Summary
Rifampicin, an antituberculosis agent, is known to be a potent inducer of microsomal drug-metabolizing enzymes in the liver. Elimination or clearance of many drugs has been reported to be enhanced, and their effectiveness reduced; however, no report in the literature has dealt with the interaction between rifampicin and dihydropiridine calcium entry-blocking drugs such as nifedipine. We present here evidence for the possible interaction between rifampicin and nifedipine in a patient with angina pectoris, which was exacerbated during coadministration or rechallenge with rifampicin. The peak plasma level and area under the curve were reduced and the apparent oral clearance of nifedipine was increased by rifampicin, suggesting that rifampicin enhanced the elimination of nifedipine via induction of a hepatic microsomal drug-metabolizing enzyme, as has been reported on other drugs widely metabolized in the liver.
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References
Baciewicz AM, Self TH (1984) Rifampin drug interaction. Arch Intern Med 144: 1667–1671
Baciewicz AM, Self TH, Bekemeyer WB (1987) Update on rifampin drug interactions. Arch Intern Med 147: 565–568
Peter U, Hausamen TU, Grosse-Brockhoff F (1974) Einfluss von Tuberkulostatika auf die Pharmakokinetik des Digitoxins. Dtsch Med Wochenschr 99: 2381–2386
Twum-Barima Y, Carruthers SG (1981) Quinidine-rifampin interaction. N Engl J Med 304: 1466–1469
Robson RA, Miners JO, Wing LMH, Birkett DJ (1984) Theophylline-rifampicin interaction: Non-selective induction of theophylline metabolic pathway. Br J Clin Pharmacol 18: 445–448
Jozequel AM, Orlandi F, Tenconi LT (1971) Changes of the smooth endoplasmic reticulum induced by rifampicin in human and guinea pig hepatocytes. Gut 12: 984–987
Shoene B, Fleischmann RA, Remmer H (1973) The cytochrome P-450 contents and the activities of various microsomal enzymes in human liver. Pathol Biol 21: 255–263
Nocke-Finck L, Breuer H, Reimers D (1973) Effects of rifampicin on menstrual cycle and on estrogen excretion in patients taking oral contraceptives, JAMA 226: 378
Maiseg DN, Brown RC, Day JL (1974) Rifampicin and cortisone replacement therapy. Lancet 2: 896–897
O'Reilly RA (1974) Interaction of sodium warfarin and rifampin. Ann Intern Med 81: 337–340
Langhoff E, Madsens (1983) Rapid metabolism of cyclosporin and predonisone in kidney transplant patient receiving tuberculostatic treatment. Lancet 2: 1031
Bennet PN, John VA, Whitmarsh VB (1982) Effect of rifampicin on metoprolol and antipyrine kinetics. Br J Clin Pharmacol 16: 565–569
Rahn KM, Mooy J, Bohn R (1985) Reduction of bioavailability of verapamil by rifampin. N Engl J Med 312: 920–921
McAllister RG (1982) Clinical pharmacology of slow channel blocking agents. Prog Cardiovasc Dis 25: 83–102
Guengerich FP, Martin MV, Beaune PH, Kremers P, Wolff T, Waxman DJ (1986) Characterization of rat and human liver microsomal cytochrome P-450 forms involved in nifedipine oxidation, a prototype for genetic polymorphism in oxidative drug metabolism. J Biol Chem 261: 5051–5060
Water DD, Bouchard A, Theróux P (1983) Spontaneous remission is a frequent outcome of variant angina. J Am Coll Cardiol 1: 195–199
Blei At, Garcia-Tsao G, Groszmann RJ, Kahrilas P, Ganger D, Morse S, Fung HO (1987) Hemodynamic evaluation of isosorbide dinitrate in alcoholic cirrhosis. Gastroenterology 93: 576–583
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Tsuchihashi, K., Fukami, K., Kishimoto, H. et al. A case of variant angina exacerbated by administration of rifampicin. Heart Vessels 3, 214–217 (1987). https://doi.org/10.1007/BF02058314
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DOI: https://doi.org/10.1007/BF02058314