Selected Protease Inhibitors/Rifabutin; Rifapentine Interactions

This information is generalized and not intended as specific medical advice. Consult your healthcare professional before taking or discontinuing any drug or commencing any course of treatment.

Medical warning:

Serious. These medicines may interact and cause very harmful effects. Contact your healthcare professional (e.g. doctor or pharmacist) for more information.

How the interaction occurs:

When these two medicines are taken together, your body may not process them properly.

What might happen:

Your blood levels of rifabutin may increase and cause harmful effects. Rifabutin and rifapentine may decrease the levels of some protease inhibitors, which may decrease their effectiveness.

What you should do about this interaction:

Make sure that your healthcare professionals (e.g. doctor or pharmacist) know that you are taking these medicines together. If you experience a persistent sore throat or fever, contact your doctor. The dose of your medicines may need adjusting.Your healthcare professionals may already be aware of this drug interaction and may be monitoring you for it. Do not start, stop, or change the dosage of any medicine before checking with them first.

  • 1.Agenerase (amprenavir) Australian prescribing information. GlaxoSmithKline Australia Pty Ltd. November 24, 2004.
  • 2.Agenerase (amprenavir) summary of product characteristics. GlaxoSmithKline UK January 18, 2005.
  • 3.Agenerase (amprenavir) Capsules US prescribing information. GlaxoSmithKline May, 2005.
  • 4.Telzir (fosamprenavir calcium) Australian prescribing information. GlaxoSmithKline Australia Pty Ltd. November 24, 2004.
  • 5.Telzir (fosamprenavir calcium) UK summary of product characteristics. GlaxoSmithKline UK October 18. 2013.
  • 6.Lexiva (fosamprenavir calcium) US prescribing information. GlaxoSmithKline March, 2019.
  • 7.Crixivan (indinavir sulfate) Australian prescribing information. Merck Sharp & Dohme (Australia) Pty Ltd. August 11, 2003.
  • 8.Crixivan (indinavir sulfphate) UK summary of product characteristics. Merck Sharp & Dohme Limited September, 2008.
  • 9.Crixivan (indinavir sulfate) US prescribing information. Merck & Co., Inc. September, 2016.
  • 10.Viracept (nelfinavir mesylate) Australian prescribing information. Roche Products Pty Ltd. October 26, 2000.
  • 11.Viracept (nelfinavir mesylate) UK summary of product characteristics. Roche Products Limited August 4, 2008.
  • 12.Viracept (nelfinavir mesylate) US prescribing information. Agouron Pharmaceuticals, Inc. September, 2016.
  • 13.Invirase (saquinavir mesylate) US prescribing information. Roche Laboratories, Inc. March, 2019.
  • 14.Mycobutin (rifabutin) US prescribing information. Pfizer Inc. July, 2015.
  • 15.Reyataz (atazanavir sulfate) Australian product information. Bristol-Myers Squibb Pharmaceuticals January 8, 2004.
  • 16.Reyataz (atazanavir) UK summary of product characteristics. Bristol-Myers Squibb Pharmaceuticals Limited September 8, 2008.
  • 17.Reyataz (atazanavir sulfate) US prescribing information. Bristol-Myers Squibb Company March, 2018.
  • 18.Prezista (darunavir) Canadian prescribing information. Jannsen-Ortho June, 2008.
  • 19.Prezista (darunavir) UK Summary of product characteristics. Janssen-Cilgat LTD August 8, 2008.
  • 20.Prezista (darunavir) US prescribing information. Tibotec Inc. May, 2019.
  • 21.Kaletra (lopinavir/ritonavir) Australian prescribing information. Abbott Australasia Pty. Ltd. April 1, 2004.
  • 22.Kaletra (lopinavir/ritonavir) UK summary of product characteristics. Abbott Laboratories, Limited July 11, 2008.
  • 23.Kaletra (lopinavir/ritonavir tablets) US prescribing information. Abbott Laboratories December, 2019.
  • 24.Aptivus (tipranavir) US prescribing information. Boehringer Ingelheim Pharmaceuticals, Inc. June, 2018.
  • 25.Norvir (ritonavir) Australian prescribing information. Abbott Australasia Pty. Ltd. January 29, 2004.
  • 26.Norvir (ritonavir) UK summary of product characteristics. AbbVie, Ltd. July 18, 2019.
  • 27.Panel on Antiretroviral Guidelines for Adults and Adolescents. Guidelines for the use of antiretroviral agents in adults and adolescents with HIV. Department of Health and Human Services. Available at http://aidsinfo.nih.gov/contentfiles/AdultandAdolescentGL.pdf July 10, 2019.
  • 28.Panel on Opportunistic Infections in Adults and Adolescents with HIV. Mycobacterium tuberculosis Infection and Disease. Guidelines for the prevention and treatment of opportunistic infections in adults and adolescents with HIV: recommendations from the CDC, the NIH, and the HIV Medicine Association of the IDSA. Available at http://aidsinfo.nih.gov/contentfiles/lvguidelines/adult_oi.pdf. September 22, 2017.
  • 29.CDC. Managing Drug Interactions in the Treatment of HIV-Related Tuberculosis online. Available at http://www.cdc.gov/tb/TB_HIV_Drugs/default.htm June, 2013.
  • 30.Naiker S, Connolly C, Wiesner L, Kellerman T, Reddy T, Harries A, McIlleron H, Lienhardt C, Pym A. Randomized pharmacokinetic evaluation of different rifabutin doses in African HIV- infected tuberculosis patients on lopinavir/ritonavir-based antiretroviral therapy. BMC Pharmacol Toxicol 2014 Nov 19;15:61.
  • 31.Lan NT, Thu NT, Barrail-Tran A, Duc NH, Lan NN, Laureillard D, Lien TT, Borand L, Quillet C, Connolly C, Lagarde D, Pym A, Lienhardt C, Dung NH, Taburet AM, Harries AD. Randomised pharmacokinetic trial of rifabutin with lopinavir/ritonavir-antiretroviral therapy in patients with HIV-associated tuberculosis in Vietnam. PLoS One 2014;9(1):e84866.
  • 32.Boulanger C, Hollender E, Farrell K, Stambaugh JJ, Maasen D, Ashkin D, Symes S, Espinoza LA, Rivero RO, Graham JJ, Peloquin CA. Pharmacokinetic evaluation of rifabutin in combination with lopinavir-ritonavir in patients with HIV infection and active tuberculosis. Clin Infect Dis 2009 Nov 1;49(9):1305-11.
  • 33.Khachi H, O'Connell R, Ladenheim D, Orkin C. Pharmacokinetic interactions between rifabutin and lopinavir/ritonavir in HIV-infected patients with mycobacterial co-infection. J Antimicrob Chemother 2009 Oct;64(4):871-3.
  • 34.Ramachandran G, Bhavani PK, Hemanth Kumar AK, Srinivasan R, Raja K, Sudha V, Venkatesh S, Chandrasekaran C, Swaminathan S. Pharmacokinetics of rifabutin during atazanavir/ritonavir co-administration in HIV-infected TB patients in India. Int J Tuberc Lung Dis 2013 Dec;17(12):1564-8.
  • 35.Tanuma J, Sano K, Teruya K, Watanabe K, Aoki T, Honda H, Yazaki H, Tsukada K, Gatanaga H, Kikuchi Y, Oka S. Pharmacokinetics of rifabutin in Japanese HIV-infected patients with or without antiretroviral therapy. PLoS One 2013;8(8):e70611.
  • 36.Jenks JD, Kumarasamy N, Ezhilarasi C, Poongulali S, Ambrose P, Yepthomi T, Devaraj C, Benson CA. Improved tuberculosis outcomes with daily vs. intermittent rifabutin in HIV-TB coinfected patients in India. Int J Tuberc Lung Dis 2016 Sep;20(9):1181-4.
  • 37.Jenny-Avital ER, Joseph K. Rifamycin-resistant Mycobacterium tuberculosis in the highly active antiretroviral therapy era: a report of 3 relapses with acquired rifampin resistance following alternate-day rifabutin and boosted protease inhibitor therapy. Clin Infect Dis 2009 May 15; 48(10):1471-4.
  • 38.Kraft WK, McCrea JB, Winchell GA, Carides A, Lowry R, Woolf EJ, Kusma SE, Deutsch PJ, Greenberg HE, Waldman SA. Indinavir and rifabutin drug interactions in healthy volunteers. J Clin Pharmacol 2004 Mar; 44(3):305-13.
  • 39.Hamzeh FM, Benson C, Gerber J, Currier J, McCrea J, Deutsch P, Ruan P, Wu H, Lee J, Flexner C. Steady-state pharmacokinetic interaction of modified-dose indinavir and rifabutin. Clin Pharmacol Ther 2003 Mar; 73(3):159-69.
  • 40.Phansalkar S, Desai AA, Bell D, Yoshida E, Doole J, Czochanski M, Middleton B, Bates DW. High-priority drug-drug interactions for use in electronic health records. J Am Med Inform Assoc 2012 Sep-Oct; 19(5):735-43.

Selected from data included with permission and copyrighted by First Databank, Inc. This copyrighted material has been downloaded from a licensed data provider and is not for distribution, except as may be authorized by the applicable terms of use.

CONDITIONS OF USE: The information in this database is intended to supplement, not substitute for, the expertise and judgment of healthcare professionals. The information is not intended to cover all possible uses, directions, precautions, drug interactions or adverse effects, nor should it be construed to indicate that use of a particular drug is safe, appropriate or effective for you or anyone else. A healthcare professional should be consulted before taking any drug, changing any diet or commencing or discontinuing any course of treatment.