ModerateSelective beta-adrenergic blockers×Antituberculous antibiotic
Updated · Methodology
Mechanism
Rifampicin induces CYP3A4, modestly lowering bisoprolol plasma levels (bisoprolol is metabolised 50% via CYP3A4 and 50% renally). The effect is weaker than for fully CYP-dependent beta-blockers.
Symptoms
Gradual blood pressure rise or return of anginal symptoms 2–3 weeks after starting rifampicin. In tachyarrhythmias: return of symptoms.
Management
During anti-TB therapy, increase bisoprolol by 50% with blood pressure and pulse monitoring. After rifampicin stops, taper back gradually (induction persists for 2 weeks).
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Sources
- FDA: Rifampin capsule (Ani Pharmaceuticals, Inc.) – Prescribing Information (2010)– ; DailyMed setid b389b1a3-672f-47e3-916c-4a9c044b211b
- AEMPS: Ficha técnica: Rifampicina (nº registro 49034), sección 4.5 (2026)– AEMPS, CIMA, nº registro 49034, revisión 08/2026, sección 4.5