How long can the effect of rifampicin on the plasma concentration of voriconazole last?
10.3760/cma.j.cn114015-20200414-00405
- VernacularTitle:利福平对伏立康唑血药浓度的影响能持续多久？
- Author:
Zhiqiang LIN
1
;
Tingting CHEN
1
;
Shuifa WU
1
;
Limian HONG
1
Author Information
1. 福建医科大学附属泉州第一医院药剂科，泉州 362000
- Publication Type:Journal Article
- Keywords:
Rifampin;
Voriconazole;
Drug monitoring;
Drug interactions;
Cytochrome P-450 enzyme system
- From:
Adverse Drug Reactions Journal
2020;22(10):573-576
- CountryChina
- Language:Chinese
-
Abstract:
A 56-year-old male patient with tuberculosis complicated by infection did not get better after treatment with moxifloxacin combined with rifampicin, isoniazid, ethambutol, and pyrazinamide. The invasive pulmonary aspergillosis was diagnosed by bronchoalveolar lavage fluid culture and detection of 1, 3-beta-D-glucan, galactomannan antigen, and Aspergillus antibody. Moxifloxacin and anti-tuberculosis drugs were discontinued and an IV infusion of voriconazole (the dose was 300 mg once per 12 hours on the first day, the maintenance dose was 150 mg once per 12 hours) was given. On the 5th day of medication, the plasma concentration of voriconazole was zero. The consultation pharmacist considered that the voriconazole plasma concentration was related to rifampicin. The next day, the dose of voriconazole was adjusted to 200 mg once per 12 hours. Two days later, the plasma concentration of voriconazole was 1.3 mg/L. The patient′s cough and expectoration were relieved, but he still repeatedly developed high fever. On the 9th day of increase of voriconazole dose, intravenous infusion of methylprednisolone 40 mg once daily was given because connective tissue disease could not be excluded by consulting rheumatologists. The patient′s temperature returned to normal the next day and the plasma concentration of voriconazole was 3.0 mg/L. Clinical pharmacists and physicians reviewed the literature and reached a consensus: the induction effect of rifampicin on drug metabolizing enzymes in the body can last for 7-10 days or even longer after discontinuation of the drug, the monitoring of plasma concentration of voriconazole should be strengthened in patients treated with rifampicin sequential voriconazole, and the dose of voriconazole should be adjusted according to the plasma concentration until the induction effect of rifampicin on drug metabolizing enzymes completely disappears and the plasma concentration of voriconazole reaches a steady state.
