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Possible Interaction of the Gut-selective Antibiotic Rifaximin with Carvedilol Associated with Transient Indirect
Dawesh Prakash Yadav1, Aakanksha Jaiswal2, Siddhartha Vats1
1Department of Gastroenterology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, 221005, India.
Introduction:
Rifaximin is a gut-selective antimicrobial with poor bioavailability. One potential indication of rifaximin use is hepatic encephalopathy. The adverse effects are limited to the gastrointestinal system, and systemic disturbances are rare. We report a case of hyperbilirubinemia possibly associated with rifaximin-carvedilol co-administration.
Case Presentation:
A 58-year-old male with chronic liver disease (Child Pugh class B) of probable autoimmune etiology and associated chronic kidney disease developed transient indirect hyperbilirubinemia temporally associated with rifaximin-carvedilol co-administration. The hyperbilirubinemia improved with the discontinuation of both drugs.
Conclusion:
This appears to be the first report of new-onset indirect hyperbilirubinemia with rifaximin in the presence of carvedilol in a patient with chronic liver disease of autoimmune etiology. Carvedilol-mediated P-glycoprotein inhibition represents a biologically plausible but unproven mechanism for overexposure to rifaximin. Clinical studies are warranted to assess the potential consequences of P-glycoprotein-mediated modulation of rifaximin pharmacokinetics in patients with chronic liver and renal disease.
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