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The co-administration of nintedanib and rifampicin is primarily studied in the context of clinical drug-drug interaction (DDI) trials. Nintedanib is a small molecule multi-target tyrosine kinase inhibitor developed by Boehringer Ingelheim, primarily indicated for idiopathic pulmonary fibrosis (IPF), systemic sclerosis-associated interstitial lung disease (SSc-ILD), and certain non-small cell lung cancers. Rifampicin is a potent rifamycin antibiotic used for tuberculosis. The combination is clinically significant because rifampicin is a powerful inducer of P-glycoprotein (P-gp) and, to a lesser extent, CYP3A4. Since nintedanib is a substrate for P-gp, co-administration with rifampicin leads to a significant reduction in nintedanib's systemic exposure (AUC and Cmax), typically by approximately 50-60%, which can compromise its therapeutic efficacy. Consequently, the use of potent P-gp inducers is generally avoided during nintedanib therapy.
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