Drug interactions
Rifabutin + Tolvaptan
Severity: Major
Rifabutin and Tolvaptan: 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 lower tolvaptan exposure, potentially reducing its aquaretic effect and efficacy. The induction by rifabutin is weaker than by rifampin but may still be clinically relevant.
What this interaction means in plain words
Rifabutin and Tolvaptan 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; Tolvaptan belongs to Endocrine.
Why it happens
Induction of CYP3A4-mediated metabolism of tolvaptan by rifabutin.
What to do
Avoid coadministration where possible; if needed, monitor serum sodium or response to therapy and increase the tolvaptan dose as labeling permits. Monitor 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 Tolvaptan
- Atazanavir + Tolvaptan Contraindicated
- Ceritinib + Tolvaptan Contraindicated
- Cobicistat + Tolvaptan Contraindicated
- Conivaptan + Tolvaptan Contraindicated
- Darunavir + Tolvaptan Contraindicated
- Idelalisib + Tolvaptan 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 Tolvaptan?
MediHelp rates the interaction as major. Rifabutin and Tolvaptan 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 lower tolvaptan exposure, potentially reducing its aquaretic effect and efficacy. The induction by rifabutin is weaker than by rifampin but may still be clinically relevant.
How serious is the interaction between Rifabutin and Tolvaptan?
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 coadministration where possible; if needed, monitor serum sodium or response to therapy and increase the tolvaptan dose as labeling permits. Monitor again after rifabutin is stopped.
What other medicines interact with Tolvaptan?
MediHelp also lists interactions of Tolvaptan with, for example, Atazanavir, Ceritinib, Cobicistat. The full list is on the Tolvaptan page.
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