KMID : 1009020230210020391
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Clinical Psychopharmacology and Neuroscience 2023 Volume.21 No. 2 p.391 ~ p.394
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Rifampin ? Risperidone and Divalproex Drug-drug Interaction: A Case Report
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Park Seo-Young
Park Young-Min
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Abstract
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Rifampin is a potent hepatic cytochrome enzyme inducer, promoting the metabolism of many drugs. Here, we describe a case wherein rifampin-induced drug interactions affected the clinical improvement of a patient on psychiatric drugs for bipolar disorder. He was administered divalproex, risperidone, quetiapine, and clonazepam, along with anti-tuberculosis drugs HERZ, containing 600 mg rifampin. Despite taking 900 mg/day divalproex, his serum valproate levels were below 2 ¥ìg/ml, and his manic symptom persisted. Therefore, the antipsychotic risperidone (5 mg) was replaced with olanzapine (20 mg). Following this, his manic symptoms improved rapidly. Rifampin is a potent CYP3A and CYP2D6 inducer and is known to significantly reduce serum risperidone levels. Thus, even a high dose of risperidone did not induce a significant clinical effect, which was observed immediately after replacing with olanzapine. Therefore, drug interactions may have had a significant effect on clinical outcomes. Clinicians should be cognizant of drug interactions when treating psychiatric patients on rifampin therapy. The case has been sufficiently revised to protect the patient¡¯s personal information.
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KEYWORD
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Rifampin, Divalproex, Risperidone, Antipsychotic agents, Bipolar disorder, Drug interactions
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