Biaxin/Rifampin combination

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New Member

Date Joined Dec 2008
Total Posts : 3
   Posted 12/8/2008 2:02 AM (GMT -6)   
My son has just been changed to Biaxin, Rifampin and Placquenil. An Internet search states Biaxin and Rifampin are not a good combo because of a drug interaction. Can't speak with Doctor for couple of days; any comments from anyone in the meantime? (He has Lyme, Babesiosis, Mycoplasma/Haemobartonella and Bartonella.)

Regular Member

Date Joined Apr 2008
Total Posts : 282
   Posted 12/8/2008 11:08 AM (GMT -6)   
It is all theoretical in the terms that Rifampin is an interaction with Biaxin.  The worst thing that could happen is that Rifampin would lower the amount of Biaxin in the blood.  Rifampin pretty much lowers everything the first few weeks...WBC.  I wouldnt worry about it.  That is a GREAT combination, may put the beast in remission.  I hope to go on the same protocol in a few days.  Hope this helps.

Veteran Member

Date Joined Dec 2005
Total Posts : 1336
   Posted 12/8/2008 11:46 AM (GMT -6)   
I was on Biaxin/plaq. It is what worked for me, but never took rifampin so I don't know much about that drug. I wouldn't imagine it is needed as well, but I am not a doctor.

New Member

Date Joined Dec 2008
Total Posts : 3
   Posted 12/8/2008 7:09 PM (GMT -6)   
Thanks for taking the time to respond. You've made me feel much better with your opinions - which I value greatly, as we are on this huge 'novice' learning curve. Thanks again for your time.

Veteran Member

Date Joined Feb 2007
Total Posts : 670
   Posted 12/9/2008 8:35 AM (GMT -6)   
I am on Biaxxin/ Plaquenil combo. It works well for me.

However, when I tried Rifampin I couldn't tolerate it. I think it was just me because most people don't react ( some herxing) to Rifampin. I tried to slowly build up my tolerance to Rifampin but it didn't work. I have taken other abx that caused me no problem that others have not tolerated.

I would just keep an eye on your son for any reaction. What dosage of Rifampin are you starting with?


New Member

Date Joined Dec 2008
Total Posts : 3
   Posted 12/9/2008 3:05 PM (GMT -6)   
Hi saxmar,
Thanks for taking the time to respond. He's on Biaxin 500mg 2xday, Placquenil 200mg 2xday, and Rifampin 300mg 2xday. He's to take the Biaxin for 7 days, then after 7 days add the Placquenil, then after 7 more days he's to add the Rifampin, so that by the end of 21 days he's on all three meds. We've been warned he'll probably Herx badly on this combo.
If I understand the literature correctly, (which I may not) if Rifampin is added to someone already on Biaxin it reduces the effectiveness of the Biaxin by roughly half. Conversely, if Biaxin is added to someone already on Rifampin, it can (up to) double the effectiveness/dosage/toxicity of the Rifampin. "...the addition of rifabutin in patients stabilized on clarithromycin therapy slowly decreased the clarithromycin area under the plasma concentration-time curve (AUC) and C(max) up to an average of 44% and 41%, respectively, at the end of 4 weeks of combination therapy. In patients stabilized on rifabutin therapy, the addition of clarithromycin significantly increased rifabutin AUC and C(max) after the first dose. After 4 weeks, average increases of 99% and 69%, respectively, were reported.Some experts recommend that this combination be avoided since it may result in decreased efficacy of the macrolide and increased rifamycin toxicity (e.g, neutropenia, uveitis)."
So if I understand correctly, putting him on Biaxin then adding Rifampin 21 days later will decrease the efficacy of the Biaxin by up to half. Perhaps the doctor has adjusted dosages to account for this. Perhaps this occurs only a small percentage of the time. For sure I'll have to talk to the doctor about this. I was just wondering if anyone else had any knowledge/experience with this or if it's a non issue. I'm GUESSING it's a non issue because his doctor is outstanding, and always leads us by the hand for warning us of drug interactions, food interactions with drugs, side effects, etc. Like you said, saxmar, no one reacts to the drugs to same and you're right - I guess just keep an eye on him. Any comments very appreciated.

Veteran Member

Date Joined Sep 2007
Total Posts : 2017
   Posted 12/9/2008 5:16 PM (GMT -6)   
I'm a herxing Rifamper. My one and only herx (about 4 yrs. ago) was on Rifampin and I'm on it again now for 6 mos. Rifampin and Levaquin. My LLDr. cannot believe that I am tolerating this combination so well.... he thinks this may be the magic combination for me. I don't know why, but I think Rifampin is "my" antibiotic.

All the bst.
Never doubt that a small group of thoughtful, committed citizens can change the world. Indeed, it's the only thing that ever has.  - Margaret Meade
06/00- The beginning, 08/01-LD positive, 10/01- Igenex and CDC LD positive, 10/02-LD positive, 11/03-LD positive, 10/07-Bartonella positive, CD57=3 Current Rx's 11/12/08: Wellbutrin 300mg, Paxil 60mg, Xanax 5mg, Rozerem 8mg, Darvocet, Acidophilus, Rifampin 600mg, Levaquin 500mg, Lyrica 150 to 300mg, Skelexa, Restoril
Medicare/SSDI theme song - 
"How much more can I take?", song

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