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Related Experiment Videos

Rifampin-fluconazole interaction in critically ill patients

D P Nicolau1, H M Crowe, C H Nightingale

  • 1Division of Infectious Disease, Hartford Hospital, CT 06102, USA.

The Annals of Pharmacotherapy
|October 1, 1995
PubMed
Summary
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Rifampin significantly reduces fluconazole levels in critically ill patients, lowering the area under the curve by 52%. This interaction necessitates close patient monitoring to prevent treatment failure when coadministering these drugs.

Area of Science:

  • Pharmacology
  • Critical Care Medicine
  • Infectious Diseases

Background:

  • Fluconazole is a widely used antifungal agent with a favorable safety profile and few known drug interactions.
  • Coadministration of fluconazole with rifampin is sometimes clinically necessary.
  • Previous studies in healthy volunteers indicated a 23% reduction in fluconazole's area under the concentration-time curve (AUC) when given with rifampin.

Observation:

  • This study investigated the pharmacokinetics of fluconazole in 5 critically ill patients, including 2 who received concurrent rifampin therapy.
  • Patient 1 received rifampin for 9 days alongside fluconazole for suspected fungal superinfection.
  • Patient 2 received intravenous rifampin and fluconazole for pneumonia and ventilatory insufficiency.

Findings:

Related Experiment Videos

  • Concurrent administration of rifampin resulted in a statistically significant 52% reduction in fluconazole's AUC.
  • Total body clearance of fluconazole was 93% higher in patients treated with rifampin.
  • This observed interaction is more pronounced than previously reported in healthy volunteers.

    • Implications:

    • The substantial decrease in fluconazole serum concentrations due to rifampin coadministration may compromise treatment efficacy.
    • Clinicians should closely monitor patient response when fluconazole and rifampin must be administered together.
    • These findings highlight the importance of considering drug-drug interactions in critically ill patients to optimize therapeutic outcomes.