Drug interactions
Rifabutin + Sirolimus
Severity: Major
Rifabutin and Sirolimus: 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
Rifabutin induces CYP3A4 and P-glycoprotein, markedly lowering sirolimus concentrations. This can lead to graft rejection.
What this interaction means in plain words
Rifabutin and Sirolimus 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 belongs to Anti Bacterial; Sirolimus belongs to Miscellaneous.
Why it happens
Induction of CYP3A4 and P-gp increases sirolimus clearance.
What to do
Avoid if possible and use an alternative antimycobacterial. If it is necessary, monitor sirolimus trough levels and increase the dose, reducing again after rifabutin 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 Sirolimus
- Adenovirus types 4 and 7 live + Sirolimus Contraindicated
- Bcg vaccine live + Sirolimus Contraindicated
- Influenza virus vaccine quadrivalent intranasal + Sirolimus Contraindicated
- Ketoconazole + Sirolimus Contraindicated
- Levoketoconazole + Sirolimus Contraindicated
- Measles mumps and rubella vaccine live + Sirolimus 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 Rifabutin with Sirolimus?
MediHelp rates the interaction as major. Rifabutin and Sirolimus 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 CYP3A4 and P-glycoprotein, markedly lowering sirolimus concentrations. This can lead to graft rejection.
How serious is the interaction between Rifabutin and Sirolimus?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Avoid if possible and use an alternative antimycobacterial. If it is necessary, monitor sirolimus trough levels and increase the dose, reducing again after rifabutin is stopped.
What other medicines interact with Sirolimus?
MediHelp also lists interactions of Sirolimus with, for example, Adenovirus types 4 and 7 live, Bcg vaccine live, Influenza virus vaccine quadrivalent intranasal. The full list is on the Sirolimus page.
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