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A pharmacokinetic interaction between clarithromycin and sirolimus in kidney transplant recipient

Domenico Capone1, Giuseppe Palmiero, Antonio Gentile

  • 1Department of Neurosciences, Section of Clinical Pharmacology, School of Medicine, Federico II University of Naples, Italy.

Current Drug Metabolism
|May 17, 2007
PubMed

Insights

This case report details a significant drug interaction between clarithromycin and sirolimus in a kidney transplant patient. Concomitant use led to dangerously high sirolimus levels and acute kidney injury, highlighting potential risks in transplant recipients.

Area of Science:

  • Pharmacology
  • Nephrology
  • Infectious Diseases

Background:

  • Bacterial infections are common in renal transplant recipients, necessitating antimicrobial therapy.
  • Sirolimus is an immunosuppressant frequently used in kidney transplant patients.
  • Clarithromycin is a macrolide antibiotic used to treat bacterial infections.

Observation:

  • A kidney transplant recipient with Hemophilus Influenzae pulmonary infection was treated with clarithromycin and sirolimus.
  • Concomitant administration of clarithromycin and sirolimus resulted in a marked increase in sirolimus trough blood concentrations (6.2 to 54 ng/mL).

Findings:

  • The observed increase in sirolimus levels correlated with acute kidney function impairment.
  • Discontinuation of both clarithromycin and sirolimus led to near-complete reversal of renal function decline.
  • The interaction is attributed to the inhibition of cytochrome P450 3A4 and P-glycoprotein.

Implications:

  • This case provides the first clinical evidence of a significant pharmacokinetic interaction between clarithromycin and sirolimus.
  • Physicians should exercise caution when prescribing clarithromycin to kidney transplant patients on sirolimus therapy.
  • Monitoring of sirolimus levels and renal function is crucial during co-administration to prevent toxicity.

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