Drug Interaction Report

Rifampin and Enalapril: Interaction Details

A pharmacist-reviewed analysis of the Rifampin and Enalapril interaction: the documented clinical effects, severity rating, onset, mechanism, and management considerations, with cited references throughout.

AI-assisted, pharmacist-reviewed · Source data updated Aug 8, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature

Rifampin

Rifadin
+

Enalapril

Epaned Vasotec Vasotec®
Dr. Brian Staiger, PharmD, BCPS
Medically reviewed by
Dr. Brian Staiger, PharmD, BCPS
Updated Aug 8, 2026
Editorial policy · Data sources
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Interaction severity
Major
Potentially serious — often needs a change or close monitoring.
How we grade severity & evidence

Severity levels

  • Contraindicated: These should generally not be used together.
  • Major: Potentially serious — often needs a change or close monitoring.
  • Moderate: Can be significant — usually manageable with monitoring.
  • Minor: Usually limited clinical impact.

Evidence grades

  • Established: Well documented — supported by controlled studies or strong clinical data.
  • Probable: Good supporting evidence, though not definitively proven.
  • Suspected: Some evidence suggests this interaction, but it is not well established.
  • Possible: Limited or conflicting evidence; the interaction may occur.
  • Theoretical: Predicted from the drugs' pharmacology; not yet confirmed in people.

Ratings come from the documented interaction literature and are reviewed by a pharmacist. They describe the documented risk of the combination, not what will necessarily happen to you — your dose, timing, and health picture all matter.

Of 176 documented Rifampin interactions, 130 are rated major — including this one.
Worried about symptoms right now? Contact your pharmacist or prescriber, or call Poison Control at 1-800-222-1222 (US). Call 911 for an emergency.
Onset
delayed
Evidence
probable
Severity
Major

What happens

Reduced enalapril active metabolite exposure

Interaction Deep Dive

Coadministration of rifAMPin and enalapril may reduce enalapril active metabolite exposure1233. In a case report, the addition of rifAMPin in a patient stabilized on enalapril resulted in an increase in blood pressure and a reduced enalapril area under the concentration-time curve by about 30%. More studies are required to evaluate this interaction and its potential mechanisms 4.

Why it happens (mechanism)

Increased metabolism of enalapril

Literature reports

1 report — tap to read

a) Concomitant administration of oral rifAMPin and oral enalapril resulted in a reduction in the hypotensive efficacy of enalapril in a 35-year-old male with hypertension and brucellosis. The patient was maintained on chronic therapy with enalapril 15 mg twice a day while rifAMPin 300 mg twice a day was added in a regimen with streptomycin and oxytetracycline for brucellosis. RifAMPin appeared to reduce the area under the plasma concentration-time curve (AUC) of enalapril by 30%, therefore, it was suggested that rifAMPin enhanced the renal clearance of the active metabolite. More studies are required to evaluate this interaction and its potential mechanisms 4.

Common questions

Can I take Rifampin and Enalapril together?

Reduced enalapril active metabolite exposure Always confirm with your pharmacist or prescriber before making any change.

How serious is the Rifampin and Enalapril interaction?

It is rated major. Potentially serious — often needs a change or close monitoring.

How quickly could this interaction happen?

The documented onset is "delayed". Effects tend to build up gradually over days to weeks.

How strong is the evidence for this interaction?

The evidence is graded "probable". Good supporting evidence, though not definitively proven.

Questions for your pharmacist

  • Does my dose of Rifampin or Enalapril need adjusting while I take them together?
  • What symptoms should prompt me to call you or my prescriber right away?
  • Does the timing of my doses matter for this combination?
  • Is there a safer alternative to one of these medications for me?

References (4)

  1. Product Information: RIFADIN(R) IV intravenous injection, rifampin intravenous injection. sanofi-aventis US LLC (per FDA), Bridgewater, NJ, 2023. DailyMed
  2. Product Information: RIFADIN(R) oral capsules, rifampin oral capsules. sanofi-aventis US LLC (per FDA), Bridgewater, NJ, 2023. DailyMed
  3. Product Information: RIFATER(R) oral tablets, rifampin, isoniazid, pyrazinamide oral tablets. sanofi-aventis US LLC (per FDA), Bridgewater, NJ, 2023. DailyMed
  4. Kandiah D, Penny WJ, Fraser AG, et al: A possible drug interaction between rifampicin and enalapril. Eur J Clin Pharmacol 1988; 35:431-432. PubMed
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Rifampin

Keep reading about Rifampin

All Rifampin interactions (176)
Also serious with: Aficamten Fostemsavir Doravirine Nifedipine
Enalapril

Keep reading about Enalapril

All Enalapril interactions (198) Enalapril drug information
Also serious with: Aliskiren Sacubitril Valsartan Eplerenone
Beyond drug–drug

These medications also interact with supplements

Prescription drugs aren't the whole picture — herbal and dietary supplements can interact with them too. From the evidence-graded Natural Medicines database:

Rifampin + Activated Charcoal Apple Asarabacca Beer Grapefruit Siberian Cocklebur St. John's Wort Sweet Orange + 214 more

major · moderate · minor — check everything you take with our drug–supplement interaction checker.

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This information is for education, not a substitute for professional medical advice. Do not start, stop, or change any medication without talking to your pharmacist or prescriber.