title: Rifampin reduces oral morphine absorption: a case of transdermal buprenorphine selection based on morphine pharmacokinetics.
abstract: A 51-year-old male was referred to the Stratton Veterans Affairs Medical Center Pain Service after hospital admission for endocarditis with a history of heroin use and chronic low back pain. During his hospital stay he experienced a reduction in his serum morphine level ostensibly as a result of concomitant rifampin administration. We hypothesize that diminished absorption was from rifampin-mediated intestinal P-glycoprotein induction, ultimately decreasing serum free morphine and metabolites. The case became more complex in an attempt to balance managed pain, history of substance abuse, completion of antibiotic therapy, and a reasonable pain regimen upon discharge. Ultimately, the patient was titrated onto a buprenorphine transdermal patch, the initiation of which was based on serum free morphine and an extrapolated oral morphine dose by calculation.
authors.affiliation: Samuel Stratton VA Medical Center, Albany, New York, USA. jeff.fudin@acphs.edu
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Fudin
authors.forename: Dania Vanesta
authors.initials: DV
authors.lastname: Fontenelle
authors.forename: Annette
authors.initials: A
authors.lastname: Payne
mesh_terms: D020168:ATP Binding Cassette Transporter, Subfamily B, Member 1 / Q000187:drug effects / Q000378:metabolism; D000284:Administration, Oral; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000493:pharmacokinetics*; D000904:Antibiotics, Antitubercular / Q000494:pharmacology; D002047:Buprenorphine / Q000008:administration & dosage / Q000627:therapeutic use*; D004347:Drug Interactions; D006787:Hospitals, Veterans; D006801:Humans; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000008:administration & dosage / Q000493:pharmacokinetics*; D012293:Rifampin / Q000494:pharmacology*; D057968:Transdermal Patch
chemical_list: D020168:ATP Binding Cassette Transporter, Subfamily B, Member 1; D000701:Analgesics, Opioid; D000904:Antibiotics, Antitubercular; D002047:Buprenorphine; D009020:Morphine; D012293:Rifampin