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Pharmacokinetic interactions of psychotropic medications in patients with schizophrenia suffering from atypical mycobacterial infections

Published online by Cambridge University Press:  13 August 2021

M. Betriu Sabaté ,
A. González-Rodríguez ,
A. Guàrdia ,
E. Pérez-Macho ,
A. Alvarez Pedrero ,
S. Acebillo ,
J.A. Monreal ,
D. Palao Vidal  and
J. Labad
M. Betriu Sabaté*
Affiliation:
Mental Health, Parc Tauli University Hospital, Sabadell, Spain
A. González-Rodríguez
Affiliation:
Mental Health, Parc Taulí University Hospital. Autonomous University of Barcelona (UAB). I3PT, Sabadell, Spain
A. Guàrdia
Affiliation:
Mental Health, Parc Taulí University Hospital. Autonomous University of Barcelona (UAB). I3PT, Sabadell, Spain
E. Pérez-Macho
Affiliation:
Emergency Service, Hospital Universitario Ramón y Cajal, Madrid, Spain
A. Alvarez Pedrero
Affiliation:
Mental Health, Parc Taulí University Hospital. Autonomous University of Barcelona (UAB). I3PT, Sabadell, Spain
S. Acebillo
Affiliation:
Mental Health, Parc Taulí University Hospital. Autonomous University of Barcelona (UAB). I3PT, Sabadell, Spain
J.A. Monreal
Affiliation:
Mental Health., Hospital Universitari Mútua de Terrassa. CIBERSAM, Terrassa, Spain
D. Palao Vidal
Affiliation:
Department Of Mental Health, Parc Taulí University Hospital. Autonomous University of Barcelona (UAB). I3PT. CIBERSAM, Sabadell, Spain
J. Labad
Affiliation:
Mental Health, Hospital of Mataró. Consorci Sanitari del Maresme. CIBERSAM., Mataró, Spain
*
*Corresponding author.

Abstract

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Introduction

Mycobacterium kansasii is a nontuberculous mycobacterium that causes infection associated with past or current tuberculosis disease. Clinical syndromes and radiological findings are mostly indistinguishable from that of Mycobacterium tuberculosis, thus requiring microbiological confirmation.

Objectives

We report a case of a 44-year-old man diagnosed with schizophrenia and Mycobacterium kansasii infection.

Methods

Case report and non-systematic narrative review from PubMed.

Results

Case report: Patient with schizophrenia who was admitted at the inpatient unit presenting psychotic exacerbation with high levels of excitement. Risperidone 6 mg/day and valproate 500 mg/day were initiated. He was also diagnosed with a M. kansasii lung infection, with radiological findings of past tuberculosis disease. Before the microbiological confirmation, it was necessary to start rifampicin, requiring an increase in doses of both psychotropic drugs. Review: (1)Comorbidity of mycobacterial infections and schizophrenia. Several studies have shown that people with severe mental illness have higher rates of tuberculosis compared with the general population. Although the relationship between tuberculosis and M. Kansasii infection is known, few literature is available with regard to the association of M. Kansasii and schizophrenia. (2)Interactions between antipsychotics and mood stabilizers with rifampicin. Rifampicin is mainly metabolized by CYP3A4 and transported by P-glycoprotein. Add-on with rifampicin have been reported to reduce clozapine and olanzapine plasma levels (despite both are metabolized by CYP1A2), reduce haloperidol and risperidone levels (possible role of P-glycoprotein in this interaction), as well as for valproate.

Conclusions

Treatment of comorbid infections in people with schizophrenia remains a challenge. Antibiotics used to treat mycobacterial infections can modify the pharmacokinetic of psychotropic drugs.

Disclosure

No significant relationships.

Keywords

schizophréniaMycobacteriuminfectiontherapeutic drug monitoring
Type
Abstract
Information
European Psychiatry , Volume 64 , Special Issue S1: Abstracts of the 29th European Congress of Psychiatry , April 2021 , pp. S649 - S650
Creative Commons
Creative Common License - CCCreative Common License - BY
This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Copyright
© The Author(s), 2021. Published by Cambridge University Press on behalf of the European Psychiatric Association
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