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Drug Interactions between rifabutin and sirolimus

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

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Interactions between your drugs

Major

rifabutin sirolimus

Applies to: rifabutin and sirolimus

GENERALLY AVOID: Coadministration with potent inducers of CYP450 3A4 and/or P-glycoprotein may significantly decrease the plasma concentrations and pharmacologic effects of sirolimus. The mechanism probably involves reduced absorption as well as accelerated clearance of sirolimus due to induction of both intestinal P-glycoprotein drug efflux transporter and hepatic/intestinal CYP450 3A4 isoenzymes. In a study of 14 healthy volunteers, a potent inducer of CYP450 3A4 and P-gp, rifampin (600 mg daily for 14 days) increased the oral clearance of sirolimus (20 mg single dose) by 5.5-fold, representing mean decreases in peak blood concentration (Cmax) and area under the concentration-time curve (AUC) of 71% and 82%, respectively.

MANAGEMENT: Given the risk of organ rejection associated with inadequate immunosuppressant levels, the use of sirolimus with potent inducers of CYP450 3A4 and/or P-gp is not recommended. Alternative therapeutic agents with less enzyme induction potential should be considered.

References (3)
  1. (2001) "Product Information. Rapamune (sirolimus)." Wyeth-Ayerst Laboratories
  2. Cerner Multum, Inc. "UK Summary of Product Characteristics."
  3. Cerner Multum, Inc. "Australian Product Information."

Drug and food interactions

Moderate

sirolimus food

Applies to: sirolimus

ADJUST DOSING INTERVAL: Consumption of food can decrease the rate and extent of gastrointestinal absorption of sirolimus. Also, the consumption of grapefruit juice may result in increased sirolimus trough concentrations.

MANAGEMENT: Experts recommend that this drug be taken either at least one hour prior to eating or consistently with or without food to avoid variations in sirolimus blood levels. The manufacturer recommends against using grapefruit juice for dilution of sirolimus doses. Patients should be monitored for clinical and laboratory evidence of altered immunosuppressant effects.

References (1)
  1. (2001) "Product Information. Rapamune (sirolimus)." Wyeth-Ayerst Laboratories

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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