Rifampicin for Cholestatic Pruritus — SCE Palliative Medicine MCQ
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Correct answer: E — Rifampicin may reduce oxycodone exposure and requires liver and interaction monitoring
Rifampicin is an enzyme inducer with clinically important interactions and potential hepatotoxicity, especially relevant in liver disease. Oxycodone is mainly metabolised through CYP3A4; its SmPC reports that rifampicin 600 mg daily for seven days reduced oral oxycodone AUC by about 86%. It is not an antihistamine, opioid antagonist, renal-only drug or topical treatment. Specialist selection, analgesia review and liver monitoring are essential.
Reference: Scottish Palliative Care Guidelines: Pruritus. https://www.rightdecisions.scot.nhs.uk/scottish-palliative-care-guidelines/symptom-control/pruritis/ Scottish Palliative Care Guidelines: End-stage liver disease. https://www.rightdecisions.scot.nhs.uk/scottish-palliative-care-guidelines/last-days-of-life-care-around-dying/end-stage-liver-disease/ OxyContin prolonged-release tablets SmPC. https://www.medicines.org.uk/emc/product/7677/smpc