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Rifabutin-associated uveitis
1Wellesley Health Center, University of Toronto, Ontario, Canada.
The Annals of Pharmacotherapy
|November 1, 1995
Summary
Rifabutin-associated uveitis is a rare, dose-related toxicity. Concurrent use of clarithromycin or fluconazole may increase this risk due to drug interactions. Prompt discontinuation of rifabutin is recommended if uveitis develops.
Area of Science:
- Ophthalmology
- Pharmacology
- Infectious Diseases
Background:
- Rifabutin is increasingly used for Mycobacterium avium complex (MAC) infections in HIV patients.
- Uveitis was initially considered a rare, dose-limited side effect of rifabutin.
- Recent reports suggest uveitis may occur at lower, commonly prescribed doses.
Purpose of the Study:
- To review rifabutin-associated uveitis.
- To discuss the mechanism of uveitis.
- To explore the role of drug interactions with clarithromycin and fluconazole.
Main Methods:
- MEDLINE search (1991-1994) for rifabutin and uveitis.
- Inclusion of relevant articles and conference abstracts.
- Synthesis of 54 identified cases of rifabutin-associated uveitis.
Main Results:
- Uveitis occurred 2 weeks to over 7 months after starting rifabutin.
- All patients with uveitis received concurrent clarithromycin and/or fluconazole.
- Drug interactions with clarithromycin/fluconazole may inhibit rifabutin metabolism.
- Uveitis resolved within 1-2 months after rifabutin discontinuation.
Conclusions:
- Rifabutin is frequently prescribed for MAC infections in HIV patients.
- Uveitis is a rare, dose-related toxicity of rifabutin.
- Concurrent clarithromycin or fluconazole may increase the risk of uveitis due to drug interactions.
- Patients should be monitored for uveitis symptoms, and rifabutin discontinued if it develops.