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Drug Interactions between rifampin and Uroplus DS

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

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Interactions between your drugs

Moderate

rifAMPin sulfamethoxazole

Applies to: rifampin and Uroplus DS (sulfamethoxazole / trimethoprim)

MONITOR: During coadministration of rifampin and sulfamethoxazole-trimethoprim (SMX-TMP), the serum concentrations of rifampin may be increased while those of SMX and TMP may be decreased. In a study of 15 tuberculosis patients treated with rifampin for at least two weeks, SMX-TMP given for 5 to 10 days increased the median peak plasma concentration (Cmax) and area under the concentration-time curve (AUC) of rifampin by 31% and 60%, respectively. The mechanism of interaction has not been established. In another study of 10 HIV-infected patients receiving SMX-TMP prophylaxis (800 mg-160 mg orally once a day) for at least one month, antituberculosis therapy containing rifampin (600 mg/day) given for more than 12 days decreased the mean AUC of SMX by 23% and that of TMP by 47%, most likely due to induction of hepatic microsomal enzymes by rifampin. The clinical significance of this interaction is unknown but may be greater with low dosages of SMX-TMP. A case-control study evaluating the effect of SMX-TMP dosage on the risk of toxoplasmosis suggest that rifampin exposure may reduce the efficacy of SMX-TMP prophylaxis.

MANAGEMENT: Patients receiving rifampin and SMX-TMP should be monitored for potentially increased toxicity of rifampin. Patients should be advised to notify their physician if they experience signs and symptoms of hepatotoxicity such as fever, rash, anorexia, nausea, vomiting, fatigue, right upper quadrant pain, dark urine, and jaundice. In addition, the possibility of reduced efficacy of SMX-TMP should be considered, particularly when used for prevention of toxoplasmic encephalitis in HIV patients because adequate drug levels are required in the central nervous system. It may be advisable to refrain from low-dose prophylactic regimens (less than 4 DS tablets per week).

References

  1. Bhatia RS, Uppal R, Malhi R, Behera D, Jindal SK (1991) "Drug interaction between rifampicin and cotrimazole in patients with tuberculosis." Hum Exp Toxicol, 10, p. 419-21
  2. Ribera E, FernandezSola A, Juste C, Rovira A, Romero FJ, ArmadansGil L, Ruiz I, Ocana I, Pahissa A (1999) "Comparison of high and low doses of trimethoprim-sulfamethoxazole for primary prevention of toxoplasmic encephalitis in human immunodeficiency virus-infected patients." Clin Infect Dis, 29, p. 1461-6
  3. Ribera E, Pou L, Fernandez-Sola A, et al. (2001) "Rifampin reduces concentrations of trimethoprim and sulfamethoxazole in serum in human immunodeficiency virus-infected patients." Antimicrob Agents Chemother, 45, p. 3238-41

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Moderate

rifAMPin trimethoprim

Applies to: rifampin and Uroplus DS (sulfamethoxazole / trimethoprim)

MONITOR: During coadministration of rifampin and sulfamethoxazole-trimethoprim (SMX-TMP), the serum concentrations of rifampin may be increased while those of SMX and TMP may be decreased. In a study of 15 tuberculosis patients treated with rifampin for at least two weeks, SMX-TMP given for 5 to 10 days increased the median peak plasma concentration (Cmax) and area under the concentration-time curve (AUC) of rifampin by 31% and 60%, respectively. The mechanism of interaction has not been established. In another study of 10 HIV-infected patients receiving SMX-TMP prophylaxis (800 mg-160 mg orally once a day) for at least one month, antituberculosis therapy containing rifampin (600 mg/day) given for more than 12 days decreased the mean AUC of SMX by 23% and that of TMP by 47%, most likely due to induction of hepatic microsomal enzymes by rifampin. The clinical significance of this interaction is unknown but may be greater with low dosages of SMX-TMP. A case-control study evaluating the effect of SMX-TMP dosage on the risk of toxoplasmosis suggest that rifampin exposure may reduce the efficacy of SMX-TMP prophylaxis.

MANAGEMENT: Patients receiving rifampin and SMX-TMP should be monitored for potentially increased toxicity of rifampin. Patients should be advised to notify their physician if they experience signs and symptoms of hepatotoxicity such as fever, rash, anorexia, nausea, vomiting, fatigue, right upper quadrant pain, dark urine, and jaundice. In addition, the possibility of reduced efficacy of SMX-TMP should be considered, particularly when used for prevention of toxoplasmic encephalitis in HIV patients because adequate drug levels are required in the central nervous system. It may be advisable to refrain from low-dose prophylactic regimens (less than 4 DS tablets per week).

References

  1. Bhatia RS, Uppal R, Malhi R, Behera D, Jindal SK (1991) "Drug interaction between rifampicin and cotrimazole in patients with tuberculosis." Hum Exp Toxicol, 10, p. 419-21
  2. Ribera E, FernandezSola A, Juste C, Rovira A, Romero FJ, ArmadansGil L, Ruiz I, Ocana I, Pahissa A (1999) "Comparison of high and low doses of trimethoprim-sulfamethoxazole for primary prevention of toxoplasmic encephalitis in human immunodeficiency virus-infected patients." Clin Infect Dis, 29, p. 1461-6
  3. Ribera E, Pou L, Fernandez-Sola A, et al. (2001) "Rifampin reduces concentrations of trimethoprim and sulfamethoxazole in serum in human immunodeficiency virus-infected patients." Antimicrob Agents Chemother, 45, p. 3238-41

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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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Moderate

sulfamethoxazole food

Applies to: Uroplus DS (sulfamethoxazole / trimethoprim)

MONITOR: Two cases have been reported in which patients on sulfamethoxazole-trimethoprim therapy, after consuming beer, reported flushing, heart palpitations, dyspnea, headache, and nausea (disulfiram - alcohol type reactions). First-generation sulfonylureas have been reported to cause facial flushing when administered with alcohol by inhibiting acetaldehyde dehydrogenase and subsequently causing acetaldehyde accumulation. Since sulfamethoxazole is chemically related to first-generation sulfonylureas, a disulfiram-like reaction with products containing sulfamethoxazole is theoretically possible. However, pharmacokinetic/pharmacodynamic data are lacking and in addition, the two reported cases cannot be clearly attributed to the concomitant use of sulfamethoxazole-trimethoprim and alcohol.

MANAGEMENT: Patients should be alerted to the potential for this interaction and although the risk for this interaction is minimal, caution is recommended while taking sulfamethoxazole-trimethoprim concomitantly with alcohol.

References

  1. Heelon MW, White M (1998) "Disulfiram-cotrimoxazole reaction." Pharmacotherapy, 18, p. 869-70
  2. Mergenhagen KA, Wattengel BA, Skelly MK, Clark CM, Russo TA (2020) "Fact versus fiction: a review of the evidence behind alcohol and antibiotic interactions." Antimicrob Agents Chemother, 64, e02167-19

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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.

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

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