CO-TRIMOXAZOLE AND RIFAMPICIN (RIFAMPIN)

Rifampicin reduces the AUCs of trimethoprim and sulfamethoxazole by 56% and 28%, respectively, in HIV-positive subjects, but apparently has no effect on trimethoprim in healthy subjects. Co-trimoxazole can increase rifampicin serum levels in patients with tuberculosis by almost a third.
The efficacy of co-trimoxazole prophylaxis may be reduced in HIV-positive patients taking rifampicin. Bear this in mind when using the combination. The risk of hepatotoxicity may be increased due to raised rifampicin levels. Liver function tests should already be closely monitored so no additional precautions seem necessary.
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