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Rifampicin-Ciclosporin Interaction — SCE Infectious Diseases MCQ

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HardTuberculosisRifampicin-Ciclosporin InteractionSCE Infectious Diseases

A 45-year-old man develops TB while on Ciclosporin for a renal transplant. He is started on Rifampicin-containing anti-TB therapy. What happens to Ciclosporin levels?

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Correct answer: B — Rifampicin dramatically reduces Ciclosporin levels (by up to 80%) through CYP3A4 induction — Ciclosporin dose must be substantially increased with close TDM

Rifampicin reduces Ciclosporin levels by up to 80% through potent CYP3A4 and P-glycoprotein induction. This can precipitate transplant rejection if the Ciclosporin dose is not substantially increased (often 3–5 fold). Very frequent TDM of Ciclosporin (initially twice-weekly) is essential when starting and stopping Rifampicin. When Rifampicin is stopped, Ciclosporin levels will rise dramatically as enzyme induction resolves — dose must then be reduced. Rifabutin is an alternative with less enzyme induction.

Reference: BNF 2024 – Rifampicin/Ciclosporin; NICE NG33 2016 – TB; BTS 2024