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Biaxin/Rifampin combination

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Lyme Disease
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Sarapha
New Member
Joined : Dec 2008
Posts : 3
Posted 12/7/2008 11:02 PM (GMT -8)
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.)
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snake1979
Regular Member
Joined : Apr 2008
Posts : 282
Posted 12/8/2008 8:08 AM (GMT -8)
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.
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Jeminij
Veteran Member
Joined : Dec 2005
Posts : 1336
Posted 12/8/2008 8:46 AM (GMT -8)
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.
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Sarapha
New Member
Joined : Dec 2008
Posts : 3
Posted 12/8/2008 4:09 PM (GMT -8)
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.
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saxmar
Veteran Member
Joined : Feb 2007
Posts : 670
Posted 12/9/2008 5:35 AM (GMT -8)
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?

saxmar
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Sarapha
New Member
Joined : Dec 2008
Posts : 3
Posted 12/9/2008 12:05 PM (GMT -8)
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)." http://www.drugs.com/drug-interactions/biaxin_d00097_rifampin_d00047.html

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.

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JELAINEP
Veteran Member
Joined : Sep 2007
Posts : 2017
Posted 12/9/2008 2:16 PM (GMT -8)
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.
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