Rifampin-warfarin interaction in a mitral valve replacement patient receiving rifampin for infective endocarditis: a case report

Fahmi, Amr Mohamed; Abdelsamad, Osama; Elewa, Hazem

doi:10.1186/s40064-015-1653-8

Cited by 19 publications

(36 citation statements)

References 24 publications

(33 reference statements)

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“…Rifampin, a life-saving antimicrobial for tuberculosis, endocarditis, and meningitis, 14 is a clinically significant inducer of CYP2B6, CYP2C19, CYP2C8, CYP2C9, and CYP3A4, as well as P glycoprotein. 10 It induces CYP2C9 transcription by binding to its main De-novo synthesis regulatory nuclear receptor, pregnane X receptor ( PXR ).…”

Section: Introductionmentioning

confidence: 99%

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Genetic Polymorphism Effect on Warfarin–Rifampin Interaction: A Case Report and Review of Literature

Salem

Eljilany

El-Bardissy

et al. 2021

PGPM

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Warfarin–rifampin interaction has been reported since the 1970s. Due to rifampin’s strong induction of CYP2C9 , most cases could not attain the target international normalized ratio (INR) despite warfarin dose escalation. Genetic polymorphisms determine up to 50% of warfarin dose variability. A 38-year-old woman was started on warfarin and rifampin for cerebral venous sinus thrombosis and pulmonary tuberculosis. Over six weeks, the daily warfarin dose was increased from 3 to 10 mg to attain three consecutive in-clinic therapeutic INRs. She completed three complications-free months of warfarin treatment with time in therapeutic range (TTR) of 46%. We performed retrospective genetic testing to determine the patient’s CYP2C9, CYP4F2 , and VKORC1 genotypes and whether they had affected the interaction outcome. The analysis revealed that the subject carries CYP2C9*3*3 and VKORC1-1639 (GA) mutations, classifying her as a slow metabolizer and, hence, highly warfarin-sensitive. This was reflected on how the case responded to a relatively lower dose than previously reported cases that did not achieve the target on warfarin daily doses up to 35 mg. This is the first report addressing the genotype effect on this interaction. Patients with genetic variants requiring low warfarin doses are more likely to respond at a feasible dose while on rifampin. Future studies to evaluate warfarin–rifampin-gene interaction are warranted.

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Section: Introductionmentioning

confidence: 99%

“… 25–27 After the INR test was universally adopted, 28 several reports demonstrated that most patients who required the anti-infective along with anticoagulation were unable to maintain target INR. 14 , 29–36 …”

Section: Introductionmentioning

confidence: 99%

Genetic Polymorphism Effect on Warfarin–Rifampin Interaction: A Case Report and Review of Literature

Salem

Eljilany

El-Bardissy

et al. 2021

PGPM

Self Cite

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“…For example, rifampin interacts with warfarin resulted from its enzyme inducer activity on CYP2C9, CYP3A4, CYP1A2, and CYP2C19. There was a case report that a female on anticoagulation increased warfarin dose from 52.5 to 210 mg/week with a target INR during the 6-week treatment with rifampin for her infective endocarditis and she was stable on the warfarin dose of 80 mg/week 5 weeks after the end of rifampin therapy ( Fahmi et al, 2016 ). Multiple dose adjustment may occur when FA is combined with CYP1A2 or CYP3A4 substrates with a narrow therapeutic index.…”

Section: Discussionmentioning

confidence: 99%

Potential Metabolic Drug–Drug Interaction of Citrus aurantium L. (Rutaceae) Evaluating by Its Effect on 3 CYP450

et al. 2018

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Aim: Fructus aurantii (FA) is widely used in clinic as an expectorant and digestant herb in traditional Chinese medicine and proven to have a variety of pharmacological functions. FA is close to grapefruit either by botanical taxonomy or by their same components (flavonoids, etc.) and grapefruit has been proven to cause drug–drug interaction when co-administrated with CYP3A4 substrates. Besides, FA contains many compounds, such as flavonoids, which have been reported to impact the expressions of CYP450. However, the effect of FA on CYP450, whose change may affect drug safety and clinical efficacy attributed to drug–drug interaction, still remains unknown.Methods: The protein, mRNA expression and enzyme activity of CYP1A2, CYP3A4, and CYP2E1 in rat were determined by Western Blotting, RT-PCR method, the cocktail method, respectively, after orally administration of FA in succession for 7 days. CYP1A2, CYP3A4, and CYP2E1 mRNA expression were investigated in HepG2 cells following FA-medicated serum incubation for 24 h.Results: In rat, compared to the control group, CYP1A2, CYP3A4 protein, and mRNA expression were significantly induced consistent with the corresponding CYP activities; the protein expression of CYP2E1 was significantly upregulated, while the corresponding mRNA expression and enzyme activity showed no significant change. In HepG2 cells, compared to the control group, the mRNA expression of CYP1A2 and CYP3A4 was up-regulated statistically while CYP2E1 mRNA expression was not significantly induced or inhibited.Conclusion: FA may be a potential slight inducer of CYP1A2 and CYP3A4 and is unlikely to impact CYP2E1 until clinical researches are conducted.

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“…However, LMWH have been proposed as a safe alternative, in case drug interactions are present, due to cytochrome p450 inhibition or induction, such in this case [24,25].…”

Section: Discussionmentioning

confidence: 99%

Heroin with a Twist: Candida Glabrata Endocarditis Concurrent with Brain Mycetomas in an IV Drug User

Panos¹

2017

JMEN

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A 47-year-old male, with a history of IV drug use and usage of fresh lemon juice in the preparation of heroin doses, with hepatitis B and hepatitis C, presented with fever, dyspnea and a new found cardiac murmur at the apex. Echocardiography showed large vegetations on both leaflets of the mitral valve. After blood cultures were drawn an empiric antibiotic regimen was initiated. The mitral valve was successfully replaced surgically. Twenty-four hours post surgically the patient was extubated and was found to be suffering from left hemiplegia. Brain CT scan showed diffused sites of hemorrhage of the brain parenchyma, compatible with septic emboli that had underwent a hemorrhagic conversion. As mycetomas were considered in the differential diagnosis of these lesions, new blood cultures were drawn with an emphasis on the isolation of fungi, as this correlates with the use of lemon juice in the preparation of heroin doses, while the treatment regimen was modified to include an echinocandin to cover extensively for Candida spp. Two sets of blood cultures were positive for Candida glabrata. The patient responded well to the treatment administered and regained a significant amount of mobility.

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Rifampin-warfarin interaction in a mitral valve replacement patient receiving rifampin for infective endocarditis: a case report

Cited by 19 publications

References 24 publications

Genetic Polymorphism Effect on Warfarin–Rifampin Interaction: A Case Report and Review of Literature

Genetic Polymorphism Effect on Warfarin–Rifampin Interaction: A Case Report and Review of Literature

Potential Metabolic Drug–Drug Interaction of Citrus aurantium L. (Rutaceae) Evaluating by Its Effect on 3 CYP450

Heroin with a Twist: Candida Glabrata Endocarditis Concurrent with Brain Mycetomas in an IV Drug User

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