Tafenoquine and Rifampin Concurrent Use

Rationale for Safety and Clinical Considerations

• The American Medical Association recommends that rifampin is a potent inducer of hepatic drug-metabolizing enzymes and causes clinically significant interactions with antiretroviral agents, such as protease inhibitors and NNRTIs, in patients with HIV, requiring dose adjustments and close monitoring 1, 2
• The National Institute of Health guidelines state that rifampin interacts with proton pump inhibitors, such as omeprazole, lansoprazole, and pantoprazole, which may require dose increases to maintain therapeutic efficacy in patients with gastrointestinal disorders 3
• The American Psychiatric Association notes that rifampin induces the metabolism of psychiatric medications, such as sertraline, requiring dose increases to maintain therapeutic efficacy in patients with mental health conditions 4
• The Centers for Disease Control and Prevention recommend that G6PD screening remains mandatory before tafenoquine initiation, regardless of rifampin use, as this is the primary safety concern with tafenoquine 1
• The World Health Organization guidelines suggest that the induction effects of rifampin reach maximum at approximately 1 week after starting rifampin and persist for approximately 2 weeks after discontinuation, requiring close monitoring of patients with tuberculosis or other conditions treated with rifampin 4, 5