Disopyramide Clarithromycin

Clinically important, potentially hazardous interactions with amiodarone, azithromycin, bepredil, bosentan, bretylium, cisapride, clarithromycin, disopyramide, erythromycin, erythromycin fluconazole, fluoxetine, fluvoxamine, grapefruit juice, indinavir, itraconazole, ketoconazole, metronidazole, miconazole, nefazodone, nilotinib, paroxetine, pimozide, probucol, procainamide, quinidine, quinine, ritonavir, saquinavir, sertraline, sotalol, SSRIs, terfenadine, troleandomycin, voriconazole, zileuton, ziprasidone... 

Drugs that may affect disopyramide include antiarrhythmics, beta blockers, cisapride, clarithromycin, erythromycin, fluoroquinolones, hydantoins, quinidine, thioridazine, rifampin, verapamil, and ziprasidone. Drugs that may be affected by disopyramide include quinidine, anticoagulants, and digoxin. 

VENLAFAXINE 1. ANTIARRHYTHMICS - amiodarone, disopyramide, procainamide, propafenone 2. ANTIBIOTICS — macrolides (especially azithromycin, clarithromycin, parenteral erythromycin, telithromycin), quinolones (especially moxifloxacin), quinupristin/ dalfopristin 3. ANTICANCER AND IMMUNOMODULATING DRUGS -arsenic trioxide 4. ANTIDEPRESSANTS-TCAs 5. ANTIEMETICS-dolasetron 6. ANTIFUNGALS-fluconazole, posaconazole, voriconazole 7. ANTIHISTAMINES-terfenadine, hydroxyzine, mizolastine 8. ANTIMALARIALS -artemetherwith lumefantrine, chloro-quine, hydroxychloroquine, mefloquine, quinine 9. ANTIPROTOZOALS -pentamidine isetionate 10. ANTIPSY-CHOTICS - atypicals, phenothiazines, pimozide 11. BETA-BLOCKERS -sotalol 12. BRONCHODILATORS-parenteral bronchodilators 13. CNS STIMULANTS - atomoxetine Risk of ventricular arrhythmias, particularly torsades de pointes Additive effect these drugs cause prolongation of the Q-T interval Avoid co-administration... 

An 86-year-old woman presented with severe hypoglycemia after clarithromycin 500 mg/day had been added for 3 days to her other therapy, which included disopyramide 500 mg/day (38). The hypoglycemia resolved completely after withdrawal of disopyramide. 

Hayashi Y, Ikeda U, Hashimoto T, Watanabe T, Mitsuhashi T, Shimada K. Torsades de pointes ventricular tachycardia induced by clarithromycin and disopyramide in the presence of hypokalemia. Pacing Clin Electrophysiol 1999 22(4 Pt 1) 672. ... 

Morlet-Barla N, Narbonne H, Vialettes B. Hypoglycemie grave et recidivante secondaire a I interaction disopyramide-clarithromicine. [Severe hypoglycemia and recurrence caused by disopyramide-clarithromycin interaction.] Presse Med 2000 29(24) 1351. 

Severe cardiac dysrhythmias and major hjrpoglycemia have occurred in patients taking disopyramide with some macrolide antibiotics, especially erythromycin and clarithromycin (153). 

In a 76-year old woman, severe prolongation of the QTc interval and self-terminating torsade de pointes were induced by the combined use of clarithromycin and disopyramide concomitant hypokalemia may have contributed to the cardiac dysrhythmia (154). 

Symptomatic hypoglycemia developed in a 59-year-old man treated with a combination of disopyramide (50 mg/day) and clarithromycin (600 mg/day) (155). 

Clinically important, potentially hazardous interactions with amiodarone, astemizole, bepridil, carbamazepine, chloroquine, cisapride, clarithromycin, dihydroergotamine, disopyramide, ergotamine, grapefruit juice, halofantrine, haloperidol, itraconazole, ketoconazole, methadone, moxifloxacin, phenobarbital, phenytoin, pimozide, procainamide, quinidine, rifampicin, ritonavir, sotalol, St John s wort, telithromycin, terfenadine, voriconazole... 

ANTIARRHYTHMICS - amiodarone, disopyramide, procainamide, propafenone 2. ANTIBIOTICS-macrolides (especially azithromycin, clarithromycin, parenteral erythromycin, telithromycin), quinolones (especially moxifloxacin), quinupristin/dalfbpristin... 

I. ANTI ARRHYTHMICS - amiodarone, disopyramide, procainamide, propafenone 2. ANTIBIOTICS -macrolides (especially azithromycin, clarithromycin, parenteral erythromycin, telithromycin), quinolones (especially moxifloxacin), quinupristin/ dalfbpristin 3. ANTICANCER AND IMMUNOMODULATING DRUGS-arsenic trioxide 4. ANTIDEPRESSANTS-TCAs, venlafaxine 5. ANTIEMETICS -dolasetron 5. ANTIFUNGALS - fluconazole, posaconazole, voriconazole... 

A 74-year-old woman who had been taking disopyramide 200 mg twiee daily for 7 years eollapsed with ventrieular fihrillation 6 days after starting to take omeprazole 40 mg, metronidazole 800 mg and elarithromyein 500 mg daily. After sueeessful resuseitation, her QTe interval, which had never previously been above 440 milliseconds, was found to have risen to 625 milliseeonds. Her disopyramide plasma level was also elevated (4.6 mierograms/mL) and the half-life was markedly prolonged (40 hours). The QTc interval normalised as her plasma disopyramide levels fell A 76-year old woman taking disopyramide developed torsades de pointes when given clarithromycin 200 mg twice daily. Hypokalaemia (potassium 2.8 mmol/L) probably contributed to this ease. ... 

Not fully established. An in vitro study using human liver microsomes indicated that erythromycin inhibits the metabolism (mono-A-dealkylation) of disopyramide which, in vivo, would be expected to reduce its loss from the body and increase its serum levels. Clarithromycin and azithromycin probably do the same. The increased serum levels of disopyramide can result in adverse effects such as QT prolongation and torsade de pointes, and may result in enhanced insulin secretion and hypoglycaemia. - Both intravenous erythromycin and clarithromycin" alone have been associated with prolongation of the QT interval and torsade de pointes. Therefore, disopyramide and macrolides may have additive effects on the QT interval in addition to the pharmacokinetic interaction. 

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