Rifampin, but not rifabutin, may produce opiate withdrawal in buprenorphine-maintained patients

Abstract: Background: This series of studies examines the pharmacokinetic/pharmacodynamic interactions between buprenorphine, an opioid partial agonist increasingly used in treatment of opioid dependence, and rifampin, a medication used as a first line treatment for tuberculosis; or rifabutin, an alternative antituberculosis medication.Methods: Opioid-dependent individuals on stable doses of buprenorphine/naloxone underwent two, 24-h blood sampling studies: (1) for buprenorphine pharmacokinetics and (2) following 15 days of rifampin 600mg daily or rifabutin 300mg daily for buprenorphine and rifampin or rifabutin pharmacokinetics.Results: Rifampin administration produced significant reduction in plasma buprenorphine concentrations (70% reduction in mean area under the curve (AUC); p= (Sourc…