Macrolide clarithromycin

McConnell SA, Amsden GW. Review and comparison of advanced-generation macrolides clarithromycin and dirithromycin. Pharmacotherapy. 1999 19 404-41 5. 

CARBAMAZEPINE MACROLIDES -CLARITHROMYCIN, ERYTHROMYCIN, TELITHROMYCIN, ISONIAZID t carbamazepine levels Inhibition of metabolism Monitor carbamazepine levels... 

ALMOTRIPTAN, ELETRIPTAN MACROLIDES -CLARITHROMYCIN, ERYTHROMYCIN, TELITHROMYCIN t plasma concentrations of almotriptan and eletriptan, with risk of toxic effects, e.g. flushing, sensations of tingling, heat, heaviness, pressure or tightness of any part of body including the throat and chest, dizziness Almotriptan is metabolized mainly by CYP3A4 isoenzymes. Most CYP isoenzymes are inhibited by clarithromycin to varying degrees, and since there is an alternative pathway of metabolism by MAO-A, toxicity responses will vary between individuals Avoid co-administration... 

BUSULFAN MACROLIDES - CLARITHROMYCIN, ERYTHROMYCIN, TELITHROMYCIN t plasma concentrations of busulfan and t risk of toxicity of busulfan such as veno-ocdusive disease and pulmonary fibrosis Busulfan clearance may be 1 by 25%, and the AUC of busulfan may t by 1500 p,mol/L Monitor clinically for veno-ocdusive disease and pulmonary toxicity in transplant patients. Monitor busulfan blood levels as AUC below 1500 p,mol/L per minute tends to prevent toxicity... 

CICLOSPORIN MACROLIDES -CLARITHROMYCIN, ERYTHROMYCIN, TELITHROMYCIN t plasma concentrations of ciclosporin, with risk of nephrotoxicity, myelosuppression, neurotoxicity, excessive immunosuppression, with risk of infection and post-transplant lymphoproliferative disease Inhibition of CYP3A4-mediated metabolism of ciclosporin these inhibitors vary in potency. Clarithromycin and telithromycin are classified as potent inhibitors Avoid co-administration with clarithromycin and telithromycin. Consider alternative antibiotics but need to monitor plasma ciclosporin levels to prevent toxicity... 

NNRTIs MACROLIDES -CLARITHROMYCIN 1.1 efficacy of clarithromycin but t efficacy and adverse effects of active metabolite 2. Rash occurs in 46% of patients when efavirenz is given with clarithromycin 1. Uncertain possibly due to altered CYP3A4-mediated metabolism 2. Uncertain 1. Clinical significance unknown no dose adjustment is recommended when clarithromycin is co-administered with nevirapine, but monitor LFTs and activity against Mycobacterium avium intracellulare complex closely 2. Consider alternatives to darithromycin for patients on efavirenz... 

PROTEASE INHIBITORS MACROLIDES - CLARITHROMYCIN, ERYTHROMYCIN Possibly T adverse effects of macrolide with atazanavir, ritonavir (with or without lopinavir) or saquinavir Inhibition of CYP3A4- and possibly CYP1A2-mediated metabolism. Altered transport via P-gp may be involved. Amprenavir and indinavir are also possibly T by erythromycin Consider alternatives unless Mycobacterium avium intracellulare infection if combined, 1 dose by 50% (75% in the presence of renal failure with a creatinine clearance of <30 mL/min)... 

Other macrolides (clarithromycin, flurithromycin, Carbamazepine High risk of carbamazepine toxicity Inhibition of carbamazepine metabolism... 

Erjdhromycin acts as a motilin receptor agonist (27-29). This mechanism may be at least partly responsible for the gastrointestinal adverse effects of macrolides. Clarithromycin may act on gastrointestinal motility in a similar way. In dogs, clarithromycin caused contractions and discomfort, as did erythromycin (30). In healthy volunteers, oral clarithromycin 250 mg bd caused a statistically significant increase in the number of postprandial antral contractions and antral motility (31). A single oral dose of clarithromycin 3000 mg resulted in severe abdominal pain within 1 hour of administration in two patients (32). 

CORTICOSTEROIDS MACROLIDES- CLARITHROMYCIN, ERYTHROMYCIN, TEEITHROMYCIN t adrenal suppressive effects of corticosteroids, which may t risk of infections and produce an inadequate response to stress scenarios Due to inhibition of metabolism of corticosteroids Monitor cortisol levels and warn patients to report symptoms such as fever and sore throat... 

The macrolides clarithromycin, dirithromycin, roxithromycin and telithromycin appear unlikely to cause combined hormonal contraceptive failure. Erythromycin is also not considered to cause failure of combined hormonal contraceptives, but isolated anecdotal cases have been reported. An isolated case has also been reported with spiramycin. 

The authors attribute what was seen to fluoxetine toxicity in the first case, and to the serotonin syndrome in the second case. They postulated that erythromycin (a known and potent inhibitor of cytochrome P450 isoenzyme CYP3A4) and the related macrolide clarithromycin, reduced the metabolism of the SSRIs, thereby raising their serum levels and precipitating the observed toxicity. ... 

Macrolide (clarithromycin, roxithromycin) pretreatment of mice inhibited an acute lung injury, which significantly ameUorated the bleomycin-induced increases in the total cell and neutrophil counts in bronchoalveolar lavage fluids and the wet lung weight (Kawashima et al. 2002). 

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