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Drug Interactions between dexamethasone and rifampin

This report displays the potential drug interactions for the following 2 drugs:

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Interactions between your drugs

Moderate

rifAMPin dexAMETHasone

Applies to: rifampin and dexamethasone

MONITOR: Rifampin may induce the hepatic metabolism of corticosteroids, possibly reducing their therapeutic effect. The elimination half-life of corticosteroids has been shown to be reduced by up to 45% when rifampin is coadministered. Theoretically, rifabutin could interact with corticosteroids in a similar manner.

MANAGEMENT: Patients should be monitored for altered corticosteroid effects. Dosage increases may be necessary. Two- to threefold increases in prednisolone dosage have been recommended.

References (7)
  1. Venkatesan K (1992) "Pharmacokinetic drug interactions with rifampicin." Clin Pharmacokinet, 22, p. 47-65
  2. Bergrem H, Refvem OK (1983) "Altered prednisolone pharmacokinetics in patients treated with rifampicin." Acta Med Scand, 213, p. 339-43
  3. Powell-Jackson PR, Gray BJ, Heaton RW, et al. (1983) "Adverse effect of rifampicin administration on steroid-dependent asthma." Am Rev Respir Dis, 128, p. 307-10
  4. Kyriazopoulou V, Parparousi O, Vagenakis AG (1984) "Rifampicin-induced adrenal crisis in Addisonian patients receiving corticosteroid replacement therapy." J Clin Endocrinol Metab, 59, p. 1204-6
  5. McAllister WA, Thompson PJ, Al-Habet SM, Rogers HJ (1983) "Rifampicin reduces effectiveness and bioavailability of prednisolone." Br Med J, 286, p. 923-5
  6. Lee KH, Shin JG, Chong WS, Kim S, Lee JS, Jang IJ, Shin SG (1993) "Time course of the changes in prednisolone pharmacokinetics after co-administration or discontinuation of rifampin." Eur J Clin Pharmacol, 45, p. 287-9
  7. Strayhorn VA, Baciewicz AM, Self TH (1997) "Update on rifampin drug interactions, III." Arch Intern Med, 157, p. 2453-8

Drug and food interactions

Moderate

rifAMPin food

Applies to: rifampin

GENERALLY AVOID: Concurrent use of rifampin in patients who ingest alcohol daily may result in an increased incidence of hepatotoxicity. The increase in hepatotoxicity may be due to an additive risk as both alcohol and rifampin are individually associated with this adverse reaction. However, the exact mechanism has not been established.

ADJUST DOSING INTERVAL: Administration with food may reduce oral rifampin absorption, increasing the risk of therapeutic failure or resistance. In a randomized, four-period crossover phase I study of 14 healthy male and female volunteers, the pharmacokinetics of single dose rifampin 600 mg were evaluated under fasting conditions and with a high-fat meal. Researchers observed that administration of rifampin with a high-fat meal reduced rifampin peak plasma concentration (Cmax) by 36%, nearly doubled the time to reach peak plasma concentration (Tmax) but reduced overall exposure (AUC) by only 6%.

MANAGEMENT: The manufacturer of oral forms of rifampin recommends administration on an empty stomach, 30 minutes before or 2 hours after meals. Patients should be encouraged to avoid alcohol or strictly limit their intake. Patients who use alcohol and rifampin concurrently or have a history of alcohol use disorder may require additional monitoring of their liver function during treatment with rifampin.

References (6)
  1. (2022) "Product Information. Rifampin (rifAMPin)." Akorn Inc
  2. (2022) "Product Information. Rifampicin (rifampicin)." Mylan Pharmaceuticals Inc
  3. (2023) "Product Information. Rifadin (rifampicin)." Sanofi
  4. (2024) "Product Information. Rifadin (rifaMPICin)." Sanofi-Aventis Australia Pty Ltd
  5. Peloquin CA, Namdar R, Singleton MD, Nix DE (2024) Pharmacokinetics of rifampin under fasting conditions, with food, and with antacids https://pubmed.ncbi.nlm.nih.gov/9925057/
  6. (2019) "Product Information. Rofact (rifampin)." Bausch Health, Canada Inc.

Therapeutic duplication warnings

No warnings were found for your selected drugs.

Therapeutic duplication warnings are only returned when drugs within the same group exceed the recommended therapeutic duplication maximum.

See also

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Drug Interaction Classification

These classifications are only a guideline. The relevance of a particular drug interaction to a specific individual is difficult to determine. Always consult your healthcare provider before starting or stopping any medication.
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 interaction information available.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

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