KLARITROMYSIINISTÄ

[Bb]

Lähettäjä: Soijuv Lähetetty: 26.8.2005 20:12

Antibiootti klaritromysiinin käyttö yhdessä kolkisiinin kanssa (lääke jota käytetään mm. kihdin hoidossa)saattaa aiheuttaa vakavia sivuvaikutuksia erityisesti sellaisille henkilöille joilla on munuaisten vajaatoimintaa:


http://www.medscape.com/viewarticle/509632?src=mp

Fatal Interactions Seen Between Clarithromycin and Colchicine

NEW YORK (Reuters Health) Jul 29 - Co-administration of the macrolide antibiotic clarithromycin and colchicine, an antimitotic used to treat gout, increases the risk of fatal colchicine toxicity, especially among patients with renal impairment, results of a retrospective study suggest.

According to senior researcher Dr. K. Y. Yuen and colleagues, many elderly patients with pneumonia develop acute gout during hospitalization. Based on their previous observation of two fatal drug interactions between clarithromycin and colchicine, they took a look-back at the outcomes of patients admitted to Queen Mary Hospital in Hong Kong between 1997 and 2004 who were prescribed the two drugs during the same admission.

They report their findings in the August 1 issue of Clinical Infectious Disease.

The investigators identified 116 patients -- 88 who had concomitant administration of the two drugs and 28 who received the drugs sequentially.

Nine patients (10.2%) in the concomitant group and one in the sequential group (3.6%) died within 28 days after hospital admission. Cause of death was pneumonia in six, acute chronic renal failure in two, congestive heart failure in one and multiorgan failure in one.

In multivariate analysis, longer duration of overlapped therapy (relative risk 2.16, p < 0.01), baseline renal impairment (RR 9.1, p < 0.001) and the development of pancytopenia during hospitalization (RR 23.4, p < 0.001) were independently associated with death.

The authors suggest that the fatal interaction is due to clarithromycin's inhibition of the cytochrome P450 enzyme CYP3A4 and the P-glycoprotein transporter system, thereby increasing bioavailability of colchicine.

Dr. Yuen's group warns that "clarithromycin and colchicine should not be prescribed concomitantly, especially for patients who have chronic renal insufficiency."

They add: "If a macrolide must be prescribed with colchicine, azithromycin should be considered, because it is mainly excreted unchanged in bile and has no effect on cytochrome P450 metabolism and the P-glycoprotein transporter system."

/Clin Infect Dis/ 2005;41:291-300.