Rifamycins and Psychotropic Drugs: Drug Drug Interactions

General Tuberculosis (TB) Therapy Information
Many psychotropic drugs are metabolized via the Cytochrome P450 (CYP450) enzymatic system in the liver . Rifampin is a potent inducer of the Cytochrome P450 and accounts for many of the drug interactions that occur during TB therapy.
Rifabutin is a weaker inducer of the Cytochrome P450 system, potentially interacting with some of the same medications as Rifampin. Enzyme induction effects can last 2-4 weeks after discontinuation of a rifamycin. Medications should be readjusted after
the discontinuation of rifamycin treatment.

Anti-Psychotics

Brand
Abilify

Generic
aripiprazole

Clinical Uses
Schizophrenia, Bi-Polar Disorder, Major
Depressive Disorder

Interactions
RIF: theoretically ? aripiprazole levels

Recommendations
Increase clinical monitoring; consider dose adjustment at initiation of therapy with a rifamycin.

Brand
Clozarine

Generic
clozapine

Clinical Uses
Schizophrenia

Interactions
RIF: ? clozapine to sub-therapeu??c levels

Recommendations
Increase clinical monitoring; consider dose adjustment at initiation of therapy with a rifamycin.

Brand
Geodon

Generic
ziprasidone

Clinical Uses
Schizophrenia, Bi-Polar Disorder

Interactions
RIF: may ? ziprasidone levels

Recommendations
Increase clinical monitoring; consider dose adjustment at initiation of therapy with a rifamycin.

Brand
Haldol

Generic
haloperidol

Clinical Uses
Tourette's Disorder

Interactions
RIF: may ? haloperidol clearance

Recommendations
Increase clinical monitoring; consider dose adjustment at initiation of therapy with a rifamycin.

Brand
Invega

Generic
paliperidone

Clinical Uses
Schizophrenia

Interactions
RIF: may slightly ? paliperidone levels

Recommendations
Increase clinical monitoring; consider dose adjustment at initiation of therapy with a rifamycin.

Brand
Risperdal

Generic
risperidone

Clinical Uses
Schizophrenia,Bi-Polar Disorder, Major
Depressive Disorder

Interactions
RIF: ? risperidone levels 43%-51%

Recommendations
Increase clinical monitoring; consider dose adjustment at initiation of therapy with a rifamycin. Consider switching to
alternate anti-psychotic agent. Alternate recommendation: (Co-administration of risperidone with rifampin avoided in
clinical practice.)

Brand
Seroquel

Generic
quetiapine

Clinical Uses
Schizophrenia, Bi-Polar Disorder,
Alzheimer's Disease

Interactions
RIF: theoretically ? que??apine levels

Recommendations
Increase clinical monitoring; consider dose adjustment at initiation of therapy with a rifamycin.

Brand
Zyprexa

Generic
olanzapine

Clinical Uses
Schizophrenia, Bi-Polar Disorder

Interactions
RIF: may ? olanzapine clearance

Recommendations
Increase clinical monitoring; consider dose adjustment at initiation of therapy with a rifamycin.

Anti-Anxiety Agents

Brand
Ambien

Generic
zolpidem

Clinical Uses
Insomnia

Interactions
RIF: ? zolpidem levels 63%

Recommendations
Increase clinical monitoring; consider dose adjustment at initiation of therapy with a rifamycin. Consider switching to
alternate anxiolytic agent or anti-depressant.

Brand
Buspar

Generic
buspirone

Clinical Uses
Anxiety Disorders

Interactions
RIF: ? anxioly??c effects of buspirone; ? 83.7% -
89.6% levels

Recommendations
Buspirone should be avoided in patients receiving rifampin . Buspirone should be used only with caution and consideration
of appropriate dosage adjustment. Increase clinical monitoring.

Brand
Valium

Generic
diazepam

Clinical Uses
Anxiety Disorders, Muscle Spasms

Interactions
RIF: ? diazepam effec??veness

Recommendations
Increase clinical monitoring; consider dose adjustment at initiation of therapy with a rifamycin.

Brand
Versed

Generic
midazolam

Clinical Uses
Anxiety Disorders, Surgical Premedication

Interactions
RIF: ? anxioly??c effects of midazolam; ? plasma
concentrations ( 95.9% decrease in AUC) and
pharmacodynamic effects of midazolam

Recommendations
Midazolam should be avoided in patients receiving rifampin . Midazolam should be used only with caution and
consideration of appropriate dosage adjustment. Increase clinical monitoring is recommended when a patient is
concurrently receiving midazolam and a rifamycin.

Brand
Xanax

Generic
alprazolam

Clinical Uses
Anxiety Disorders, Panic Disorders

Interactions
RIF: theoretically ?alprazolam levels

Recommendations
Increase clinical monitoring; consider dose adjustment at initiation of therapy with a rifamycin.

Anti-Depressants

Brand
Aventyl

Generic
nortriptyline

Clinical Uses
Depression

Interactions
RIF: may ? to subtherapeu??c levels

Recommendations
Increase monitoring; consider dose adjustment of anti-depressant agents or alternative therpauetic agents.

Brand
Celexa

Generic
citalopram

Clinical Uses
Depression

Interactions
RIF: ? citalopram levels

Recommendations
Increase monitoring; consider dose adjustment of anti-depressant agents or alternative therpauetic agents.

Brand
Cymbalta

Generic
duloxetine

Clinical Uses
Depression, Generalized Anxiety
Disorder, Diabetic Neuropathy,
Fibromyalgia, Osteoarthritis Pain

Interactions
RIF: may ? effects of duloxetine

Recommendations
Increase monitoring; Consider dose adjustment of anti-depressant agents or alternative therpauetic agents.

Brand
Desyrel

Generic
trazodone

Clinical Uses
Depression

Interactions
RIF: may ? effects of trazodone

Recommendations
Increase monitoring; consider dose adjustment of anti-depressant agents or alternative therpauetic agents.

Brand
Effexor XR

Generic
venlafaxine

Clinical Uses
Depression, Social Anxiety
Disorder,Panic Disorders

Interactions
RIF: may ? effects of venlafaxine

Recommendations
Increase monitoring; consider dose adjustment of anti-depressant agents or alternative therpauetic agents.

Brand
Lexapro

Generic
escitalopram

Clinical Uses
Depression, Generalized Anxiety Disorder

Interactions
RIF: may ? escitalopram (When coadministered
with a potent 3A4 inhibitor (ritonavir), it did not
significantly affect the pharmacokinetics of
escitalopram.)

Recommendations
Low likelihood of interaction, patient should be monitored for evidence of interactions. Consider dose adjustment at
initiation of therapy with rifampin and after cessation of rifampin treatment. Consider switching to alternate antidepressant.

Brand
Pristiq

Generic
desvenlafaxine

Clinical Uses
Depression

Interactions
RIF: may ? effects of desvenlafaxine

Recommendations
Increase monitoring; consider dose adjustment of anti-depressant agents or alternative therpauetic agents.

Brand
Wellbutrin XL

Generic
bupropion HCl

Clinical Uses
Depression, Seasonal Affective Disorder,
Smoking Cessation

Interactions
RIF: may ? effects of bupropion

Recommendations
Increase monitoring; consider dose adjustment of anti-depressant agents or alternative therpauetic agents.

Brand
Zoloft

Generic
sertraline

Clinical Uses
Depression, Obsessive Compulsive
Disorder, Post Traumatic Stress
Disorder,Social Anxiety Disorder,
Premenstrual Dysphoric Disorder

Interactions
RIF: may bring about the loss of sertraline efficacy;
may double sertraline clearance

Recommendations
Increase monitoring; consider dose adjustment of anti-depressant agents or alternative therpauetic agents.

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