MajorClass III antiarrhythmic×Antituberculous antibiotic
Updated · Methodology
Mechanism
Rifampicin is a strong CYP3A4 inducer. At 600 mg daily it lowered dronedarone levels by 80% without major change in the active metabolite, and the antiarrhythmic effect weakens. The EU SmPC of dronedarone does not recommend the combination, and the FDA label says to avoid it. Neither the dronedarone nor the rifampicin labels list the pair as a contraindication.
Symptoms
Recurrence of atrial fibrillation symptoms: palpitations, irregular pulse, fatigue, dyspnoea. Possible rhythm breakthroughs requiring admission.
Management
Avoid the combination. In a patient with atrial fibrillation who needs tuberculosis treatment, plan rhythm control with a cardiologist for the rifampicin course, including catheter ablation. Rifampicin is hard to replace because it is part of the standard first-line regimen. Other antiarrhythmics lose exposure too: the rifampicin SmPC reports falls of 80% for quinidine and 87% for propafenone. If the pair continues, watch for recurrent atrial fibrillation on ECG and by symptoms.
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: Multaq (dronedarone) prescribing information (2025)– FDA, DailyMed setid 7fa41601-7fb5-4155-8e50-2ae903f0d2d6 (Sanofi-Aventis U.S.), version 37, revised 05/2025, sections 4, 5.8 and 7.1
- AEMPS: Ficha técnica Rifaldin 300 mg cápsulas (rifampicina) (2026)– AEMPS, CIMA, nº registro 46029, revisión 03/2026, sección 4.5
- EMA: Multaq (dronedarona) – ficha técnica en CIMA (2026)– AEMPS CIMA, Multaq 400 mg comprimidos recubiertos con película, nº registro 09591003 (EU/1/09/591), secciones 4.3, 4.4 y 4.5