Major
Rifampicin × tacrolimus
Antituberculous antibiotic×Calcineurin inhibitor (immunosuppressant)
Mechanism
Strong CYP3A4 inducer. Tacrolimus falls 3-fold – transplant rejection risk.
Symptoms
Rejection signs, rising creatinine.
Management
For TB in transplant patient – increase tacrolimus 3-5 fold with blood 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.
Sources
- FDA: Rifadin (rifampin) prescribing information (2010)
- FDA: Prograf (tacrolimus) section 7 (2013)
- FDA: Prograf (tacrolimus) prescribing information – CYP3A4 inducer interactions (2021)– FDA Prograf label, Drug Interactions §7
- AEMPS: Ficha tecnica de Prograf (tacrolimus) (2024)– AEMPS CIMA, 2024