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Rimactane (rifampin) Disease Interactions

There are 6 disease interactions with Rimactane (rifampin):


Rifampin (Includes Rimactane) ↔ Hematopoietic Disturbances

Severe Potential Hazard, Low plausibility

Applies to: Bone Marrow Depression/Low Blood Counts

Rifampin may infrequently cause hematopoietic abnormalities such as thrombocytopenia, leukopenia, decreased hemoglobin, and acute hemolytic anemia. Hemolysis has been described as part of an immune-mediated reaction which generally occurs after gaps in therapy. Thrombocytopenia is observed most frequently in patients receiving high-dose intermittent therapy or after a lapse in therapy, but very rarely during daily administration. It is reversible if rifampin is discontinued as soon as purpura appears. Patients with preexisting bone marrow depression or blood dyscrasias should be monitored closely during rifampin therapy for further decreases in blood counts. Although rifampin-related hematologic effects are often transient, cerebral hemorrhage and fatalities have been reported with the continued administration of rifampin after the appearance of purpura.


  1. "Product Information. Rifadin (rifampin)." Hoechst Marion-Roussel Inc, Kansas City, MO.
  2. Lee M, Berger HW "Eosinophilia caused by rifampin." Chest 77 (1980): 579
  3. Dutt AK, Moers D, Stead WW "Undesirable side effects of isoniazid and rifampin in largely twice-weekly short-course chemotherapy for tuberculosis." Am Rev Respir Dis 128 (1983): 419-24
  4. Ferguson GC "Rifampicin and thrombocytopenia." Br Med J 3 (1971): 638
  5. Levine M, Collin K, Kassen BO "Acute hemolysis and renal failure following discontinuous use of rifampin." DICP 25 (1991): 743-4
  6. Allen RJ, Almond SN, Caiolsa SM, et al "Rifampin." Drug Intell Clin Pharm 5 (1971): 364-5
  7. Tahan SR, Diamond JR, Blank JM, Horan RF "Acute hemolysis and renal failure with rifampicin-dependent antibodies after discontinuous administration." Transfusion 25 (1985): 124-7
  8. Kindelan JM, Serrano I, Jurado R, Villanueva JL, Garcialazaro M, Garciaherola A, Cisneros JT "Rifampin-induced severe thrombocytopenia in a patient with pulmonary tuberculosis." Ann Pharmacother 28 (1994): 1304-5
  9. Hadfield JW "Rifampicin-induced thrombocytopenia." Postgrad Med J 56 (1980): 59-60
  10. Brook G, Pain A "Major adverse reactions to a short course of daily rifampicin." Scand J Infect Dis 19 (1987): 271-2
  11. Lee CH, Lee CJ "Thrombocytopenia: a rare but potentially serious side effect of initial daily and interrupted use of rifampicin." Chest 96 (1989): 202-3
  12. van Assendelft AH "Renal failure and haemolysis caused by rifampicin." Tubercle 67 (1986): 234-5
  13. Nolan RL, Cleary JD, Chapman SW "Fever associated with daily rifampin therapy." Clin Pharm 9 (1990): 57-8
  14. Mariette X, Mitjavila MT, Moulinie JP, et al "Rifampicin-induced pure red cell aplasia." Am J Med 87 (1989): 459-60
  15. Hall AP, Thorpe JW, Seaton D "New hazard of meningococcal chemoprophylaxis." J Antimicrob Chemother 31 (1993): 451
View all 15 references

Rifampin (Includes Rimactane) ↔ Hepatotoxicity

Severe Potential Hazard, High plausibility

Applies to: Liver Disease, Alcoholism

The use of rifampin has been associated with hepatocellular injury and liver dysfunction. Hepatitis and jaundice resulting in death have occurred, mostly in patients with underlying liver disease and during coadministration with other hepatotoxic agents including other antituberculous drugs such as isoniazid and pyrazinamide. Therapy with rifampin should be administered cautiously and under strict medical supervision in patients with liver disease or a history of alcoholism. Serum transaminases (ALT, AST) and bilirubin should be measured at baseline and every 2 to 4 weeks during therapy, but keeping in mind that elevated levels may occur transiently in 10% to 15% of patients, usually during the early days of treatment. Patients should be instructed to discontinue the drug promptly and seek medical attention if signs and symptoms of hepatic injury develop, including fever, rash, anorexia, nausea, vomiting, fatigue, right upper quadrant pain, dark urine, and jaundice.


  1. Dutt AK, Moers D, Stead WW "Short-course chemotherapy for tuberculosis with mainly twice-weekly isoniazid and rifampin: community physicians' seven-year experience with mainly outpatients." Am J Med 77 (1984): 233-42
  2. Maddrey WC "Drug-related acute and chronic hepatitis." Clin Gastroenterol 9 (1980): 213-24
  3. Dutt AK, Moers D, Stead WW "Undesirable side effects of isoniazid and rifampin in largely twice-weekly short-course chemotherapy for tuberculosis." Am Rev Respir Dis 128 (1983): 419-24
  4. CDC. Centers for Disease Control. "Update: fatal and severe liver injuries associated with rifampin and pyrazinamide for latent tuberculosis infection, and revisions in American Thoracic Society/CDC recommendations--United States, 2001." Morb Mortal Wkly Rep 50 (2001): 733-5
  5. "Product Information. Rifadin (rifampin)." Hoechst Marion-Roussel Inc, Kansas City, MO.
  6. Yoshikawa TT, Nagami PH "Adverse drug reactions in TB therapy: risks and recommendations." Geriatrics 37 (1982): 61-8
  7. Allen RJ, Almond SN, Caiolsa SM, et al "Rifampin." Drug Intell Clin Pharm 5 (1971): 364-5
  8. Gabriel R "Rifampin jaundice." Br Med J 3 (1971): 182
  9. O'Brien RJ, Long MW, Cross FS, et al "Hepatotoxicity from isoniazid and rifampin among children treated for tuberculosis." Pediatrics 72 (1983): 491-9
  10. Bartelink AK, Lenders JW, van Herwaarden CL, et al "Fatal hepatitis after treatment with isoniazid and rifampicin in a patient on anticonvulsant therapy." Tubercle 64 (1983): 125-8
View all 10 references

Rifampin (Includes Rimactane) ↔ Liver Disease

Severe Potential Hazard, High plausibility

Applies to: Liver Disease

Rifampin is primarily metabolized by the liver. Patients with liver disease may be at greater risk for adverse effects from rifampin due to decreased drug clearance. In addition, the accumulation of rifampin may result in hyperbilirubinemia because rifampin competes with bilirubin for uptake by hepatocytes. Dosage adjustments are recommended in patients with liver disease. Withdrawal of rifampin therapy may be required if serum bilirubin is persistently high.


  1. Nitti V, Virgilio R, Patricolo MR, Iuliano A "Pharmacokinetic study of intravenous rifampicin." Chemotherapy 23 (1977): 1-6
  2. Acocella G "Clinical pharmacokinetics of rifampicin." Clin Pharmacokinet 3 (1978): 108-27
  3. "Product Information. Rifadin (rifampin)." Hoechst Marion-Roussel Inc, Kansas City, MO.
  4. Loos U, Musch E, Jensen JC, et al "Pharmacokinetics of oral and intravenous rifampicin during chronic administration." Klin Wochenschr 63 (1985): 1205-11
View all 4 references

Rifampin (Includes Rimactane) ↔ Porphyria

Severe Potential Hazard, Moderate plausibility

Applies to: Porphyria

Rifampin may induce the activity of delta amino levulinic acid synthetase, an enzyme involved in the biosynthesis of porphyrins. The use of rifampin has been associated with isolated cases of porphyria exacerbation. Therapy with rifampin should be administered cautiously in patients with a history of porphyria.


  1. "Product Information. Rifadin (rifampin)." Hoechst Marion-Roussel Inc, Kansas City, MO.

Antibiotics (Includes Rimactane) ↔ Colitis

Moderate Potential Hazard, Low plausibility

Applies to: Colitis/Enteritis (Noninfectious)

Pseudomembranous colitis has been reported with most antibacterial agents and may range in severity from mild to life-threatening, with an onset of up to two months following cessation of therapy. Antibiotic therapy can alter the normal flora of the colon and permit overgrowth of Clostridium difficile, whose toxin is believed to be a primary cause of antibiotic- associated colitis. The colitis is usually characterized by severe, persistent diarrhea and severe abdominal cramps, and may be associated with the passage of blood and mucus. The most common culprits are clindamycin, lincomycin, the aminopenicillins (amoxicillin, ampicillin), and the cephalosporins. Therapy with broad-spectrum antibiotics and other agents with significant antibacterial activity should be administered cautiously in patients with a history of gastrointestinal diseases, particularly colitis. There is some evidence that pseudomembranous colitis, if it occurs, may run a more severe course in these patients and that it may be associated with flares in their underlying disease activity. The offending antibiotic(s) should be discontinued if significant diarrhea occurs during therapy. Stool cultures for Clostridium difficile and stool assay for C. difficile toxin may be helpful diagnostically. A large bowel endoscopy may be considered to establish a definitive diagnosis in cases of severe diarrhea.


  1. Moriarty HJ, Scobie BA "Pseudomembranous colitis in a patient on rifampicin and ethambutol." N Z Med J 04/23/80 (1980): 294-5
  2. Thomas E, Mehta JB "Pseudomembranous colitis due to oxacillin therapy." South Med J 77 (1984): 532-3
  3. Harmon T, Burkhart G, Applebaum H "Perforated pseudomembranous colitis in the breast-fed infant." J Pediatr Surg 27 (1992): 744-6
  4. Davies J, Beck E "Recurrent colitis following antibiotic-associated pseudomembranous colitis." Postgrad Med J 57 (1981): 599-601
  5. Milstone EB, McDonald AJ, Scholhamer CF Jr "Pseudomembranous colitis after topical application of clindamycin." Arch Dermatol 117 (1981): 154-5
  6. Burt RA "A review of the drug events reported by 12,917 patients treated with cephalexin." Postgrad Med J 59 (1983): 47-50,51-3
  7. Meadowcroft AM, Diaz PR, Latham GS "Clostridium difficile toxin-induced colitis after use of clindmycin phosphate vaginal cream." Ann Pharmacother 32 (1998): 309-11
  8. Dan M, Samra Z "Clostridium difficile colitis associated with ofloxacin therapy." Am J Med 87 (1989): 479
  9. Saadah HA "Carbenicillin and pseudomembranous enterocolitis." Ann Intern Med 93 (1980): 645
  10. Bauwens JE, McFarland LV, Melcher SA "Recurrent clostridium difficile disease following ciprofloxacin use." Ann Pharmacother 31 (1997): 1090
  11. Trexler MF, Fraser TG, Jones MP "Fulminant pseudomembranous colitis caused by clindamycin phosphate vaginal cream." Am J Gastroenterol 92 (1997): 2112-3
  12. Daly JJ, Chowdary KV "Pseudomembranous colitis secondary to metronidazole." Dig Dis Sci 28 (1983): 573-4
  13. Lyon JA "Imipenem/cilastatin: the first carbapenem antibiotic." Drug Intell Clin Pharm 19 (1985): 894-8
  14. O'Meara TF, Simmons RA "Carbenicillin and pseudomembranous enterocolitis." Ann Intern Med 92 (1980): 440-1
  15. Calandra GB, Brown KR, Grad LC, et al "Review of adverse experiences and tolerability in the first 2,516 patients treated with imipenem/cilastatin." Am J Med 78 (1985): 73-8
  16. Ehrenpreis ED, Lievens MW, Craig RM "Clostridium difficile-associated diarrhea after norfloxacin." J Clin Gastroenterol 12 (1990): 188-9
  17. Bernstein L "Adverse reaction to trimethoprim-sulfamethoxazole, with particular reference to long-term therapy." Can Med Assoc J 112 (1975): s96-8
  18. Hutcheon DF, Milligan FD, Yardley JH, Hendrix TR "Cephalosporin-associated pseudomembranous colitis." Am J Dig Dis 23 (1978): 321-6
  19. Bingley PJ, Harding GM "Clostridium difficile colitis following treatment with metronidazole and vancomycin." Postgrad Med J 63 (1987): 993-4
  20. Van Ness MM, Cattau EL Jr "Fulminant colitis complicating antibiotic-associated pseudomembranous colitis: case report and review of the clinical manifestations and treatment." Am J Gastroenterol 82 (1987): 374-7
  21. Hinton NA "The effect of oral tetracycline HCl and doxycycline on the intestinal flora." Curr Ther Res Clin Exp 12 (1970): 341-52
  22. Cone JB, Wetzel W "Toxic megacolon secondary to pseudomembranous colitis." Dis Colon Rectum 25 (1982): 478-82
  23. Cannon SR, Dyson PH, Sanderson PJ "Pseudomembranous colitis associated with antibiotic prophylaxis in orthopaedic surgery." J Bone Joint Surg Br 70-B (1988): 600-2
  24. Wang C, Calandra GB, Aziz MA, Brown KR "Efficacy and safety of imipenem/cilastatin: a review of worldwide clinical experience." Rev Infect Dis 7 (1985): s528-36
  25. Clissold SP, Todd PA, Campoli-Richards DM "Imipenem/cilastatin: a review of its antibacterial activity, pharmacokinetic properties and therapeutic efficacy." Drugs 33 (1987): 185-241
  26. Midtvedt T, Carlstedt-Duke B, Hoverstad T, et al "Influence of peroral antibiotics upon the biotransformatory activity of the intestinal microflora in healthy subjects." Eur J Clin Invest 16 (1986): 11-7
  27. Altamirano A, Bondani A "Adverse reactions to furazolidone and other drugs. A comparative review." Scand J Gastroenterol Suppl 169 (1989): 70-80
  28. Pokorney BH, Nichols TW, Jr "Pseudomembranous colitis. A complication of sulfasalazine therapy in a patient with Crohn's colitis." Am J Gastroenterol 76 (1981): 374-6
  29. Miller DL, Sedlack JD, Holt RW "Perforation complicating rifampin-associated pseudomembranous enteritis." Arch Surg 124 (1989): 1082
  30. Miller SN, Ringler RP "Vancomycin-induced pseudomembranous colitis." J Clin Gastroenterol 9 (1987): 114-5
  31. Osler T, Lott D, Bordley J, et al "Cefazolin-induced pseudomembranous colitis resulting in perforation of the sigmoid colon." Dis Colon Rectum 29 (1986): 140-3
  32. Parry MF, Rha CK "Pseudomembranous colitis caused by topical clindamycin phosphate." Arch Dermatol 122 (1986): 583-4
  33. Boriello SP, Jones RH, Phillips I "Rifampicin-associated pseudomembranous colitis." Br Med J 281 (1980): 1180-1
  34. Klinger D, Radford P, Collin J "Pneumoperitoneum without faecal peritonitis in a patient with pseudomembranous colitis." Br Med J 288 (1984): 1271-2
  35. Saginur R, Hawley CR, Bartlett JG "Colitis associated with metronidazole therapy." J Infect Dis 141 (1980): 772-4
  36. Edlund C, Brismar B, Nord CE "Effect of lomefloxacin on the normal oral and intestinal microflora." Eur J Clin Microbiol Infect Dis 1 (1990): 35-9
  37. Sankarankutty M, McGeorge D, Galasko CS "Pseudomembranous colitis following cephradine prophylaxis." Postgrad Med J 58 (1982): 726-8
  38. Gordin F, Gibert C, Schmidt ME "Clostridium difficile colitis associated with trimethoprim-sulfamethoxazole given as prophylaxis for pneumocystis carinii pneumonia." Am J Med 96 (1994): 94-5
  39. Sugarman B "Trimethoprim-sulfamethoxazole, pseudomembranous colitis, and spinal cord injury." South Med J 78 (1985): 711-3
  40. Golledge CL, Riley TV "Clostridium difficile-associated diarrhoea after doxycycline malaria prophylaxis." Lancet 345 (1995): 1377-8
  41. Ring FA, Hershfield NB, Machin GA, Scott RB "Sulfasalazine-induced colitis complicating idiopathic ulcerative colitis." Can Med Assoc J 131 (1984): 43-5
  42. Leigh DA, Simmons K, Williams S "Gastrointestinal side effects following clindamycin and lincomycin treatment: a follow up study." J Antimicrob Chemother 6 (1980): 639-45
  43. Friedman RJ, Mayer IE, Galambos JT, Hersh T "Oxacillin-induced pseudomembranous colitis." Am J Gastroenterol 73 (1980): 445-7
  44. "Multum Information Services, Inc. Expert Review Panel"
  45. Edlund C, Lidbeck A, Kager L, Nord CE "Effect of enoxacin on colonic microflora of healthy volunteers." Eur J Clin Microbiol 6 (1987): 298-300
  46. Hecht JR, Olinger EJ "Clostridium difficile colitis secondary to intravenous vancomycin." Dig Dis Sci 34 (1989): 148-9
  47. Brause BD, Romankiewicz JA, Gotz V, Franklin JE Jr, Roberts RB "Comparative study of diarrhea associated with clindamycin and ampicillin therapy." Am J Gastroenterol 73 (1980): 244-8
View all 47 references

Rifampin (Includes Rimactane) ↔ Enzyme Induction

Moderate Potential Hazard, Moderate plausibility

Applies to: Hyperthyroidism, Hyperadrenocorticism, Hypoparathyroidism, Hypothyroidism, Panhypopituitarism, Hyperparathyroidism, Adrenal Insufficiency

Rifampin has enzyme-inducing effects that can enhance the metabolism of many endogenous substrates, including adrenal hormones, thyroid hormones, and vitamin D, the latter of which may affect serum calcium, phosphate and parathyroid hormone levels. Patients with preexisting imbalances of these hormones should be monitored more closely during long-term therapy with rifampin. In patients whose hormonal condition is stabilized on treatment, adjustments may be necessary in their treatment regimen to compensate for these effects.


  1. "Product Information. Rifadin (rifampin)." Hoechst Marion-Roussel Inc, Kansas City, MO.

Rimactane (rifampin) drug Interactions

There are 743 drug interactions with Rimactane (rifampin)

Drug Interaction Classification

The classifications below are a general guideline only. It is difficult to determine the relevance of a particular drug interaction to any individual given the large number of variables.
Major Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.
Moderate Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.
Minor Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.
Unknown No information available.

Do not stop taking any medications without consulting your healthcare provider.

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