MajorAtypical antipsychotics×Antituberculous antibiotic
Updated · Methodology
Mechanism
Rifampicin is the most potent CYP3A4 inducer available. Quetiapine plasma levels fall 5- to 8-fold – clinical inefficacy of the antipsychotic.
Symptoms
Return of positive symptoms: hallucinations, delusions, agitation. In bipolar disorder: manic episode risk.
Management
During anti-TB therapy, increase quetiapine 5-fold with clinical monitoring. Alternative antipsychotics without CYP3A4 dependence: olanzapine or aripiprazole. Alternative anti-TB drug: rifabutin (weaker CYP3A4 induction).
Check the full regimen, not just this pair
Opens the checker with these two drugs prefilled. Add the rest of the regimen and recompute additive risks.
Summary of a multi-drug list →
Medicine list: everything you take in one place →
Sources
- FDA: Rifampin capsule (Ani Pharmaceuticals, Inc.) – Prescribing Information (2010)– ; DailyMed setid b389b1a3-672f-47e3-916c-4a9c044b211b