Macrolide drug interactions

Bizjak ED, Mauro VF. Digoxin-macrolide drug interaction. Ann Phar mac other 1997 31 1077-9. 

Macrolide Drug Interactions of Potential Clinical Importance... 

Macrolides, drug interactions, 14.220 intestinal motility, 18.269 Malaria vaccines, 22.306 Mannitol, 28.236... 

Sirolimus is currently the only FDA-approved ToR inhibitor. One of its derivatives, everolimus, is in phase III clinical trials and has been approved for use in some European countries.30 Sirolimus is a macrolide antibiotic that has no effect on cal-cineurin phosphatase.11,31,32 Sirolimus inhibits T cell activation and proliferation by binding to and inhibiting the activation of the mammalian ToR, which suppresses cellular response to IL-2 and other cytokines (i.e., IL-4 and IL-15J.11,31 Studies have shown that sirolimus may be used safely and effectively with either cyclosporine or tacrolimus as a replacement for either azathioprine or mycophenolate mofetil.33 However, when using both sirolimus and cyclosporine as part of a patient s immunosuppressant therapy, because of a drug interaction between the two resulting in a marked increase in sirolimus concentrations, it is recommended to separate the sirolimus and cyclosporine doses by at least 4 hours. Sirolimus also can be used as an alternative agent for patients who do not tolerate calcineurin inhibitors due to nephrotoxicity or other adverse events.34... 

Tegretol consists of carbamazepine, which is an anti-epileptic drug. There is a clinically significant drug interaction between carbamazepine and clarithromycin (macrolide antibacterial agent) resulting in higher plasma concentrations of carbamazepine. 

Carbamazepine also can induce the enzymes that metabolize other anticonvulsant drugs, including phenytoin, primidone, phenobarbital, valproic acid, clonazepam, and ethosuximide, and metabolism of other drugs the patient may be taking. Similarly, other drugs may induce metabolism of carbamazepine the end result is the same as for autoinduction, and the dose of carbamazepine must be readjusted. A common drug-drug interaction is between carbamazepine and the macrolide antibiotics erythromycin and trolean-domycin. After a few days of antibiotic therapy, symptoms of carbamazepine toxicity develop this is readily reversible if either the antibiotic or carbamazepine is discontinued. 

Based on case reports or small studies, the potential for drug interactions between macrolides and lovastatin should be considered (17). 

Goldman RC, Scaglione F. The macrolide-bacterium interaction and its biological basis. Curr Drug Targets Infect Disord. 2004 4 241-260. 

Poehlsgaard J, Douthwaite S. Macrolide antibiotic interaction and resistance on the bacterial ribosome. Curr Opin Investig Drugs. 2003 4 140-148. 

Nahata M. Drug interactions with azithromycin and the macrolides an overview. J Antimicrob Chemother 1996 37 133-142. 

Iatsimirskaia E, Tulebaev S, Storozhuk E, et al. Metabolism of rifabutin in human enterocyte and liver microsomes kinetic paramters, identification of enzyme systems, and drug interactions with macrolides and antifungal agents. Clin Pharmacol Ther 1997 61 554-562. 

Westphal JF. Macrolide-induced clinically relevant drug interactions with cytochrome P-450A (CYP) 3A4 an update focused on clarithromycin, azithromycin and dirithromycin. Br J Clin Pharmacol 2000 50 285-295. 

Amsden GW. Macrolides versus azalides a drug interaction update. Ann Pharmacother 1995 29(9) 906-17. 

Although there is no evidence that neuropsychiatric complications of macrolides develop more readily in uremic patients, several factors may predispose toward these adverse effects, such as reduced drug clearance, altered plasma protein binding, different penetration of drug across the blood-brain barrier, and an increased propensity for drug interactions. 

Danse tte PM, Delaforge M, Sartori E, Beaune P, Jaouen M, Mansuy D. Drug interactions with macrolide antibiotics Specificity of pseudo-suicide inhibition and induction of cytochrome P-450. Adv Exp Med Biol 1986 197 155-62. 

Macrolides are metabolized primarily in the liver with their metabolites excreted into bile metabolism occurs to a lesser degree in the kidneys and lungs [259, 260]. Since macrolides vary widely in their serum and tissue concentrations, half-lives, and active metabolites, knowledge of their metabolism is important for optimizing dosage schedules. Some macrolides also influence the metabolism of certain other drugs, and modified metabolic conditions such as liver disease may alter antibiotic concentrations [260-264]. Because such events can lead to toxicity from either excess antibiotic or adverse drug interactions, metabolism is examined in patients... 

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