Which antimicrobial agent has been associated with clinically significant withdrawal symptoms in patients maintained on buprenorphine?
Rifampin. Due to strong CYP3A4 induction, rifampin 600 mg daily was associated with a 70% reduction in AUC of buprenorphine and 88% reduction in AUC of norbuprenorphine. Symptoms of withdrawal were identified in 5/12 patients receiving rifampin with onset ranging from day 6-15. Buprenorphine doses were increased by 25-100% for management of withdrawal symptoms and patients were able to return to previous buprenorphine doses between 1-5 days after rifampin cessation. (McCance-Katz EF, et al. Rifampin, but not Rifabutin, May Produce Opiate Withdrawal in Buprenorphine-Maintained Patients. Drug Alcohol Depend 2011 doi: 10.1016/j.drugalcdep.2011.04.013)