Concentrations and effects of buspirone are considerably reduced by rifampicin

Aims The effects of rifampicin on the pharmacokinetics and pharmacodynamics of buspirone, a non-benzodiazepine anxiolytic agent, were investigated. Methods In a randomized, placebo-controlled cross-over study with two phases, 10 young healthy volunteers took either 600 mg rifampicin or matched placebo once daily for 5 days. On day 6, 30 mg buspirone was administered orally. Plasma buspirone concentrations and effects of buspirone were measured up to 10 h. Results The total area under the plasma buspirone concentration-time curve after rifampicin was 10.4% (95% CI, 6.3-14.5%) of that after placebo (1.64 +/- 0.35 ng ml(-1) h vs 22.0 +/- 15.1 ng ml(-1) h (mean +/- s.d.); P<0.01). Rifampicin decreased the peak plasma concentration of buspirone from 6.6 +/- 3.7 ng ml(-1) to 0.84 +/- 0.23 ng ml(-1) (P<0.01) and the half-life from 2.8 +/- 0.7 h to 1.3 +/- 0.5 h (P<0.01). A significant (P<0.05) reduction in the effects of buspirone was observed in three of the six psychomotor tests employed (postural sway test with eyes closed, subjective drowsiness and overall drug effect) after rifampicin pretreatment. Conclusions The strong interaction between rifampicin and buspirone is probably mostly due to enhanced CYP3A4-mediated first-pass metabolism of buspirone. Buspirone will most likely show a greatly reduced anxiolytic effect when used together with rifampicin or other potent inducers of CYP3A4 such as phenytoin and carbamazepine.