title: Exacerbation of panic disorder with rifampin therapy in a patient receiving citalopram.
abstract: Citalopram, a selective serotonin reuptake inhibitor, is used in the management of anxiety disorders. A 55-year-old man receiving citalopram for panic disorder reported a decrease in the agent's therapeutic efficacy when rifampin was started for osteomyelitis. His condition improved when the rifampin was stopped. Rifampin is known to induce the metabolism of cytochrome P450 3A4 substrates and thus plays a role in several drug-drug interactions. We suspect that the efficacy of citalopram was blunted with the concurrent use of rifampin. To our knowledge, only one other case of an interaction of rifampin with a selective serotonin reuptake inhibitor is described in the literature. Clinicians should monitor all drugs and dietary supplements that patients with psychiatric conditions take, regardless of the indication, intended purpose, or prescriber. This is especially important, however, for a drug that is pivotal to a patient's well-being; its therapeutic effect should be carefully monitored when any new drug is added or a change in the dosage of a concurrent drug is made.
authors.affiliation: Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, Iowa 52242-1112, USA.
authors.forename: Oladipo
authors.initials: O
authors.lastname: Kukoyi
authors.forename: Tami R
authors.initials: TR
authors.lastname: Argo
authors.forename: Ryan M
authors.initials: RM
authors.lastname: Carnahan
mesh_terms: D000900:Anti-Bacterial Agents / Q000009:adverse effects* / Q000627:therapeutic use; D015283:Citalopram / Q000009:adverse effects* / Q000627:therapeutic use; D051544:Cytochrome P-450 CYP3A; D003577:Cytochrome P-450 Enzyme System / Q000096:biosynthesis; D004336:Drug Antagonism; D004790:Enzyme Induction; D006801:Humans; D008297:Male; D008875:Middle Aged; D016584:Panic Disorder / Q000139:chemically induced* / Q000188:drug therapy; D012293:Rifampin / Q000009:adverse effects* / Q000627:therapeutic use; D017367:Selective Serotonin Reuptake Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use; D013203:Staphylococcal Infections / Q000188:drug therapy
chemical_list: D000900:Anti-Bacterial Agents; D015283:Citalopram; D051544:Cytochrome P-450 CYP3A; D003577:Cytochrome P-450 Enzyme System; D012293:Rifampin; D017367:Selective Serotonin Reuptake Inhibitors; C104464:CYP3A protein, human