OBJECT DRUGS

• Rifabutin (Mycobutin)

PRECIPITANT DRUGS

Antidepressants:

• Fluvoxamine (Luvox, etc.)
• Nefazodone

Comment:

Rifabutin serum concentrations can be markedly increased by CYP3A4 inhibitors; toxicity is often manifested by uveitis but rash, bone marrow suppression, and increased hepatic enzymes can also occur.

Class 2: Use Only if Benefit Felt to Outweigh Risk

• Use Alternative: Sertraline (Zoloft), citalopram (Celexa), escitalopram (Lexapro), venlafaxine (Effexor), and paroxetine (Paxil) appear less likely to inhibit CYP3A4. Fluoxetine (Prozac) appears to be a weak inhibitor of CYP3A4.
• Circumvent/Minimize: Rifabutin dose may require reduction if used with CYP3A4 inhibitors.
• Monitor: If CYP3A4 inhibitors are used with rifabutin, monitor for rifabutin toxicity.