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Article: Fatal interaction between clarithromycin and colchicine in patients with renal insufficiency: A retrospective study

TitleFatal interaction between clarithromycin and colchicine in patients with renal insufficiency: A retrospective study
Authors
Issue Date2005
PublisherOxford University Press. The Journal's web site is located at http://www.oxfordjournals.org/our_journals/cid/
Citation
Clinical Infectious Diseases, 2005, v. 41 n. 3, p. 291-300 How to Cite?
AbstractBackground. Clarithromycin is frequently used to treat community-acquired pneumonia in elderly persons. Like erythromycin, it may interact with other drugs by interfering with metabolism by cytochrome P450 enzymes and with the P-glycoprotein transporter system. Colchicine, used for treatment of acute gout and for prophylaxis, may cause bone marrow toxicity. It is metabolized by CYP3A4 and is transported by P-glycoprotein. Initial case reports suggested potentially fatal interactions between clarithromycin and colchicine. Methods. A retrospective study was conducted with 116 patients who were prescribed clarithromycin and colchicine during the same clinical admission. Case-control comparisons were made between patients who received concomitant therapy with the 2 drugs and patients who received sequential therapy. We assessed the clinical presentations and outcomes of the 2 patient groups and analyzed the risk factors associated with fatal outcomes. Results. Nine (10.2%) of the 88 patients who received the 2 drugs concomitantly died. Only 1 (3.6%) of the 28 patients who received the drugs sequentially died. Multivariate analysis of the 88 patients who received concomitant therapy showed that longer overlapped therapy (relative risk [RR], 2.16; 95% confidence interval [CI], 1.41-3.31; P ≤ .01), the presence of baseline renal impairment (RR, 9.1; 95% CI, 1.75-47.06; P < .001), and the development of pancytopenia (RR, 23.4; 95% CI, 4.48-122.7; P < .001) were independently associated with death. Conclusions. Clarithromycin increases the risk of fatal colchicine toxicity, especially for patients with renal insufficiency. Since there are other drugs for treatment of pneumonia and gout, these 2 drugs should not be coprescribed, because of the risk of fatality. © 2005 by the Infectious Diseases Society of America. All rights reserved.
Persistent Identifierhttp://hdl.handle.net/10722/45008
ISSN
2015 Impact Factor: 8.736
2015 SCImago Journal Rankings: 4.742
ISI Accession Number ID
References

 

DC FieldValueLanguage
dc.contributor.authorHung, IFNen_HK
dc.contributor.authorWu, AKLen_HK
dc.contributor.authorCheng, VCCen_HK
dc.contributor.authorTang, BSFen_HK
dc.contributor.authorTo, KWen_HK
dc.contributor.authorYeung, CKen_HK
dc.contributor.authorWoo, PCYen_HK
dc.contributor.authorLau, SKPen_HK
dc.contributor.authorCheung, BMYen_HK
dc.contributor.authorYuen, KYen_HK
dc.date.accessioned2007-10-30T06:15:30Z-
dc.date.available2007-10-30T06:15:30Z-
dc.date.issued2005en_HK
dc.identifier.citationClinical Infectious Diseases, 2005, v. 41 n. 3, p. 291-300en_HK
dc.identifier.issn1058-4838en_HK
dc.identifier.urihttp://hdl.handle.net/10722/45008-
dc.description.abstractBackground. Clarithromycin is frequently used to treat community-acquired pneumonia in elderly persons. Like erythromycin, it may interact with other drugs by interfering with metabolism by cytochrome P450 enzymes and with the P-glycoprotein transporter system. Colchicine, used for treatment of acute gout and for prophylaxis, may cause bone marrow toxicity. It is metabolized by CYP3A4 and is transported by P-glycoprotein. Initial case reports suggested potentially fatal interactions between clarithromycin and colchicine. Methods. A retrospective study was conducted with 116 patients who were prescribed clarithromycin and colchicine during the same clinical admission. Case-control comparisons were made between patients who received concomitant therapy with the 2 drugs and patients who received sequential therapy. We assessed the clinical presentations and outcomes of the 2 patient groups and analyzed the risk factors associated with fatal outcomes. Results. Nine (10.2%) of the 88 patients who received the 2 drugs concomitantly died. Only 1 (3.6%) of the 28 patients who received the drugs sequentially died. Multivariate analysis of the 88 patients who received concomitant therapy showed that longer overlapped therapy (relative risk [RR], 2.16; 95% confidence interval [CI], 1.41-3.31; P ≤ .01), the presence of baseline renal impairment (RR, 9.1; 95% CI, 1.75-47.06; P < .001), and the development of pancytopenia (RR, 23.4; 95% CI, 4.48-122.7; P < .001) were independently associated with death. Conclusions. Clarithromycin increases the risk of fatal colchicine toxicity, especially for patients with renal insufficiency. Since there are other drugs for treatment of pneumonia and gout, these 2 drugs should not be coprescribed, because of the risk of fatality. © 2005 by the Infectious Diseases Society of America. All rights reserved.en_HK
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dc.languageengen_HK
dc.publisherOxford University Press. The Journal's web site is located at http://www.oxfordjournals.org/our_journals/cid/en_HK
dc.relation.ispartofClinical Infectious Diseasesen_HK
dc.rightsClinical Infectious Diseases. Copyright © University of Chicago Press.en_HK
dc.rightsCreative Commons: Attribution 3.0 Hong Kong License-
dc.subject.meshClarithromycin - adverse effects - contraindicationsen_HK
dc.subject.meshColchicine - adverse effects - contraindicationsen_HK
dc.subject.meshDrug Interactionsen_HK
dc.subject.meshKidney Failure - complicationsen_HK
dc.subject.meshMultivariate Analysisen_HK
dc.titleFatal interaction between clarithromycin and colchicine in patients with renal insufficiency: A retrospective studyen_HK
dc.typeArticleen_HK
dc.identifier.openurlhttp://library.hku.hk:4550/resserv?sid=HKU:IR&issn=1058-4838&volume=41&issue=3&spage=291&epage=300&date=2005&atitle=Fatal+interaction+between+clarithromycin+and+colchicine+in+patients+with+renal+insufficiency:+a+retrospective+studyen_HK
dc.identifier.emailHung, IFN:ivanhung@hkucc.hku.hken_HK
dc.identifier.emailTo, KW:kelvinto@hkucc.hku.hken_HK
dc.identifier.emailWoo, PCY:pcywoo@hkucc.hku.hken_HK
dc.identifier.emailLau, SKP:skplau@hkucc.hku.hken_HK
dc.identifier.emailCheung, BMY:mycheung@hku.hken_HK
dc.identifier.emailYuen, KY:kyyuen@hkucc.hku.hken_HK
dc.identifier.authorityHung, IFN=rp00508en_HK
dc.identifier.authorityTo, KW=rp01384en_HK
dc.identifier.authorityWoo, PCY=rp00430en_HK
dc.identifier.authorityLau, SKP=rp00486en_HK
dc.identifier.authorityCheung, BMY=rp01321en_HK
dc.identifier.authorityYuen, KY=rp00366en_HK
dc.description.naturepublished_or_final_versionen_HK
dc.identifier.doi10.1086/431592en_HK
dc.identifier.pmid16007523-
dc.identifier.scopuseid_2-s2.0-22544447418en_HK
dc.identifier.hkuros109612-
dc.relation.referenceshttp://www.scopus.com/mlt/select.url?eid=2-s2.0-22544447418&selection=ref&src=s&origin=recordpageen_HK
dc.identifier.volume41en_HK
dc.identifier.issue3en_HK
dc.identifier.spage291en_HK
dc.identifier.epage300en_HK
dc.identifier.isiWOS:000230305300003-
dc.publisher.placeUnited Statesen_HK
dc.identifier.scopusauthoridHung, IFN=7006103457en_HK
dc.identifier.scopusauthoridWu, AKL=7402998681en_HK
dc.identifier.scopusauthoridCheng, VCC=23670479400en_HK
dc.identifier.scopusauthoridTang, BSF=8908243000en_HK
dc.identifier.scopusauthoridTo, KW=14323807300en_HK
dc.identifier.scopusauthoridYeung, CK=7201354123en_HK
dc.identifier.scopusauthoridWoo, PCY=7201801340en_HK
dc.identifier.scopusauthoridLau, SKP=7401596211en_HK
dc.identifier.scopusauthoridCheung, BMY=7103294806en_HK
dc.identifier.scopusauthoridYuen, KY=36078079100en_HK

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