Tipranavir and Lefamulin: Interaction Details
AI-assisted, pharmacist-reviewed · Source data updated Aug 8, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Tipranavir
Lefamulin
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.
What happens
Reduced lefamulin exposure, reduced efficacy of lefamulin, an increased tipranavir exposure and an increased risk of tipranavir adverse effects
Interaction Deep Dive
Avoid concomitant use of oral or IV lefamulin with P-gp inducers such as tipranavir as it may reduce lefamulin exposure, which may also reduce the efficacy of lefamulin unless the benefit outweighs the risks. Concomitant administration of oral lefamulin with a sensitive CYP3A4 substrate such as tipranavir may result in increased tipranavir exposure; monitor for tipranavir adverse effects if used concomitantly with lefamulin. Oral rifAMPin (P-gp inducer) reduced the mean lefamulin AUC and Cmax by 72% and 57%, respectively, when administered concomitantly with oral lefamulin. In a drug interaction study, mean AUC and Cmax of midazolam (sensitive CYP3A4 substrate) were increased by approximately 200% and 100%, respectively, when oral midazolam was administered concomitantly with and at 2 or 4 hours after administration of oral lefamulin1.
Why it happens (mechanism)
Induction of P-gp-mediated efflux transport of lefamulin; inhibition of CYP3A4-mediated metabolism of tipranavir
Literature reports
2 reports — tap to read
a) Oral rifAMPin (a strong CYP3A4 inducer and P-gp inducer) reduced the mean lefamulin AUC(0 to inf) and Cmax by 28% and 8%, respectively, when administered concomitantly with IV lefamulin. Additionally, oral rifAMPin reduced the mean lefamulin AUC(0 to inf) and Cmax by 72% and 57%, respectively, when administered concomitantly with oral lefamulin 1.
b) In a drug interaction study, mean AUC and Cmax of midazolam (a sensitive CYP3A substrate) were increased by approximately 200% and 100%, respectively, when oral midazolam was administered concomitantly with and at 2 or 4 hours after administration of lefamulin oral tablets 1.
Common questions
Can I take Tipranavir and Lefamulin together?
Reduced lefamulin exposure, reduced efficacy of lefamulin, an increased tipranavir exposure and an increased risk of tipranavir adverse effects Always confirm with your pharmacist or prescriber before making any change.
How serious is the Tipranavir and Lefamulin interaction?
It is rated major. Potentially serious — often needs a change or close monitoring.
How quickly could this interaction happen?
The documented onset is "unspecified". The timing of this interaction is not well characterized.
How strong is the evidence for this interaction?
The evidence is graded "theoretical". Predicted from the drugs' pharmacology; not yet confirmed in people.
Questions for your pharmacist
- Does my dose of Tipranavir or Lefamulin 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 (1)
- Product Information: XENLETA(R) oral tablets, intravenous injection, lefamulin oral tablets, intravenous injection. Nabriva Therapeutics US Inc (per FDA), King of Prussia, PA, 2021. DailyMed
Keep reading about Tipranavir
Keep reading about Lefamulin
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Prescription drugs aren't the whole picture — herbal and dietary supplements can interact with them too. From the evidence-graded Natural Medicines database:
major · moderate · minor — check everything you take with our drug–supplement interaction checker.
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