Rifampin-divalproex drug-drug interaction in an adult patient: A case report
The divalproex (DVP) package insert states that rifampin may increase the oral clearance of valproate by 40% and that valproic acid derivative dose adjustments may be required when starting or stopping rifampin. However, the overall clinical significance of this drug-drug interaction remains unclear...
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| Format: | Article |
| Language: | English |
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American Association of Psychiatric Pharmacists
2021-01-01
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| Series: | Mental Health Clinician |
| Subjects: | |
| Online Access: | https://theijpt.org/doi/pdf/10.9740/mhc.2021.01.019 |
| _version_ | 1797383365456822272 |
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| author | Christine Doran, PharmD Michael Moro, MEd Jennifer Green, DO Kristen N. Gardner, PharmD, BCPP |
| author_facet | Christine Doran, PharmD Michael Moro, MEd Jennifer Green, DO Kristen N. Gardner, PharmD, BCPP |
| author_sort | Christine Doran, PharmD |
| collection | DOAJ |
| description | The divalproex (DVP) package insert states that rifampin may increase the oral clearance of valproate by 40% and that valproic acid derivative dose adjustments may be required when starting or stopping rifampin. However, the overall clinical significance of this drug-drug interaction remains unclear given that limited clinical outcome data has been published. This case describes a 52-year-old female with bipolar disorder, borderline personality disorder, and PTSD who was previously stable on a medication regimen consisting of DVP delayed-release 500 mg every morning and 1500 mg every evening (baseline steady-state trough 99.8 mcg/mL). Throughout rifampin therapy for latent tuberculosis treatment, she required an increase in both the frequency of DVP administration, from 2 to 3 times daily, and DVP dose by 75% to maintain clinical stability. Valproic acid trough concentrations ranged from 56.4 to 75.9 mcg/mL during the 4-month course of rifampin. This report supports that the DVP-rifampin interaction may be clinically significant and of a greater magnitude than suggested by the package insert. |
| first_indexed | 2024-03-08T21:19:55Z |
| format | Article |
| id | doaj.art-075c66f9a3ee4c7cbe19e9aab2a2a4d5 |
| institution | Directory Open Access Journal |
| issn | 2168-9709 |
| language | English |
| last_indexed | 2024-03-08T21:19:55Z |
| publishDate | 2021-01-01 |
| publisher | American Association of Psychiatric Pharmacists |
| record_format | Article |
| series | Mental Health Clinician |
| spelling | doaj.art-075c66f9a3ee4c7cbe19e9aab2a2a4d52023-12-21T11:41:30ZengAmerican Association of Psychiatric PharmacistsMental Health Clinician2168-97092021-01-01111192210.9740/mhc.2021.01.019i2168-9709-11-1-019Rifampin-divalproex drug-drug interaction in an adult patient: A case reportChristine Doran, PharmD0https://orcid.org/0000-0003-1461-6634Michael Moro, MEd1https://orcid.org/0000-0003-3067-4260Jennifer Green, DO2https://orcid.org/0000-0003-1686-5511Kristen N. Gardner, PharmD, BCPP3https://orcid.org/0000-0003-4016-47311 PGY-2 Ambulatory Care Pharmacy Resident, Kaiser Permanente Colorado, Denver, Colorado2 Doctor of Pharmacy Candidate 2019, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Denver, Colorado3 Adult Psychiatrist, Kaiser Permanente Colorado, Denver, Colorado4 Clinical Pharmacy Specialist–Behavioral Health, Kaiser Permanente Colorado, Denver, ColoradoThe divalproex (DVP) package insert states that rifampin may increase the oral clearance of valproate by 40% and that valproic acid derivative dose adjustments may be required when starting or stopping rifampin. However, the overall clinical significance of this drug-drug interaction remains unclear given that limited clinical outcome data has been published. This case describes a 52-year-old female with bipolar disorder, borderline personality disorder, and PTSD who was previously stable on a medication regimen consisting of DVP delayed-release 500 mg every morning and 1500 mg every evening (baseline steady-state trough 99.8 mcg/mL). Throughout rifampin therapy for latent tuberculosis treatment, she required an increase in both the frequency of DVP administration, from 2 to 3 times daily, and DVP dose by 75% to maintain clinical stability. Valproic acid trough concentrations ranged from 56.4 to 75.9 mcg/mL during the 4-month course of rifampin. This report supports that the DVP-rifampin interaction may be clinically significant and of a greater magnitude than suggested by the package insert.https://theijpt.org/doi/pdf/10.9740/mhc.2021.01.019rifamycinrifabutinrifapentinevalproatepharmacokineticvalproic acid |
| spellingShingle | Christine Doran, PharmD Michael Moro, MEd Jennifer Green, DO Kristen N. Gardner, PharmD, BCPP Rifampin-divalproex drug-drug interaction in an adult patient: A case report Mental Health Clinician rifamycin rifabutin rifapentine valproate pharmacokinetic valproic acid |
| title | Rifampin-divalproex drug-drug interaction in an adult patient: A case report |
| title_full | Rifampin-divalproex drug-drug interaction in an adult patient: A case report |
| title_fullStr | Rifampin-divalproex drug-drug interaction in an adult patient: A case report |
| title_full_unstemmed | Rifampin-divalproex drug-drug interaction in an adult patient: A case report |
| title_short | Rifampin-divalproex drug-drug interaction in an adult patient: A case report |
| title_sort | rifampin divalproex drug drug interaction in an adult patient a case report |
| topic | rifamycin rifabutin rifapentine valproate pharmacokinetic valproic acid |
| url | https://theijpt.org/doi/pdf/10.9740/mhc.2021.01.019 |
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