Artemether + Lumefantrine
Contraindicated
Database
Significantly reduces artemether and lumefantrine exposure, risking treatment failure
Avoid concurrent use; choose alternative antimalarial
Source: Kimi deep-research + Cla
Drug reference
Rifampicin
Rifamycin antibiotic / antitubercular / enzyme inducer · Antitubercular
Also known as Rifampin
START
TB: 10 mg/kg OD (max 600 mg) as part of standard 4-drug regimen; take on empty stomach if tolerated; review all medications for interactions
TYPICAL MAX
600 mg/day continuous; 1200 mg intermittent (supervised)
STOP IF
Jaundice, LFTs >3x ULN with symptoms, severe rash, thrombocytopenia (<100,000)
WATCH
LFTs monthly, symptom review, sputum smear/culture, INR if on warfarin, effectiveness of hormonal contraceptives, all co-prescribed drugs for interactions
CDSCO approvedSchedule HJan AushadhiNPPA price-controlledATC J04AB02
KDIGO 2024 + manufacturer label
- ONSET
- 45min · absorption onset
- PEAK
- 3h · Peak plasma concentration
- t½
- 3.5h · Short half-life; auto-induction over 2 weeks
- DURATION
- 1d · Once-daily dosing for TB
EXCRETION
Biliary/fecal (major); renal (~30%)
route + CYP
INTERACTIONS
12 major
incl. contraindicated
PREGNANCY
Compatible with pregnancy for TB treatment; benefits outweigh risks; use with INH and pyridoxine
FDA category + note
Top interactionssee all 12 →
- Artemether + LumefantrineContraindicatedDatabaseKimi deep-research + Cla
- Protease InhibitorsContraindicatedDatabaseKimi deep-research + Cla
- ChloramphenicolSevereTextbook-citedKDT 7e · p949
- DesogestrelSevereTextbook-citedKDT 7e · p949
Available in India
54 branded formulations and 210 fixed-dose combinations. Look up specific brands in the Drugs workspace.
Jan Aushadhi — generic available at GoI pharmacies
Mechanism
Binds to beta-subunit of bacterial DNA-dependent RNA polymerase, inhibiting transcription initiation. Bactericidal against Mycobacterium tuberculosis, M. leprae, and many Gram-positive and some Gram-negative organisms. Potent inducer of hepatic CYP450 enzymes (1A2, 2C9, 2C19, 3A4) and P-glycoprotein.
Indications
Tuberculosis (first-line, as part of combination therapy)Leprosy (as part of MDT)Methicillin-resistant Staphylococcus aureus (MRSA) colonizationProphylaxis of meningococcal disease and Haemophilus influenzae type bBrucellosis (combination therapy)Legionnaires' disease (combination therapy)
Dosing
- Adult
- TB: 10 mg/kg (max 600 mg) OD or intermittent dosing per regimen. Leprosy: 600 mg monthly (MDT). MRSA: 600 mg BD x 5 days. Meningococcal prophylaxis: 600 mg BD x 2 days
- Pediatric
- TB: 15 mg/kg (max 600 mg) OD. Meningococcal prophylaxis: 10 mg/kg BD x 2 days (max 600 mg)
- Renal adjustment
- No adjustment needed; hepatically metabolized
- Hepatic adjustment
- Avoid or use with extreme caution in severe hepatic impairment; may worsen liver function
- Geriatric
- Standard dosing; monitor hepatic function closely
- Max dose
- 600 mg/day (usual max); 1200 mg/day intermittent dosing under supervision
Pharmacokinetics
Onset
Days to weeks (for TB treatment)
Peak effect
2-4 hours (Tmax)
Duration
24 hours
Half-life
2-5 hours (auto-induction shortens half-life over first 2 weeks)
Bioavailability
~70%
Protein binding
80%
Metabolism
Hepatic deacetylation to active metabolite 25-desacetylrifampicin; potent CYP450 inducer
Excretion
Biliary/fecal (major, as unchanged drug and metabolites); renal (~30%)
Contraindications
- Hypersensitivity to rifamycins
- Concurrent use with most protease inhibitors (saquinavir, ritonavir)
- Concurrent use with certain hepatitis C antivirals
- Acute porphyria (may precipitate attacks)
- Jaundice or cholestasis
Side effects
Common
Orange-red discoloration of body fluids (urine, tears, sweat, saliva - harmless)NauseaVomitingAnorexiaAbdominal painDiarrheaHeadacheFlu-like symptoms (with intermittent high-dose)
Serious
- Hepatotoxicity (dose-related; especially with INH)
- Thrombocytopenia
- Acute renal failure (interstitial nephritis)
- Hypersensitivity reactions
- Pseudomembranous colitis
- Severe skin reactions
- Orange staining of contact lenses
Pregnancy & lactation
Pregnancy
Compatible with pregnancy for TB treatment; benefits outweigh risks; use with INH and pyridoxine
Lactation
Excreted in breast milk in small amounts; compatible with breastfeeding; infant should receive pyridoxine if mother on INH
Drug interactions
Protease Inhibitors
Contraindicated
Database
Complex bidirectional interaction; may lead to therapeutic failure of both drugs
Avoid concurrent use; consult guidelines for alternatives
Source: Kimi deep-research + Cla
Chloramphenicol
Severe
Textbook-cited
Reduced chloramphenicol efficacy
Avoid concurrent use or increase dose with monitoring
Source: KDT 7e · p949
Desogestrel
Severe
Textbook-cited
Contraceptive failure
Advise alternative or higher-dose contraception
Source: KDT 7e · p949
Ethinylestradiol
Severe
Textbook-cited
Contraceptive failure
Advise alternative or higher-dose contraception
Source: KDT 7e · p949
Glibenclamide
Severe
Textbook-cited
Loss of glycemic control; hyperglycemia
Increase sulfonylurea dose or switch to non-interacting agent
Source: KDT 7e · p949
Gliclazide
Severe
Textbook-cited
Loss of glycemic control; hyperglycemia
Increase sulfonylurea dose or switch to non-interacting agent
Source: KDT 7e · p949
Glimepiride
Severe
Textbook-cited
Loss of glycemic control; hyperglycemia
Increase sulfonylurea dose or switch to non-interacting agent
Source: KDT 7e · p949
Glipizide
Severe
Textbook-cited
Loss of glycemic control; hyperglycemia
Increase sulfonylurea dose or switch to non-interacting agent
Source: KDT 7e · p949
Levonorgestrel
Severe
Textbook-cited
Contraceptive failure
Advise alternative or higher-dose contraception
Source: KDT 7e · p949
Metronidazole
Severe
Textbook-cited
Loss of therapeutic efficacy of metronidazole.
Avoid concurrent use or increase dose with monitoring
Source: KDT 7e · p949
Norethisterone
Severe
Textbook-cited
Contraceptive failure
Advise alternative or higher-dose contraception
Source: KDT 7e · p949
Related guidelines
Ask House about Rifampicin
Continue into a citation-backed clinical answer with the drug context already attached.
Sources: KD Tripathi 7e, Goodman & Gilman 14e, Katzung, BNF·Verified: 2026-05-19 · House clinical team·Cockpit curated: 2026-05-19