.
What to do
Monitor clinical response and increase the prednisone dose as needed while rifampin is given. Reassess and reduce the dose again after 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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References
- Prednisone - FDA drug label (DailyMed) — openFDA / DailyMed
Other interactions of Prednisone
- Bcg vaccine live + Prednisone Contraindicated
- Measles vaccine + Prednisone Contraindicated
- Mifepristone + Prednisone Contraindicated
- Prednisone + Radium-223 dichloride Contraindicated
- Prednisone + Smallpox vaccine live Contraindicated
- Adenovirus types 4 and 7 live + Prednisone Major
Frequently asked questions
Can I take Prednisone with Rifampin?
MediHelp rates the interaction as major. Prednisone 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 markedly lowers corticosteroid exposure and can cause loss of disease control or adrenal insufficiency in patients on replacement. Reduced efficacy has been documented in transplant, asthma and autoimmune patients.
How serious is the interaction between Prednisone 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 prednisone dose as needed while rifampin is given. Reassess and reduce the dose again after rifampin is stopped.
What other medicines interact with Prednisone?
MediHelp also lists interactions of Prednisone with, for example, Bcg vaccine live, Measles vaccine, Mifepristone. The full list is on the Prednisone page.
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