...interactions been reported, we recently reviewed those studies and clinical observations in a published article. (6) Here we have summarized key points from that article, with an emphasis on the tables.

Rifampin is a potent inducer of cytochrome P-450 (GYP) oxidative enzymes. A few examples of well-documented, clinically sigrnficant interactions are shown in Table 1. Other potentially important interactions are listed in Table 2. More recently reported rifampin-drug interactions are summarized in Table 3.

Rifampin is an effective inducer of both the hepatic and intestinal GYP enzyme system and P-glycoprotein (P-gp) transport system. Schuetz and colleagues (7) found that rifampin intracellular concentrations strongly correlated with P-gp levels and, thus, the extent to which rifampin was able to induce GYP3A. P-gp, a transmembrane protein, is a member of the adenosine triphosphate--binding cassette family, which is a group of molecules that control concentrations of both endogenous and exogenous substances across cell membranes by functioning as cellular efflux pumps. (7)

Rifabutin use continues to increase in HIV-infected patients, and new drug interactions with this agent are being reported. While rifabutindrug interactions are usually less dramatic than rifampin-drug interactions, many are clinically important. Rifabutin- and rifampin-drug interactions are compared in Table 4.

When you prescribe therapy with either rifampin or rifabutin, it is prudent to screen for drug interactions. To avoid reduced therapeutic response, therapeutic failure, or toxic reactions when rifampin is added to or discontinued from medication regimens, you need to be aware of these interactions and manage them appropriately....

NOTE: All illustrations and photos have been removed from this article.



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