Explore the groundbreaking research on the use of verapamil as an adjunctive therapy in tuberculosis treatment. This blog post delves into a recent dose-finding study, shedding light on its potential implications for enhancing the effectiveness of current tuberculosis therapies and contributing to the fight against this global health threat.
– by The Don
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A dose-finding study to guide use of verapamil as an adjunctive therapy in tuberculosis.
Padmapriyadarsini et al., Clin Pharmacol Ther 2023
DOI: 10.1002/cpt.3108
Listen folks, we’ve got a problem with Mycobacterium tuberculosis, or Mtb, and it’s a big one. It’s got these things called efflux pumps, and they’re causing drug tolerance. It’s a real barrier to shortening treatment for tuberculosis, believe me. But we’ve got a solution, and it’s called verapamil. This stuff inhibits those nasty Mtb efflux pumps, and it even limits Mtb growth in macrophages without any antibiotics. It’s fantastic, really fantastic.
But here’s the catch, verapamil gets metabolized pretty quickly when you take it with rifampin, which is a cornerstone of tuberculosis treatment. So, we did a clinical trial, and we found out that we can counter this by giving larger doses of verapamil. We’re talking about 360 mg of sustained-release verapamil every 12 hours with rifampin. And guess what? It worked. The results were similar to those in people taking daily doses of 240 mg verapamil but without rifampin.
And there’s more. Rifampin administration favors the less-cardioactive verapamil metabolites and enantiomers that have similar Mtb efflux inhibitory activity to verapamil. This increases the overall benefit. Plus, rifampin exposures were 50% greater after verapamil administration, which could be a good thing.
So here’s the bottom line: we can safely use a higher dosage of verapamil as an adjunctive treatment in rifampin-containing treatment regimens. It’s a game-changer, folks.