Rhabdomyolysis clarithromycin

Rhabdomyolysis was associated with third-degree atrioventricular block in a patient taking atorvastatin with esomeprazole and clarithromycin. 

Sipe BE, Jones RJ, Bokhart GH. Rhabdomyolysis causing AV blockade due to possible atorvastatin, esomeprazole, and clarithromycin interaction. Ann Pharmacother 2003 37 808-11. 

The macrolide antibiotic erythromycin together with statins enhances the risk of rhabdomyolysis (SED-13, 1328) (112), as do clarithromycin and azithromycin (113). 

Grunden JW, Fisher KA. Lovastatin-induced rhabdomyolysis possibly associated with clarithromycin and azithromycin. Ann Pharmacother 1997 31(7-8) 859-63. 

Rhabdomyolysis requiring short-term dialysis occurred in a 57-year-old man with chronic renal insufficiency treated with lovastatin 40 mg/day, gemfibrozil 600 mg bd, and clarithromycin 500 mg tds (18). 

A 49-year-old man developed rhabdomyolysis after taking simvastatin 80 mg/day combined with clarithromycin 500 mg bd for 6 weeks (55). This effect was probably causal according to the Naranjo algorithm. 

Lee AJ, Maddix DS. Rhabdomyolysis secondary to a drug interaction between simvastatin and clarithromycin. Ann Pharmacother 2001 35(1) 26-31. 

Kahri AJ, Valkonen MM, Vuoristo MK, Pentikainen PJ. Rhabdomyolysis associated with concomitant use of simvastatin and clarithromycin. Ann Pharmacother 2004 38(4) 719. 

ATORVASTATIN, SIMVASTATIN MACROLIDES Macrolides may t levels of atorvastatin and simvastatin the risk of myopathy t over 10-fold when eiythromycin is co-administered with a statin Macrolides inhibit CYP3A4-mediated metabolism of atorvastatin and simvastatin. Also, erythromycin and clarithromycin inhibit intestinal P-gp, which may t the bioavailability of statins Avoid co-administration of macrolides with atorvastatin or simvastatin (temporarily stop the statin if the patient needs macrolide therapy). Manufacturers also recommend that patients be warned to look for the early signs of rhabdomyolysis when other statins are co-ingested with macrolides... 

A 64-year-old African-American man developed rhabdomyolysis resulting from concomitant use of clarithromycin and simvastatin (175). 

In a 72-year-old man, the administration of clarithromycin (400 mg/day) plus modified-release theophylline (200 mg/day) resulted in acute rhabdomyolysis with renal insufficiency requiring hemodialysis after 5 days of combined treatment (179). 

Shimada N, Omuro H, Saka S, Ebihara I, Koide H. [A case of acute renal failure with rhabdomyolysis caused by the interaction of theophylline and clarithromycin.] Nippon Jinzo Gakkai Shi 1999 41(4) 460-3. 

Cases of acnte rhabdomyolysis have been reported between lovas-tatin and azithromycin, clarithromycin, or erythromycin and between simvastatin and clarithromycin or roxithromycin. Macrolide antibacterials have also been potentially implicated in cases of rhabdomyolysis with atorvastatin and pravastatin. Pharmacokinetic stndies sn est that the macrolides increase the levels of the statins metabolised by CYP3A4 (namely atorvastatin, Iovastatin and simvastatin). 

Mah Ming JB, Gill MJ. Drug-induced rhabdomyolysis after concomitant use of clarithromycin, atorvastatin, and lopinavir/ritonavir in a tient with HIV AIDS Patient Care STDS (2003) 17,207-10. 

McKinnell J, Tayek JA. Short term treatment with clarithromycin resulting in colchicine-induced rhabdomyolysis. J Clin Rheumatol 2009 15(6) 303-5. 

Musculoskeletal Rhabdomyolysis has been attributed to clarithromycin without concurrent use of other medications [128 ]. 

Drug-drug interactions Colchicine Rhabdomyolysis occurred in a 48-year-old African-American man with hypertension and chronic gout, who was taking colchicine 0.6 mg/day and who took clarithromycin 500 mg bd for 3 days for a community-acquired pneumonia [130" ]. The serum aminotransferases rose and the serum creatine kinase activity was 22 996 U/1 the urine contained myoglobin. Withdrawal of colchicine and clarithromycin resulted in clinical and biochemical resolution. 

Simvastatin Rhabdomyolysis after combined therapy with simvastatin 80 mg/day and clarithromycin has been recently reported in two women they recovered rapidly, after simvastatin withdrawal [13T, 132 ]. The interacting mechanism was probably inhibition of CYP3A4 inhibition of P glycoprotein transport of simvastatin may also have contributed. 

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