Drug interactions
Rifampin + Tacrolimus
Severity: Major
Rifampin 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
Rifampin strongly induces CYP3A4 and P-glycoprotein, markedly lowering tacrolimus concentrations. This can cause graft rejection if the dose is not increased.
What this interaction means in plain words
Rifampin 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.
Why it happens
Induction of CYP3A4 and P-glycoprotein increases tacrolimus metabolism and reduces absorption.
What to do
Use an alternative antimycobacterial if possible. If needed, increase tacrolimus dose guided by frequent trough levels, and reduce it again after rifampin is stopped as induction wanes.
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
Frequently asked questions
Can I take Rifampin with Tacrolimus?
MediHelp rates the interaction as major. Rifampin 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. Rifampin strongly induces CYP3A4 and P-glycoprotein, markedly lowering tacrolimus concentrations. This can cause graft rejection if the dose is not increased.
How serious is the interaction between Rifampin 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: Use an alternative antimycobacterial if possible. If needed, increase tacrolimus dose guided by frequent trough levels, and reduce it again after rifampin is stopped as induction wanes.
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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