Rifampicin/tolvaptan interaction
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Drug level in blood decreased: case report A 66-year-old patient [sex not stated] experienced decreased level of tolvaptan in blood during concurrent administration of rifampicin and tolvaptan [routes and not all dosages stated]. The patient presented with disseminated tuberculosis and tuberculous meningitis. Treatment with isoniazid, pyrazinamide, rifampicin, and ethambutol was initiated. During the hospitalisation, the patient developed hyponatraemia. Several laboratory tests were done, and a diagnosis of syndrome of inappropriate antidiuresis was made. The patient received treatment with tolvaptan at an initial dose of 7.5 mg/day. However, the natraemia got worsened, and the tolvaptan dose was increased to 37.5 mg/day. The patient’s natraemia normalised in few days, and no recurrence was noted on follow-up visit after 1 month. Rifampicin is a strong inductor of cytochrome P450-dependent monooxygenases, notably CYP3A4, with which, tolvaptan gets metabolised. Thus, the coadministration of tolvaptan with rifampicin lead to decreased concentration and effects of tolvaptan. Piccica M, et al. Tolvaptan efficacy and drug-drug interactions. Minerva Endocrinologica 45: 264-265, No. 3, Sep 2020. Available from: URL: http://doi.org/10.23736/ 803518677 S0391-1977.20.03189-2
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Reactions 5 Dec 2020 No. 1833
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