Department of Clinical Pharmacy, University of California San Francisco, San Francisco, CA 94143, USA.
Am J Health Syst Pharm. 2010 Oct 1;67(19):1611-4. doi: 10.2146/ajhp090516.
The case of a patient with decreased plasma efavirenz concentrations during concomitant rifabutin therapy is reported.
A 42-year-old Hispanic man newly diagnosed with acquired immune deficiency syndrome (AIDS) and coinfected with aseptic meningitis and disseminated Mycobacterium avium complex (MAC) received efavirenz-based highly active antiretroviral therapy (HAART). When the patient was admitted to the hospital, his medications included enoxaparin, metformin, ganciclovir, clarithromycin, ethambutol, rifampin, pyrazinamide, isoniazid, pyridoxine, trimethoprim-sulfamethoxazole, dexamethasone, and tenofovir-emtricitabine- efavirenz. Rifampin was changed to rifabutin 450 mg daily due to the potential interaction with rifampin and efavirenz. Clarithromycin was replaced with azithromycin for the treatment of MAC infection, and dexamethasone was gradually decreased over three months. The established therapeutic plasma concentration of efavirenz is 1-4 μg/mL. After receiving the standard efavirenz dosage of 600 mg daily, the patient had subtherapeutic plasma efavirenz concentrations. To correct these low concentrations, the patient's efavirenz dosage was increased to 800 mg daily; however, his efavirenz concentrations continued to remain subtherapeutic (two concentrations of 0.58 μg/mL). The patient's viral load decreased slowly while on HAART; however, it only became undetectable 12 days after rifabutin was discontinued. The Drug Interaction Probability Scale demonstrated a probable relationship between the coadministration of rifabutin and the decreased efavirenz concentrations due to the possible induction of efavirenz metabolism by rifabutin.
A 42-year-old Hispanic man newly diagnosed with AIDS had subtherapeutic efavirenz levels during concomitant treatment with rifabutin.
报道 1 例同时接受利福布丁治疗时血浆依非韦伦浓度降低的患者病例。
一名 42 岁的西班牙裔男性新诊断为获得性免疫缺陷综合征（AIDS），合并无菌性脑膜炎和播散性鸟分枝杆菌复合群（MAC）感染，接受依非韦伦为基础的高效抗逆转录病毒治疗（HAART）。当患者入院时，他正在服用依诺肝素、二甲双胍、更昔洛韦、克拉霉素、乙胺丁醇、利福平、吡嗪酰胺、异烟肼、吡哆醇、复方磺胺甲噁唑、地塞米松和替诺福韦-恩曲他滨-依非韦伦。由于利福平与依非韦伦有潜在相互作用，利福平被换用利福布丁 450mg 每日 1 次。由于 MAC 感染，克拉霉素被换用阿奇霉素，地塞米松在 3 个月内逐渐减少。依非韦伦的治疗血浆浓度为 1-4μg/mL。给予标准剂量的 600mg 每日 1 次依非韦伦后，患者的血浆依非韦伦浓度低于治疗范围。为了纠正这些低浓度，将患者的依非韦伦剂量增加至 800mg 每日 1 次；然而，他的依非韦伦浓度仍持续低于治疗范围（两次浓度为 0.58μg/mL）。该患者接受 HAART 治疗时，病毒载量缓慢下降，但在停用利福布丁 12 天后才变为不可检测。药物相互作用可能性量表显示，利福布丁与依非韦伦浓度降低之间存在可能的关系，这可能是由于利福布丁诱导了依非韦伦的代谢。
一名新诊断为 AIDS 的 42 岁西班牙裔男性在同时接受利福布丁治疗时，依非韦伦水平低于治疗范围。
