Renal impairment, clarithromycin

Clarithromycin is a macrolide antibacterial agent that should be used with caution in patients with renal impairment. The dose should be reduced if creatinine clearance is less than 30 mL/minute and the modified-release oral preparation should be avoided in this scenario. 

Pregnancy (ergotamine s powerful uterine stimulant actions may cause fetal harm) hypersensitivity to ergot alkaloids peripheral vascular disease (eg, thromboangiitis obliterans, leutic arteritis, severe arteriosclerosis, thrombophlebitis, Raynaud s disease) hepatic or renal impairment severe pruritus coronary artery disease hypertension sepsis. The use of potent CYP3A4 inhibitors (ritonavir, nelfinavir, indinavir, erythromycin, clarithromycin, troleandomycin, ketoconazole, itraconazole) with dihydroergotamine is contraindicated. 

Clarithromycin - In the presence of severe renal impairment (Ccr less than 30 mL/min) with or without coexisting hepatic impairment, decreased dosage or prolonged dosing intervals may be appropriate. 

Clarithromycin - Studies show age-related decreases in renal function. Consider dosage adjustment in elderly patients with severe renal impairment. 

Both and AUC values for clarithromycin and 14-(/ )-hydroxy-clarithromycin increased markedly in patients with renal impairment after five consecutive 500-mg doses of the parent drug [73]. Creatinine clearance (CLcr) was significantly (p <... 

Shi J, Chapel S, Montay G, Hardy P, Barrett JS, Sica D, Swan SK, Noveck R, Ler( B, Bhargava VO. Effect of ketoconazole on the pharmacokinetics and safety of telithromycin and clarithromycin in older subjects with renal impairment. IntJ Clin Pharmacol Ther(2005) 43,123-33. 

Two further cases of fatal agranulocytosis, presumed to result from use of colchicine with clarithromycin, have been reported, and 2 other cases describe colchicine toxicity during clarithromycin use in patients with renal impairment. ... 

Erythromycin and clarithromycin may inhibit the hepatic metabolism of colchicine via the cytochrome P450 isoenzyme CYP3A4, and/or might increase its bioavailability via effects on P-glycoprotein. - These effects would be more marked in patients with renal impairment. 

Deravirdine (Rescnptor) [Antiretroviral/NNRTI] Uses HIV Infxn Action Nonnucleoside RT inhibitor Dose 400 mg PO tid Caution [C, ] CDC recommends HIV-infected mothers not to breast-feed (transmission risk) w/ renal/hepatic impair Contra Use w/ drugs dependent on CYP3A for clearance (Table VI-8) Disp Tabs SE Fat redistribution, immune reconstitution synd, HA, fatigue, rash, T transaminases, N/V/D Interactions T Effects W/ fluoxetine T effects OF benzodiazepines, cisapride, clarithromycin, dapsone, ergotamine, indinavir, lovastatin, midazolam, nifedipine, quinidine, ritonavir, simvastatin, terfena-dine, triazolam, warfarin effects W/ antacids, barbiturates, carbamazepine, cimetidine, famotidine, lansoprazole, nizatidine, phenobarbital, phenytoin, ranitidine, rifabutin, rifampin effects OF didanosine EMS Use of benzodiazepines and CCBs should be avoided may cause a widespread rash located on upper body and arms OD May cause an extension of nl SEs symptomatic and supportive Deferasirox (Exjade) [Iron Chelator] Uses Chronic iron overload d/t transfusion in pts >2 y Action Oral iron chelator Dose Initial 20 mg/kg... 

Severe hypoglycemia occurred in two elderly men with type 2 diabetes mellitus and mild to moderate impaired renal function, who took clarithromycin 1000 mg/day for respiratory infections, in addition to a sulfonylurea (glibenclamide 5 mg/day in one case and glipizide 15 mg/day in the other) (168). Both developed severe hypoglycemia within 48 hours of starting clarithromycin. 

Henoch-Schdnlein purpura developed in an 84-year-old Indian woman 10 days after she started to take clarithromycin (250 mg bd) for pneumonia (52). She was otherwise healthy and taking no regular medications. Histology confirmed a leukocytoclastic vasculitis of superficial vessels, with extravasation of erythrocytes, and direct immunofluorescence showed immunoglobulin A in superficial dermal vessels. Treatment with prednisone (1 mg/kg/day) was required. Most of the symptoms and signs resolved within a few days, but renal function remained impaired. 

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