Rifampicin is one of the most potent inducers of hepatic enzymes and drug transporters. Within about a week it can sharply lower levels of many co-prescribed drugs, and the effect persists for about two weeks after stopping.
Commonly affected drugs include warfarin and direct oral anticoagulants, oral contraceptives, many antiretrovirals, azole antifungals, calcineurin inhibitors, some antiepileptics, methadone and corticosteroids.
- Review every co-prescribed drug for interactions before starting rifampicin.
- Advise a non-hormonal or additional contraceptive method during and after treatment.
- Monitor INR closely when rifampicin is started or stopped in a patient on warfarin.
- Expect induction to last about two weeks after rifampicin is stopped.
Why it matters
Most rifampicin harm comes from what it does to other drugs, not from rifampicin itself.
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