Drug Interactions between rilpivirine and troleandomycin

Food significantly increases the absorption of rilpivirine. You should take each dose of rilpivirine with a meal. Taking it on an empty stomach may lead to inadequate blood levels and reduced effectiveness of the medication. Grapefruit juice can also increase the absorption of rilpivirine and should preferably be avoided.

Troleandomycin is primarily excreted by the liver and may accumulate in patients with impaired hepatic function. In addition, the use of troleandomycin has been associated with an allergic type of cholestatic hepatitis, particularly in patients receiving the drug for more than 2 weeks or given repeated courses. Therapy with troleandomycin should be administered cautiously in patients with liver and/or biliary disease. Liver function tests should be monitored during prolonged or repeated courses of therapy, and the drug discontinued if abnormalities develop.

Clostridioides difficile-associated diarrhea (CDAD), formerly pseudomembranous colitis, has been reported with almost all antibacterial drugs and may range from mild diarrhea to fatal colitis. The most common culprits include clindamycin and lincomycin. Antibacterial therapy alters the normal flora of the colon, leading to overgrowth of C difficile, whose toxins A and B contribute to CDAD development. Morbidity and mortality are increased with hypertoxin-producing strains of C difficile; these infections can be resistant to antimicrobial therapy and may require colectomy. CDAD must be considered in all patients who present with diarrhea after antibacterial use. Since CDAD has been reported to occur more than 2 months after antibacterial use, careful medical history is necessary. Therapy with broad-spectrum antibacterials and other agents with significant antibacterial activity should be administered cautiously in patients with history of gastrointestinal disease, particularly colitis; pseudomembranous colitis (generally characterized by severe, persistent diarrhea and severe abdominal cramps, and sometimes associated with the passage of blood and mucus), if it occurs, may be more severe in these patients and may be associated with flares in underlying disease activity. Antibacterial drugs not directed against C difficile may need to be stopped if CDAD is suspected or confirmed. Appropriate fluid and electrolyte management, protein supplementation, antibacterial treatment of C difficile, and surgical evaluation should be started as clinically indicated.

Troleandomycin is primarily excreted by the liver and may accumulate in patients with impaired hepatic function. In addition, the use of troleandomycin has been associated with an allergic type of cholestatic hepatitis, particularly in patients receiving the drug for more than 2 weeks or given repeated courses. Therapy with troleandomycin should be administered cautiously in patients with liver and/or biliary disease. Liver function tests should be monitored during prolonged or repeated courses of therapy, and the drug discontinued if abnormalities develop.

Depressive symptoms including suicide ideation and suicide attempts have been reported with the use of rilpivirine. Patients should be monitored for the appearance of these symptoms and should seek medical evaluation immediately if severe depressive symptoms occur. Caution should be used in patients with a history of depression or other psychiatric conditions.

Hepatic adverse events have been reported in patients taking rilpivirine. Patients with underlying hepatitis B or C virus infection or marked transaminase elevations prior to therapy may be at increased risk for worsening or development of transaminase elevations; a few cases of hepatic toxicity have been reported in patients without preexisting hepatic disease or other known risk factors. Appropriate laboratory testing before starting therapy and monitoring for hepatotoxicity during therapy are recommended in patients with underlying hepatic disease (e.g., hepatitis B or C virus infection) or in patients with marked baseline transaminase elevations. Rilpivirine has not been studied in patients with severe liver dysfunction (Child-Pugh C); caution is recommended.

Depressive symptoms including suicide ideation and suicide attempts have been reported with the use of rilpivirine. Patients should be monitored for the appearance of these symptoms and should seek medical evaluation immediately if severe depressive symptoms occur. Caution should be used in patients with a history of depression or other psychiatric conditions.

Rilpivirine should be used with caution and with increased monitoring for side effects in patients with severe renal dysfunction or end-stage renal disease, as drug concentrations can be increased due to alteration of drug absorption, distribution, and metabolism secondary to renal dysfunction. No dose adjustment is required in patients with mild or moderate renal dysfunction.