Rifampin Anxiety

I’m new here. Doc started me out on 300mg rifampin once a day, then after 2 weeks increased to 300mg twice a day. After 3 weeks on the higher dose I stared having severe full body anxiety all day. Doc dropped me back down to 300mg once a day. Since then the severE anxiety has let up, but I still have this awful dread and uneasy feeling I can’t shake. Strangely it gets worse when I’m away from home. Please tell me this is normal and goes away or at least gets better after awhile on the treatment. It’s messing with my head and making me feel miserable. Anyone experienced this and have healing still?

Rifampin interacts with many other medications.

Are you by any chance on any medication for anxiety/depression?

It could be interfering with those.

Welcome to the forum! Please feel free to reach out for venting, questions, discussion, etc. Use the search bar to see if there are past threads about topics of interest to you. Also check out the "New to Lyme" sticky thread for some basics, if this is a new area for you. I hope we can be helpful!It might be helpful to know more about your symptoms, your history, your infections, etc. I can tell from your name that mold is an issue for you, so I assume that this feels different from your mold symptoms? What other kids of treatment and supportive measures are you taking? What you are describing sounds like a Bartonella herx to me, since anxiety is so intense with Bartonella. Is that one of the infections you are treating? It makes total sense that you feel worse away from home - more variables, more stimulation, etc. SO sorry you are going through this. Anxiety is just miserable.

I've never had urinary symptoms when my adrenal system is wonky (like Quin mentioned) but anxiety certainly does flare when my adrenal system is taxed, and (irritatingly) also when it's recovering and therefore sensitized to healthier levels of hormone production. I find adaptogenic herbs helpful, but I strongly urge to you try them at a tiny dose (like one drop) because they can be powerful to a depleted system. Do you have any adrenal issues that you know of? Have you had salivary cortisol testing? How about the other hormonal systems? A lot of us end up with HPA axis dysfunction, meaning that some hormones might be in normal range, but others aren't, and when they try to compensate for each other things go haywire.

For those forays out of the house during an anxious period, I find it helpful to have a rescue plan. I keep Rescue Remedy pastilles with me, as well as a roller-ball bottle of a calming essential oils blend. I count colors (three reds, three oranges...), tune into senses (five things I see, four I hear, three I feel, two I smell, one I taste), or play an alphabet game (name an animal that starts with each letter of the alphabet...). I carry a pleasing stone to hold and focus on. Do breathing exercises. Whatever you do, just have a plan for a thing or two to try.

This definitely does not mean that you are not healing. It sounds directly related to your meds. There are other meds, other forms of treatment, and ways to manage the anxiety if you and your doctor feel like this particular med is a necessity. If it's intolerable, then tell your LLMD; it's their job to help you find a treatment that is tolerable!

https://liferaftgroup.org/long-list-of-inhibitors-and-inducers-of-cyp3a4-and-cyp2d6

look for Paroxetine (paxil) and Rifampin on this page.

Hi MoldyMama - welcome!

Anxiety is one of my Bartonella symptoms -

Our symptoms often get worse when we are treating the infection that is causing the symptoms.
I suspect that has happened to you.

My anxiety is pretty much gone except for some minor lower level episodes.

MoldyMama said...
I’m new here. Doc started me out on 300mg rifampin once a day, then after 2 weeks increased to 300mg twice a day. After 3 weeks on the higher dose I stared having severe full body anxiety all day. Doc dropped me back down to 300mg once a day. Since then the severE anxiety has let up, but I still have this awful dread and uneasy feeling I can’t shake. Strangely it gets worse when I’m away from home. Please tell me this is normal and goes away or at least gets better after awhile on the treatment. It’s messing with my head and making me feel miserable. Anyone experienced this and have healing still?

MoldyMama, are you taking any medicine apart rifampicin, like anti anxiety, anti depressions meds?

MoldyMama, no, it is documented and your doctor should knew that, my doctor didnt either because i was taking a benzo and rifampin decreased its levels, in fact it decreases tons of drug levels. I would speak to your doctor to change your abx. Rainycloud is right. Rifampins is decreasing your paxil levels. Rifabutin seems to have less drug interactions tham rifampin and it is in the same family of antibiotics like rifampin, but it must be tried first.

You can show this to your doctor if you want:

https://www.medicinenet.com/paroxetine_brisdelle/article.htm

"Strong CYP2D6 inducers may decrease the blood levels of paroxetine, resulting in poor treatment outcomes. Examples of strong CYP2D6 inducers include rifampin (Rimactane), carbamazepine (Tegretol), and phenytoin (Dilantin)."

This could be the probable culprit for your anxiety raising, altough bartonella can cause that to, but when people are taking psych drugs that work for anxiety like paroxetine or other ssri it less likely that bart is the cause of it. But there is only one way to know. If i was you i would speak with your doctor to say if there is alternative like rifabutin or other abx and try it. There are other abx for bart also.

Post Edited (isitlyme) : 12/19/2019 2:24:23 PM (GMT-7)

I just checked the leaflet from paroxetine, check yours if you have it in the paxil box. It warns about rifampin:

https://www.medicines.org.uk/emc/files/pil.5833.pdf

"Some medicines can affect the way Paroxetine tablets work, or make it more likely that you’ll have side effects. Paroxetine tablets can also affect the way some other medicines work. These include:

rifampicin (to treat tuberculosis (TB) and leprosy)"

I would speak to you doctor about this.

If eventually you stop rifampin dont expect the inteeaction to dissapear immediatelly as i read Somewhere that it takes almost 2 weeks to rifampin to stop the enzyme inducing effect. But perhaps it could be different depending on the person and it could be sooner. But just to say dont be surprised if it doesnt goes away immediatelly.

You're welcome MoldyMama.

We are always here to help.

We'd love to have you stick around this forum and keep us up to date with your progress.

RainyCloud said...
Rifampin induces the CYP3A4 enzyme.
Paxil inhibits the CYP3A4 enzyme.

I'm surprised the interaction checker isn't showing up a match.

I can almost guarantee you that's what's happening here.

There is an interaction between these 2 drugs happening.

I had the same happen with my SSRI (Lexapro) + Rifampin.

So quick question back on this post. You were absolutely right about the rifampin and Paxil interaction. I have the same reaction with houttuynia. I’m having trouble finding any information on whether houttuynia also induces the CYP3A4 enzyme.