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Interacciones farmacológicas entre el bloqueador de los canales de calcio y la claritromicina y lesiones renales
Sonja Gandhi1, Jamie L Fleet2, David G Bailey3
1Division of Nephrology, Department of Medicine, Western University, London, Canada2Department of Epidemiology and Biostatistics, Western University, London, Canada.
JAMA
|December 19, 2013
Resumen
Los adultos mayores que tomaban bloqueadores de los canales de calcio experimentaron un mayor riesgo de lesión renal aguda e hipotensión cuando se les recetó claritromicina versus azitromicina. Este estudio pone de relieve las posibles interacciones farmacológicas entre los inhibidores del CYP3A4 y los bloqueadores de los canales de calcio.
Área de la Ciencia:
- Farmacología Farmacología.
- Interacciones farmacológicas Interacciones farmacológicas
- Medicina Geriátrica La medicina geriátrica es una especialidad de la medicina geriátrica.
Sus antecedentes:
- Los bloqueadores de los canales de calcio (CCB) son metabolizados por el citocromo P450 3A4 (CYP3A4).
- La inhibición de CYP3A4 puede conducir a un aumento de las concentraciones sanguíneas de CCB y a una potencial toxicidad.
- La claritromicina es un inhibidor del CYP3A4, mientras que la azitromicina no lo es, lo que los hace adecuados para estudios comparativos de interacciones farmacológicas.
Objetivo del estudio:
- Para evaluar el riesgo de eventos adversos agudos en adultos mayores, se recetó claritromicina versus azitromicina mientras se toma un CCB.
- Para comparar los perfiles de seguridad de la claritromicina y la azitromicina en el contexto del uso de CCB.
Principales métodos:
- Estudio de cohorte retrospectivo basado en la población en Ontario, Canadá (2003-2012).
- Inclusión de adultos mayores (edad media 76) recientemente recetados claritromicina (n=96,226) o azitromicina (n=94,083) con un CCB.
- Resultado primario: hospitalización con lesión renal aguda; resultados secundarios: hospitalización con hipotensión y mortalidad por cualquier causa, evaluada dentro de los 30 días.
Principales resultados:
- La co-prescripción de claritromicina con un CCB se asoció con un mayor riesgo de hospitalización por lesión renal aguda (OR, 1.98) en comparación con la azitromicina.
- El aumento del riesgo se observó particularmente con los CCB de dihidropiridina como la nifedipina.
- El uso de claritromicina también se relacionó con mayores riesgos de hipotensión (OR, 1.60) y mortalidad por cualquier causa (OR, 1.74).
Conclusiones:
- El uso simultáneo de claritromicina con CCB en adultos mayores se asocia con un aumento pequeño pero significativo en el riesgo de 30 días de lesión renal aguda.
- Los hallazgos apoyan las advertencias existentes contra la combinación de inhibidores de CYP3A4 con CCBs.
- El estudio subraya la importancia de considerar las vías de metabolismo de los fármacos al prescribir antibióticos macrólidos a pacientes con CCB.
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