If a patient has a past history of gout, however, it's far more likely and in oftentimes is an indication to Pyrazinamide. One important thing to keep in mind in the management if a patient does develop acute gout is that Colchicine should be avoided as treatment in when using TB medications – because the levels are unpredictable. They are increased by Isoniazid and decreased by Rifamycins. But we can't determine those interactions are not necessarily equal. And, in fact, in this – case the Isoniazid effect can be greater and lead to Colchicine toxicity. Steroids are safe to give; so this question does come up regularly if a person has gout or has some other process that needs steroids and is getting TB treatment. And the answer generally is steroids are safe to give as long as you've got the person on adequate TB treatments. And certainly steroids are recommended in the study of meningeal and pericardial TB; NSAIDs are also safe and a good choice for the management of acute gout. Slide 34 The other option and I think some of the folks chose Rifamycin. And since I didn’t give you a history of gout, the Rifamycin absolutely could have been the cause of his worsening, chronic knee pain. Rifamycin is one of the big considerations always to keep in mind when starting a person on Rifampin, Rifabutin or Rifapentine are the drug interactions. So the Rifamycins cause an increase in hepatic enzymes that are involved in drug metabolism. Rifampin is a very potent inducer and more potent than Rifabutin of these enzymes and Rifapentine probably falls somewhere in between. And it will decrease the effective levels of multiple medications, including narcotic medications like the Vicodin that patient I mentioned was taking; but also things oral contraceptives. HIV protease inhibitors become ineffective in the setting of Rifampin. And so it's contraindicated to give Rifampin in someone who is on HIV treatment with that.
If a patient has a past history of gout, however, it's far more likely and in is an indication to Pyrazinamide. One important thing to keep in mind in the management if a patient does develop acute gout is that Colchicine should be avoided as treatment in – when using TB medications because the levels are unpredictable. They are increased by Isoniazid and decreased by Rifamycins. But we can't determine – those interactions are not necessarily equal. And, in fact, in this case the Isoniazid effect can be greater and lead to Colchicine toxicity. Steroids are safe to give; so this question does come up regularly if a person has gout or has some other process that needs steroids and is getting TB treatment. And the answer generally is steroids are safe to give as long as you've got the person on adequate TB treatments. And certainly steroids are recommended in the study of meningeal and pericardial TB; NSAIDs are also safe and a good choice for the management of acute gout. Slide 34 The other option and I think some of the folks chose Rifamycin. And since I didn’t give you a history of gout, the Rifamycin absolutely could have been the cause of his worsening, chronic knee pain. Rifamycin is one of the big considerations always to keep in mind when starting a person on Rifampin, Rifabutin or Rifapentine are the drug interactions. So the Rifamycins cause an increase in hepatic enzymes that are involved in drug metabolism. Rifampin is a very potent inducer and more potent than Rifabutin of these enzymes and Rifapentine probably falls somewhere in between. And it will decrease the effective levels of multiple medications, including narcotic medications like the Vicodin that patient I mentioned was taking; but also things oral contraceptives. HIV protease inhibitors become ineffective in the setting of Rifampin. And so it's contraindicated to give Rifampin in someone who is on HIV treatment with that. oftentimes
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