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Drug Interactions between fluvastatin and rifampin

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

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Interactions between your drugs

Moderate

rifAMPin fluvastatin

Applies to: rifampin and fluvastatin

MONITOR: Coadministration with rifampin may decrease the plasma concentrations of fluvastatin due to induction of its metabolism via CYP450 2C9. Plasma clearance of immediate-release fluvastatin has been reported to increase by 95% during rifampin coadministration, resulting in a 59% decrease in peak plasma concentration (Cmax) and a 51% decrease in area under the plasma concentration-time curve (AUC) of fluvastatin.

MANAGEMENT: Use of fluvastatin in combination with rifampin may result in diminished hypolipidemic efficacy, and dosage adjustment of the statin may be necessary during long-term treatment with rifampin. Alternatively, pravastatin may be a suitable substitution, as it is not a substrate of CYP450 enzymes or P-glycoprotein. One study reported only a 31% decrease in the mean AUC of single-dose pravastatin following pretreatment with rifampin, and the interaction did not occur in all subjects.

References

  1. Everett DW, Chando TJ, Didonato GC, Singhvi SM, Pan HY, Weinstein SH (1991) "Biotransformation of pravastatin sodium in humans." Drug Metab Dispos, 19, p. 740-8
  2. (2001) "Product Information. Lescol (fluvastatin)." Novartis Pharmaceuticals
  3. (2001) "Product Information. Lipitor (atorvastatin)." Parke-Davis
  4. Kyrklund C, Backman JT, Kivisto KT, Neuvonen M, Laitila J, Neuvonen PJ (2000) "Rifampin greatly reduces plasma simvastatin and simvastatin acid concentrations." Clin Pharmacol Ther, 68, p. 592-7
  5. Bogman K, Peyer AK, Torok M, Kusters E, Drewe J (2001) "HMG-CoA reductase inhibitors and P-glycoprotein modulation." Br J Pharmacol, 132, p. 1183-92
  6. Scripture CD, Pieper JA (2001) "Clinical pharmacokinetics of fluvastatin." Clin Pharmacokinet, 40, p. 263-81
  7. Kyrklund C, Backman JT, Neuvonen M, Neuvonen PJ (2004) "Effect of rifampicin on pravastatin pharmacokinetics in healthy subjects." Br J Clin Pharmacol, 57, p. 181-7
View all 7 references

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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

  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.
View all 6 references

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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.

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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

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