Drug interactions
Rifampin + Sirolimus
Severity: Major
Rifampin 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
Rifampin strongly induces CYP3A4 and P-gp, causing a marked fall in sirolimus concentrations. Therapeutic failure and rejection are well documented.
What this interaction means in plain words
Rifampin 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.
Why it happens
Potent induction of CYP3A4 and P-glycoprotein increases sirolimus clearance.
What to do
Avoid if possible and consider rifabutin or another alternative. If needed, monitor trough levels closely and increase the sirolimus dose, reducing it 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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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
Frequently asked questions
Can I take Rifampin with Sirolimus?
MediHelp rates the interaction as major. Rifampin 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. Rifampin strongly induces CYP3A4 and P-gp, causing a marked fall in sirolimus concentrations. Therapeutic failure and rejection are well documented.
How serious is the interaction between Rifampin 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 consider rifabutin or another alternative. If needed, monitor trough levels closely and increase the sirolimus dose, reducing it again after rifampin 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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