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BI 685509 + rifampin is a combination of the investigational small molecule soluble guanylate cyclase (sGC) activator **BI 685509** and the antibiotic **rifampin**. BI 685509 functions as an NO-independent sGC activator, increasing levels of cyclic guanosine monophosphate (cGMP) to restore functionality of nitric oxide pathways impaired by oxidative stress, with demonstrated renal protection and antifibrotic activity in preclinical models. It is under investigation primarily for chronic kidney disease, diabetic kidney disease, and portal hypertension in liver cirrhosis, and shows rapid oral absorption and dose-proportional pharmacokinetics[1][2][3][4][5]. **Rifampin** is a well-established oral antibiotic that inhibits DNA-dependent RNA polymerase, used to treat tuberculosis and other bacterial infections. The combination **may be studied in drug-drug interaction trials to assess the impact of rifampin—a known inducer of cytochrome P450 enzymes and drug transporters—on the pharmacokinetics of BI 685509**; co-administration can significantly alter exposure and effectiveness of co-administered investigational compounds. The combination itself does not have an established clinical indication as a therapeutic regimen, but rather has been studied for pharmacokinetic and interaction purposes.
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