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Concurrent clarithromycin and cyclosporin A treatment
B Sádaba1, A López de Ocáriz, J R Azanza
1Clinical Pharmacology Department, University Clinic of Navarra School of Medicine, Pamplona, Spain. bsadaba@unav.es
Insights
Clarithromycin, despite its low interaction reputation, significantly increased cyclosporin A levels in transplant patients. Doses of cyclosporin A required a mean 33% reduction during co-administration, highlighting potential drug interactions.
Area of Science:
- Pharmacology
- Transplantation Medicine
- Drug Interactions
Background:
- Macrolide antibiotics are known for significant pharmacokinetic interactions.
- Clarithromycin is generally perceived to have a limited capacity for drug interactions.
Purpose of the Study:
- To investigate the interaction between clarithromycin and cyclosporin A in transplant recipients.
- To assess the impact of clarithromycin on cyclosporin A dosage requirements.
Main Methods:
- Observational study involving six transplant recipients.
- Co-administration of cyclosporin A with clarithromycin.
- Monitoring of cyclosporin A whole blood levels and dosage adjustments.
Main Results:
- All patients required a mean 33% reduction in daily cyclosporin A dose.
- Cyclosporin A dosage parameters normalized by the fourth day after discontinuing clarithromycin.
- Co-administration led to elevated whole blood cyclosporin A levels.
Conclusions:
- Clarithromycin can significantly increase whole blood cyclosporin A levels.
- Physicians should consider dose reductions of cyclosporin A when co-administered with clarithromycin.
- This interaction necessitates careful monitoring in transplant patients.
Abstract:
Although macrolides have been associated with significant pharmacokinetic interactions, clarithromycin is considered to have a low interaction capacity. In this study, six transplant recipients treated with cyclosporin A also received clarithromycin. In all patients, the dose of cyclosporin A had to be reduced by a mean of 33% per day depending on the macrolide dose. Normalization of the dosage parameters began on the fourth day after stopping clarithromycin treatment. Co-administration of cyclosporin A and clarithromycin may lead to increases in whole blood cyclosporin levels, and appropriate dose reductions should be considered.