Successful Anticoagulation With Warfarin After Switching From Rifampin to Rifabutin

Author:

Alnewais Marwah E.12ORCID,Landolfa Samantha L.3,Bean Madelyne4,Fermo Joli D.5

Affiliation:

1. King Faisal University, Alahsa, Saudi Arabia

2. Boston Medical Center, Boston, MA, USA

3. Christiana Care Health System, Newark, DE, USA

4. Independent Researcher, USA

5. Medical University of South Carolina, Charleston, SC, USA

Abstract

Purpose:A case of a patient receiving warfarin for pulmonary embolism (PE) concomitantly with rifampin for treatment of active pulmonary tuberculosis (PTB) is presented. A successful clinical intervention whereby the patient achieved therapeutic anticoagulation after switching to an alternative rifamycin antibacterial, rifabutin, is described.Summary:The drug-drug interaction between warfarin and rifampin is well known and documented. However, to our knowledge, no case reports of the interaction between warfarin and rifabutin have been published, and literature describing this interaction is lacking. We describe the case of a 27-year-old African American female referred to a pharmacist-managed anticoagulation clinic for treatment of PE with warfarin. The patient was also being treated for active tuberculosis with rifampin, isoniazid, pyrazinamide, and ethambutol. Warfarin was initiated and over the course of 1 month was continuously increased to a total weekly dose (TWD) of 140 mg without ever achieving the target international normalized ratio (INR) of 2 to 3. In an attempt to reach the target INR, rifampin was switched to rifabutin to minimize the drug-drug interaction with warfarin. Six days after this switch, the target INR was achieved with a lower warfarin TWD of 115 mg. Rifabutin interacts with warfarin to a lesser degree than rifampin and may be considered as an alternative in patients taking warfarin who require treatment with a rifamycin.Conclusion:For patients in whom therapeutic anticoagulation with warfarin has been difficult, the use of rifabutin may be considered in place of rifampin when the concomitant use of a rifamycin is required.

Publisher

SAGE Publications

Subject

Public Health, Environmental and Occupational Health,Community and Home Care

Reference19 articles.

1. Antithrombotic Therapy for VTE Disease

2. COUMADIN®. (warfarin sodium) tablets [package insert on the Internet]. Princeton, NJ: Bristol-Myers Squibb Company. 2011. https://www.accessdata.fda.gov/drugsatfda_docs/label/2011/009218s107lbl.pdf

3. Update on the Interaction of Rifampin and Warfarin

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

5. Difficulties in Anticoagulation Management during Coadministration of Warfarin and Rifampin

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