MajorAntituberculous antibiotic×HMG-CoA reductase inhibitors (statins)
Updated · Methodology
Mechanism
Rifampicin strongly induces CYP3A4 and the OATP1B1 transporter – the routes of simvastatin activation and hepatocyte uptake. Simvastatin plasma levels fall by 87%; lipid-lowering effect practically disappears.
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 simvastatin to pravastatin (less induction-sensitive metabolism). Induction persists for 2 weeks after rifampicin stops – reintroduce simvastatin gradually.
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: Rifampicina (nº registro 49034), sección 4.5 (2026)– AEMPS, CIMA, nº registro 49034, revisión 08/2026, sección 4.5