Rifampin-divalproex drug-drug interaction in an adult patient: A case report

Rifampin-divalproex drug-drug interaction in an adult patient: A case report

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The divalproex (DVP) package insert states that rifampin may increase the oral clearance of valproate by 40% and that valproic acid derivative dose adjustments may be required when starting or stopping rifampin.However, the overall clinical significance of this drug-drug interaction remains unclear given that limited clinical outcome data has been published.This case describes a 52-year-old female with bipolar disorder, borderline personality disorder, and PTSD who was previously stable on nightstick twm-850xl a medication regimen consisting of DVP delayed-release 500 mg every morning and 1500 mg every evening (baseline steady-state trough 99.

8 mcg/mL).Throughout rifampin therapy for latent tuberculosis treatment, she required an increase in both the frequency of DVP administration, from 2 to 3 times daily, and DVP dose by 75% to maintain clinical stability.Valproic acid trough concentrations ranged from 56.

4 to 75.9 mcg/mL during the 4-month course of rifampin.This report supports that the DVP-rifampin interaction may be clinically abc material significant and of a greater magnitude than suggested by the package insert.