MajorHMG-CoA reductase inhibitors (statins)×Antituberculous antibiotic
Updated · Methodology
Mechanism
Rifampicin strongly induces CYP3A4 and the OATP1B1 transporter – two atorvastatin clearance routes. Atorvastatin plasma levels fall by 80%; lipid-lowering effect weakens.
Symptoms
The patient feels nothing. Laboratory: LDL cholesterol and total cholesterol rise. In high cardiovascular risk patients, myocardial infarction and stroke risk increase.
Management
During anti-TB therapy, switch to pravastatin (less induction-sensitive metabolism) or temporarily stop the statin for a short course. Induction persists for 2 weeks after rifampicin stops.
Check the full regimen, not just this pair
Opens the checker with these two drugs prefilled. Add the rest of the regimen and recompute additive risks.
Summary of a multi-drug list →
Medicine list: everything you take in one place →
Sources
- FDA: Rifampin capsule (Ani Pharmaceuticals, Inc.) – Prescribing Information (2010)– ; DailyMed setid b389b1a3-672f-47e3-916c-4a9c044b211b
- AEMPS: Ficha técnica: Atorvastatina (nº registro 69536), sección 4.5 (2024)– AEMPS, CIMA, nº registro 69536, sección 4.5