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Adverse effect of rifampicin administration on steroid-dependent asthma
Abstract:
Induction of steroid metabolism has been reported after rifampicin administration but it is not known how much corticosteroid requirements increase and whether disease control can be satisfactorily maintained with increases in corticosteroid dosage. Because rifampicin may be needed in the treatment of tuberculosis in patients with steroid-dependent asthma, the dose of prednisolone needed to control this condition after rifampicin administration (600 mg daily for 6 wk) was determined in 6 patients in a randomized, double-blind, placebo-controlled trial. The plasma elimination half-life and bioavailability of prednisolone decreased significantly after rifampicin administration, but despite an increase of 93% in the dose of prednisolone (p less than 0.02), asthma control remained inferior compared to placebo. Asthma relapse in a seventh patient necessitated withdrawal from the trial after 2 wk of rifampicin administration despite a five-fold increase in prednisolone dosage. It is concluded that despite substantial increases in the dose of prednisolone the coadministration of rifampicin and prednisolone to steroid-dependent patients may seriously complicate their clinical management.
Insights
Rifampicin significantly increases prednisolone dosage requirements in patients with steroid-dependent asthma. Even with a 93% dose increase, asthma control worsened, complicating treatment for tuberculosis patients.
Area of Science:
- Pharmacology
- Pulmonology
- Infectious Diseases
Background:
- Rifampicin induces steroid metabolism, but its impact on corticosteroid requirements and disease control is unclear.
- Tuberculosis treatment may necessitate rifampicin in patients with steroid-dependent asthma.
Purpose of the Study:
- To determine the prednisolone dose needed to control steroid-dependent asthma during rifampicin administration.
- To assess if increased prednisolone dosage can maintain asthma control when co-administered with rifampicin.
Main Methods:
- A randomized, double-blind, placebo-controlled trial involving 6 steroid-dependent asthma patients.
- Patients received rifampicin (600 mg daily for 6 weeks) or placebo.
- Prednisolone dosage was adjusted to maintain asthma control.
Main Results:
- Rifampicin significantly decreased prednisolone plasma elimination half-life and bioavailability.
- A 93% increase in prednisolone dose was insufficient to maintain asthma control compared to placebo (p < 0.02).
- One patient experienced asthma relapse requiring trial withdrawal despite a five-fold prednisolone dose increase.
Conclusions:
- Coadministration of rifampicin and prednisolone complicates clinical management in steroid-dependent asthma patients.
- Substantial increases in prednisolone dosage may not adequately control asthma during rifampicin therapy.
- Careful monitoring and dose adjustments are crucial for managing these patients.