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Tuberculosis — SCE Infectious Diseases MCQ

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ModerateTuberculosisTuberculosisSCE Infectious Diseases

A 52-year-old man is diagnosed with smear-positive pulmonary TB. He takes Amlodipine 10 mg and Atorvastatin 40 mg for cardiovascular disease. What is the most important drug interaction to address when starting standard anti-TB treatment?

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Correct answer: C — Rifampicin reduces Atorvastatin levels via CYP3A4 induction

Rifampicin is a potent inducer of CYP3A4 and P-glycoprotein. It dramatically reduces levels of statins metabolised by CYP3A4, including Atorvastatin and Simvastatin, potentially rendering them ineffective. The statin should be switched to one less affected by CYP3A4 (e.g. Rosuvastatin or Pravastatin). Amlodipine levels will also be reduced by Rifampicin but the statin interaction is more clinically significant. Regular cardiovascular risk monitoring is needed throughout TB treatment.

Reference: BNF 2024 – Drug interactions: Rifampicin; NICE NG33 2016 – Tuberculosis