Methylprednisolone with Rifampin Interaction Details
Brand Names Associated with Methylprednisolone
- Medrol®
- Methylprednisolone
Brand Names Associated with Rifampin
- Rifadin®
- Rifamate® (as a combination product containing Isoniazid, Rifampin)
- Rifampin
- Rifater® (as a combination product containing Isoniazid, Pyrazinamide, Rifampin)
- Rimactane®
Medical Content Editor Dr. Brian Staiger, PharmD
Last updated
Dec 03, 2023
Interaction Effect
Decreased methylPREDNISolone effectiveness
Interaction Summary
Concurrent use of rifampin and corticosteroids has resulted in enhanced metabolism of the corticosteroid and decreased effectiveness.
Severity
Moderate
Onset
Delayed
Evidence
Probable
How To Manage Interaction
Monitor corticosteroid effects and increase the dose of methylPREDNISolone if necessary. A dose reduction may be necessary if rifampin is discontinued.
Mechanism Of Interaction
Induction of hepatic metabolism
Literature Reports
A) A case report evaluated a stabilized patient with steroid-dependent asthma receiving methylPREDNISolone 8 mg per day, who was given rifampin for a positive tuberculosis skin test. After rifampin was started, the patient's asthma worsened and two emergency room visits were necessary within one month. Despite substantial increases in the methylPREDNISolone dose and switching to prednisone, the patient's condition worsened and FEV1 values continued to decrease. After rifampin was discontinued, the patient improved and FEV1 values returned to baseline .
B) Two patients with respiratory disease in whom concomitant administration of rifampin and prednisolone affected the metabolism of the steroid were described. In addition, the effects of rifampin on the pharmacokinetics of prednisolone in seven patients were determined. The two patients with respiratory disease, receiving combination drug therapy, showed considerable improvement only after rifampin was discontinued. When the effects of rifampin on the pharmacokinetics of prednisolone were assessed in the seven additional patients, rifampin increased the mean plasma clearance of the steroid by 45% and reduced the amount of drug available to the tissues by 66%. Maximum plasma concentration and plasma half-life of prednisolone were unaltered .
C) One study described two cases in which concurrent use of rifampin and prednisone in the treatment of giant cell arteritis resulted in ineffectiveness of the steroid therapy. A pharmacokinetic study with both patients was then undertaken to determine an effective steroid dose. Blood samples were taken after oral prednisone 1.1 mg per kg per day (patient 1) and 0.9 mg per kg per day (patient 2) were administered with rifampin 600 mg per day and after four weeks of prednisolone treatment alone. Prednisolone total body clearance increased by more than 200%, half-life decreased by 40% to 60%, and AUC decreased by 60% with rifampin coadministration. In patients with giant cell arteritis, it is recommended that the prednisone dose be increased to 2 mg per kg per day when rifampin cotherapy is required .
Methylprednisolone Overview
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Methylprednisolone, a corticosteroid, is similar to a natural hormone produced by your adrenal glands. It is often used to replace this chemical when your body does not make enough of it. It relieves inflammation (swelling, heat, redness, and pain) and is used to treat certain forms of arthritis; skin, blood, kidney, eye, thyroid, and intestinal disorders (e.g., colitis); severe allergies; and asthma. Methylprednisolone is also used to treat certain types of cancer.
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This medication is sometimes prescribed for other uses; ask your doctor or pharmacist for more information.
Rifampin Overview
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Rifampin is used with other medications to treat tuberculosis (TB; a serious infection that affects the lungs and sometimes other parts of the body). Rifampin is also used to treat some people who have Neisseria meningitidis (a type of bacteria that can cause a serious infection called meningitis) infections in their noses or throats. These people have not developed symptoms of the disease, and this treatment is used to prevent them from infecting other people. Rifampin should not be used to treat people who have developed symptoms of meningitis. Rifampin is in a class of medications called antimycobacterials. It works by killing the bacteria that cause infection.
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Antibiotics such as rifampin will not work for colds, flu, or other viral infections. Using antibiotics when they are not needed increases your risk of getting an infection later that resists antibiotic treatment.
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Definitions
Severity Categories
Contraindicated
These drugs, generally, should not be used together simultaneously due to the high risk of severe adverse effects. Combining these medications can lead to dangerous health outcomes and should be strictly avoided unless otherwise instructed by your provider.
Major
This interaction could result in very serious and potentially life-threatening consequences. If you are taking this drug combination, it is very important to be under close medical supervision to minimize severe side effects and ensure your safety. It may be necessary to change a medication or dosage to prevent harm.
Moderate
This interaction has the potential to worsen your medical condition or alter the effectiveness of your treatment. It's important that you are monitored closely and you potentially may need to make adjustments in your treatment plan or drug dosage to maintain optimal health.
Minor
While this interaction is unlikely to cause significant problems, it could intensify side effects or reduce the effectiveness of one or both medications. Monitoring for changes in symptoms and your condition is recommended, and adjustments may be made if needed to manage any increased or more pronounced side effects.
Onset
Rapid: Onset of drug interaction typically occurs within 24 hours of co-administration.
Delayed: Onset of drug interaction typically occurs more than 24 hours after co-administration.
Evidence
Level of documentation of the interaction.
Established: The interaction is documented and substantiated in peer-reviewed medical literature.
Theoretical: This interaction is not fully supported by current medical evidence or well-documented sources, but it is based on known drug mechanisms, drug effects, and other relevant information.
How To Manage The Interaction
Provides a detailed discussion on how patients and clinicians can approach the identified drug interaction as well as offers guidance on what to expect and strategies to potentially mitigate the effects of the interaction. This may include recommendations on adjusting medication dosages, altering the timing of drug administration, or closely monitoring for specific symptoms.
It's important to note that all medical situations are unique, and management approaches should be tailored to individual circumstances. Patients should always consult their healthcare provider for personalized advice and guidance on managing drug interactions effectively.
Mechanism Of Interaction
The theorized or clinically determined reason (i.e., mechanism) why the drug-drug interaction occurs.
Disclaimer: The information provided on this page is for informational purposes only and should not be considered medical advice. Always consult with a qualified healthcare professional regarding your specific circumstances and medical conditions.
Where Does Our Information Come From?
Information for our drug interactions is compiled from several drug compendia, including:
The prescribing information for each drug, as published on DailyMED, is also used.
Individual drug-drug interaction detail pages contain references specific to that interaction. You can click on the reference number within brackets '[]' to see what reference was utilized.
The information posted is fact-checked by HelloPharmacist clinicians and reviewed quarterly.