Drug interactions
Rifabutin + Tacrolimus
Severity: Major
Rifabutin and Tacrolimus: 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 can substantially lower tacrolimus blood levels. This may lead to loss of immunosuppression and graft rejection.
What this interaction means in plain words
Rifabutin and Tacrolimus 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; Tacrolimus belongs to Miscellaneous.
Why it happens
Rifabutin induces CYP3A4 and P-glycoprotein, accelerating tacrolimus clearance.
What to do
Monitor tacrolimus trough concentrations frequently and raise the dose as needed. Reduce it again after rifabutin is stopped, or choose a non-inducing alternative.
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 Tacrolimus
- Adenovirus types 4 and 7 live + Tacrolimus Contraindicated
- Bcg vaccine live + Tacrolimus Contraindicated
- Cidofovir + Tacrolimus Contraindicated
- Cyclosporin + Tacrolimus Contraindicated
- Influenza virus vaccine quadrivalent intranasal + Tacrolimus Contraindicated
- Measles mumps and rubella vaccine live + Tacrolimus 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 Tacrolimus?
MediHelp rates the interaction as major. Rifabutin and Tacrolimus 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 can substantially lower tacrolimus blood levels. This may lead to loss of immunosuppression and graft rejection.
How serious is the interaction between Rifabutin and Tacrolimus?
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 tacrolimus trough concentrations frequently and raise the dose as needed. Reduce it again after rifabutin is stopped, or choose a non-inducing alternative.
What other medicines interact with Tacrolimus?
MediHelp also lists interactions of Tacrolimus with, for example, Adenovirus types 4 and 7 live, Bcg vaccine live, Cidofovir. The full list is on the Tacrolimus page.
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