Interactions Between Proton Pump Inhibitors and Rifampicin

Introduction to Interactions

The American College of Clinical Pharmacology recommends avoiding the concomitant use of omeprazol, lansoprazol, and pantoprazol with rifampicin due to the significant reduction of their plasma concentrations, resulting in therapeutic failure of gastric acid suppression 1

The American Society for Clinical Pharmacology and Therapeutics states that rifampicin is a potent inducer of hepatic microsomal enzymes, specifically cytochrome P450 (CYP2C19 and CYP3A4), which are the primary metabolic pathways of proton pump inhibitors (PPIs) 1

The American Gastroenterological Association recommends using H2 receptor antagonists such as famotidine or nizatidine, which are not significantly metabolized by the cytochrome P450 system and have a low potential for interaction with rifampicin 1
The European Society of Clinical Microbiology and Infectious Diseases suggests that these agents completely avoid pharmacological interaction and provide adequate acid suppression without the risk of therapeutic failure 1

The Centers for Disease Control and Prevention advise that if rifampicin is discontinued, one should wait at least 2 weeks before adjusting the dose of the PPI to avoid relative overdose 1
The World Health Organization recommends close monitoring of symptoms of inadequate acid suppression if any PPI is used during tuberculosis treatment 1
The American Thoracic Society suggests monthly clinical monitoring of all patients on rifampicin treatment 2
The Infectious Diseases Society of America recommends a complete review of concomitant medications before initiating rifampicin 3, 4, 5