Featured Research

from universities, journals, and other organizations

Use of calcium-channel blocker, antibiotic associated with small increased risk of kidney injury

Date:
November 9, 2013
Source:
American Medical Association (AMA)
Summary:
Among older adults taking a calcium-channel blocker, simultaneous use of the antibiotic clarithromycin, compared with azithromycin, was associated with a small but statistically significant greater 30-day risk of hospitalization with acute kidney injury, according to a study.

Among older adults taking a calcium-channel blocker, simultaneous use of the antibiotic clarithromycin, compared with azithromycin, was associated with a small but statistically significant greater 30-day risk of hospitalization with acute kidney injury, according to a study published by JAMA. The study is being published early online to coincide with its presentation at the American Society of Nephrology's Kidney Week 2013.

The commonly used antibiotics clarithromycin and erythromycin are clinically important inhibitors of the enzyme CYP3A4, while azithromycin is much less so. Calcium-channel blockers are metabolized by this enzyme. Blood concentrations of these drugs may rise to harmful levels when CYP3A4 activity is inhibited. "Currently, the U.S. Food and Drug Administration warns that 'serious adverse reactions have been reported in patients taking clarithromycin concomitantly with CYP3A4 substrates, which includes hypotension [abnormally low blood pressure] with calcium-channel blockers [that are] metabolized by CYP3A4.' Yet, calcium-channel blockers and clarithromycin continue to be frequently coprescribed in routine care," according to background information in the article. When hypotension occurs, the kidney is particularly prone to injury from poor circulation. "Despite this knowledge, the risk of acute kidney injury following coprescription of clarithromycin with a calcium-channel blocker is unknown."

Sonja Gandhi, B.Sc., of Western University, London, Canada, and colleagues conducted a study to investigate the interaction between calcium-channel blockers (amlodipine, felodipine, nifedipine, diltiazem, or verapamil) and the antibiotic clarithromycin (n = 96,226), compared with azithromycin (n = 94,083), with a focus on acute kidney injury, among older adults (average age, 76 years).

Amlodipine was the most commonly prescribed calcium-channel blocker (more than 50 percent of patients).

The researchers found that coprescribing clarithromycin with a calcium-channel blocker was associated with a higher risk of hospitalization with acute kidney injury compared with coprescribing azithromycin (0.44 percent vs. 0.22 percent); in absolute terms, coprescription with clarithromycin resulted in a 0.22 percent higher incidence of hospitalization with acute kidney injury.

When examined by type of calcium-channel blocker, the risk of hospitalization with acute kidney injury was highest among patients coprescribed clarithromycin with nifedipine (absolute risk increase, 0.63 percent). Coprescription of a calcium-channel blocker with clarithromycin was also associated with a higher risk of hospitalization with hypotension (0.12 percent vs. 0.07 percent patients taking azithromycin; absolute risk increase, 0.04 percent) and all-cause mortality (1.02 percent vs. 0.59 percent patients taking azithromycin; absolute risk increase, 0.43 percent).

"Although the absolute increases in the risks were small, these outcomes have important clinical implications. Our results suggest that potentially hundreds of hospitalizations and deaths in our region may have been associated with this largely preventable drug-drug interaction. This burden on the health care system, given the high costs of managing acute kidney injury, might have been avoided," the authors write. "Our study highlights the need for quality improvement initiatives that will mitigate the clinical effects of such drug interactions. Potential strategies may include temporary cessation of the calcium-channel blocker for the duration of clarithromycin therapy or selection of a non-CYP3A4 inhibiting antibiotic (such as azithromycin) when clinically appropriate."


Story Source:

The above story is based on materials provided by American Medical Association (AMA). Note: Materials may be edited for content and length.


Journal Reference:

  1. Sonja Gandhi, Jamie L. Fleet, David G. Bailey, Eric McArthur, Ron Wald, Faisal Rehman, Amit X. Garg. Calcium-Channel Blocker–Clarithromycin Drug Interactions and Acute Kidney Injury. JAMA, 2013; DOI: 10.1001/jama.2013.282426

Cite This Page:

American Medical Association (AMA). "Use of calcium-channel blocker, antibiotic associated with small increased risk of kidney injury." ScienceDaily. ScienceDaily, 9 November 2013. <www.sciencedaily.com/releases/2013/11/131109153756.htm>.
American Medical Association (AMA). (2013, November 9). Use of calcium-channel blocker, antibiotic associated with small increased risk of kidney injury. ScienceDaily. Retrieved October 20, 2014 from www.sciencedaily.com/releases/2013/11/131109153756.htm
American Medical Association (AMA). "Use of calcium-channel blocker, antibiotic associated with small increased risk of kidney injury." ScienceDaily. www.sciencedaily.com/releases/2013/11/131109153756.htm (accessed October 20, 2014).

Share This



More Health & Medicine News

Monday, October 20, 2014

Featured Research

from universities, journals, and other organizations


Featured Videos

from AP, Reuters, AFP, and other news services

How Nigeria Beat Its Ebola Outbreak

How Nigeria Beat Its Ebola Outbreak

Newsy (Oct. 20, 2014) The World Health Organization has declared Nigeria free of Ebola. Health experts credit a bit of luck and the government's initial response. Video provided by Newsy
Powered by NewsLook.com
Another Study Suggests Viagra Is Good For The Heart

Another Study Suggests Viagra Is Good For The Heart

Newsy (Oct. 20, 2014) An ingredient in erectile-dysfunction medications such as Viagra could improve heart function. Perhaps not surprising, given Viagra's history. Video provided by Newsy
Powered by NewsLook.com
Ebola Worries End for Dozens on U.S. Watch Lists

Ebola Worries End for Dozens on U.S. Watch Lists

Reuters - US Online Video (Oct. 20, 2014) Forty-three people who had contact with Thomas Eric Duncan, the first person diagnosed with Ebola in the U.S., were cleared overnight of twice-daily monitoring after 21 days of showing no symptoms. Rough Cut (no reporter narration). Video provided by Reuters
Powered by NewsLook.com
Beijing Marathon Runners Brave Hazardous Air Pollution

Beijing Marathon Runners Brave Hazardous Air Pollution

AFP (Oct. 19, 2014) Tens of thousands of runners battled thick smog at the Beijing Marathon on Sunday, with some donning masks as the levels of PM2.5 small pollutant particles soared to 16 times the maximum recommended level. Duration: 00:54 Video provided by AFP
Powered by NewsLook.com

Search ScienceDaily

Number of stories in archives: 140,361

Find with keyword(s):
Enter a keyword or phrase to search ScienceDaily for related topics and research stories.

Save/Print:
Share:

Breaking News:

Strange & Offbeat Stories


Health & Medicine

Mind & Brain

Living & Well

In Other News

... from NewsDaily.com

Science News

Health News

Environment News

Technology News



Save/Print:
Share:

Free Subscriptions


Get the latest science news with ScienceDaily's free email newsletters, updated daily and weekly. Or view hourly updated newsfeeds in your RSS reader:

Get Social & Mobile


Keep up to date with the latest news from ScienceDaily via social networks and mobile apps:

Have Feedback?


Tell us what you think of ScienceDaily -- we welcome both positive and negative comments. Have any problems using the site? Questions?
Mobile: iPhone Android Web
Follow: Facebook Twitter Google+
Subscribe: RSS Feeds Email Newsletters
Latest Headlines Health & Medicine Mind & Brain Space & Time Matter & Energy Computers & Math Plants & Animals Earth & Climate Fossils & Ruins