Mania clarithromycin

Clarithromycin inhibits CYP3A4, which is responsible for the metabolic clearance of prednisolone, the biologically active metabolite of prednisone. Clarithromycin (500 mg bd for 2 days) reduced the clearance of methylpredniso-lone by 65% and significantly increased its plasma concentrations clarithromycin did not influence the clearance or plasma concentrations of prednisone (488). Acute mania has been reported to be related to inhibition of the metabolic clearance of prednisone by clarithromycin (SEDA-22, 444 489). 

Finkenbine R, Gill HS. Case of mania due to prednisone-clarithromycin interaction. Can J Psychiatry 1997 42(7) 778. 

Of cases of mania attributed to antibiotics and reported to the WHO, 28% were due to clarithromycin (173). 

A 77-year-old man who was HIV-negative developed mania after 6 days treatment with clarithromycin 1 g/ day for a soft tissue infection his mental state resolved on withdrawal (174). 

Nightingale SD, Koster FT, Mertz GJ, Loss SD. Clarithromycin-induced mania in two patients with AIDS. Clin Infect Dis 1995 20(6) 1563-4. 

Cone LA, Sneider RA, Nazemi R, Dietrich EJ. Mania due to clarithromycin therapy in a patient who was not infected with human immunodeficiency virus. Clin Infect Dis 1996 22(3) 595-6. 

Many other commonly used antibiotics can cause psychiatric symptoms, for example, clarithromycin (trade name, Biaxin)—which is frequently used to treat respiratory illness, ear infections, and skin infections—has been reported to cause mania in some patients. Metronidazole (trade name Flagyl), which is used to treat many types of infections—from parasites to vaginal infections and abscesses—has been reported to cause depression, agitation, confusion, hallucinations, and mania. Trimethoprim-sulfamethoxazole (trade names Bactrim and Septra)—which is used, for example, for bladder infections and sinus and ear infections—has been reported to cause delirium, psychosis, depression, and hallucinations in rare cases. The fluoroquinolone antibiotics—such as ciprofloxacin (trade name Cipro), levofloxacin (trade name Levaquin), ofloxacin (trade name Floxin), trovafloxacin (trade name Trovan), and others of this class—can cause psychiatric symptoms fairly often, including confusion, agitation, depression, insomnia, mania, paranoia, and psychosis. 

Troleandomycin and, to a lesser extent, clarithromycin and erythromycin can reduce the clearance of methylprednisolone, thereby increasing both its therapeutic and adverse effects. A patient receiving long-term clarithromycin developed Cushing s syndrome after starting treatment with inhaled budesonide. There appears to be no pharmacokinetic interaction between erythromycin and inhaled ciclesonide. Similarly, prednisolone appears not to be affected by macrolides, except possibly in those also taking enzyme-inducers such as phenobarbital. Isolated case reports describe the development of acute mania and psychosis in two patients, apparently due to an interaction between prednisone and clarithromycin. 

Mania is an extremely rare psychiatric adverse drug reaction but has been reported in a child who took clarithromycin [123 ]. 

Fidan T, Fidan V. Clarithromycin-induced mania in a child. Int J Clin Pharmacol Ther 2009 47(6) 402-4. 

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