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Inhibition of methylprednisolone elimination in the presence of clarithromycin therapy

D A Fost1, D Y Leung, R J Martin

  • 1Ira J. and Jacqueline Neimark Laboratory of Clinical Pharmacology in Pediatrics, Divisions of Clinical Pharmacology, Denver, CO, USA.

The Journal of Allergy and Clinical Immunology
|June 9, 1999
PubMed
Abstract

Insights

Clarithromycin significantly reduces methylprednisolone clearance, increasing steroid levels and potential adverse effects in asthma patients. Prednisone may be a safer alternative to methylprednisolone during clarithromycin treatment.

Area of Science:

  • Pharmacology
  • Clinical Medicine
  • Drug Interactions

Background:

  • Macrolide antibiotics are used as steroid-sparing agents in severe asthma.
  • Their efficacy is partly due to delaying glucocorticoid clearance.
  • Potential for potentiating glucocorticoid adverse effects exists.

Purpose of the Study:

  • To investigate if clarithromycin alters oral glucocorticoid pharmacokinetics.
  • To assess the risk of steroid-induced adverse effects from clarithromycin use.

Main Methods:

  • Open-label, paired study design in 6 adult asthma patients.
  • Administered single doses of prednisone and methylprednisolone before and during clarithromycin therapy.
  • Measured 12-hour plasma pharmacokinetic profiles for both glucocorticoids.

Main Results:

  • Clarithromycin reduced methylprednisolone clearance by 65%.
  • Mean plasma methylprednisolone concentrations were significantly higher post-clarithromycin.
  • No significant effect on prednisolone clearance or plasma concentrations was observed.

Conclusions:

  • Clinicians should be aware of drug interactions between clarithromycin and methylprednisolone.
  • Concomitant use may increase the risk of steroid-induced adverse effects.
  • Substituting prednisone for methylprednisolone is recommended during clarithromycin therapy.

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