MajorImmunosuppressants. Calcineurin inhibitors×Antituberculous antibiotic
Updated · Methodology
Mechanism
Rifampicin is a strong inducer of CYP3A4 and P-glycoprotein, the pathways that clear cyclosporine. In healthy volunteers cyclosporine oral bioavailability fell from 33% to 9% with rifampicin, and in kidney transplant recipients cyclosporine AUC fell by about 60%. Levels drop below the therapeutic range and the risk of graft rejection rises.
Symptoms
Rejection signs within 1–2 weeks.
Management
Increase cyclosporine 3–5 fold with level monitoring. Alternative – rifabutin (weaker).
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
- FDA: Sandimmune (cyclosporine) prescribing information (2015)
- AEMPS: Ficha técnica Rifaldin 300 mg cápsulas (rifampicina) (2026)– AEMPS, CIMA, nº registro 46029, revisión 03/2026, sección 4.5
- AEMPS: Ficha técnica Sandimmun Neoral 100 mg cápsulas blandas (ciclosporina) (2026)– AEMPS, CIMA, nº registro 60320, revisión 04/2026, sección 4.5
- FDA: Neoral (cyclosporine) – Prescribing Information (2026)– FDA, DailyMed SPL, Novartis, Precautions (Drug Interactions)