Rifampin Reduces Oral Morphine Absorption: A Case of Transdermal Buprenorphine Selection Based on Morphine Pharmacokinetics

Jeffrey FudinJeffrey Fudin, BS, PharmD, FCCP, DAAPM, is a clinical pharmacy specialist in pain management and Director of the Pharmacy Pain Residency at the Samuel Stratton VA Medical Center, Albany, New York, and Adjunct Associate Professor of Pharmacy Practice at Albany College of Pharmacy and Health Sciences, Albany, New York, USA. Dania Vanesta Fontenelle is a Doctor of Pharmacy candidate at the Albany College of Pharmacy and Health Sciences. Annette Payne, PhD, is Chief of Psychology, Samuel Stratton VA Medical Center, Albany, New York, USA.Correspondence[email protected]

Dania Vanesta FontenelleJeffrey Fudin, BS, PharmD, FCCP, DAAPM, is a clinical pharmacy specialist in pain management and Director of the Pharmacy Pain Residency at the Samuel Stratton VA Medical Center, Albany, New York, and Adjunct Associate Professor of Pharmacy Practice at Albany College of Pharmacy and Health Sciences, Albany, New York, USA. Dania Vanesta Fontenelle is a Doctor of Pharmacy candidate at the Albany College of Pharmacy and Health Sciences. Annette Payne, PhD, is Chief of Psychology, Samuel Stratton VA Medical Center, Albany, New York, USA.

Annette PayneJeffrey Fudin, BS, PharmD, FCCP, DAAPM, is a clinical pharmacy specialist in pain management and Director of the Pharmacy Pain Residency at the Samuel Stratton VA Medical Center, Albany, New York, and Adjunct Associate Professor of Pharmacy Practice at Albany College of Pharmacy and Health Sciences, Albany, New York, USA. Dania Vanesta Fontenelle is a Doctor of Pharmacy candidate at the Albany College of Pharmacy and Health Sciences. Annette Payne, PhD, is Chief of Psychology, Samuel Stratton VA Medical Center, Albany, New York, USA.

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.

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Rifampin Reduces Oral Morphine Absorption: A Case of Transdermal Buprenorphine Selection Based on Morphine Pharmacokinetics

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Rifampin Reduces Oral Morphine Absorption: A Case of Transdermal Buprenorphine Selection Based on Morphine Pharmacokinetics

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