Re: Eplerenone + Biaxin

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I knew about ketoconazole etc. and now see Marcolide antibiotics. AKA clarithromyocin. So if you need the C then just decrease the dose of E would be one way to do it.CE Grim, MDOn May 13, 2012, at 11:01 PM, Valarie wrote: www.drugs.com clarithromycin ↔ eplerenoneApplies to: Biaxin (clarithromycin), eplerenone (Major contraindication)CONTRAINDICATED: Coadministration with potent inhibitors of CYP450 3A4 may significantly increase the plasma concentrations of eplerenone, which is primarily metabolized by the isoenzyme. In pharmacokinetic studies, administration of eplerenone (100 mg single dose) with ketoconazole (200 mg twice a day) resulted in a 1.7-fold increase in eplerenone peak plasma concentration (Cmax) and a 5.4-fold increase in systemic exposure (AUC).MANAGEMENT: The use of eplerenone with potent inhibitors of CYP450 3A4 (e.g., itraconazole, ketoconazole, nefazodone, delavirdine, ketolide and certain macrolide antibiotics, most protease inhibitors) is considered contraindicated. This is the interaction checker http://www.drugs.com/interactions-check.php?drug_list=997-0,685-337 Val From: hyperaldosteronism [mailto:hyperaldosteronism ] On Behalf Of Clarence Grim I find this on webMD BUT cannot find the publication? On May 13, 2012, at 16:07, Valarie <val@...> wrote: 20 mg of doxy is not very much and I didn't feel it. It did stop the periodontal progression but didn't improve it. A normal dose is 100 mg x 3/d. My doc just switched me to doxy from Biaxin because of the newly-emerged Biaxin-eplerenone contraindication.

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I talked to CVS Pharmacy about the eplerenone-clarithromycin contraindication.  The only problem is possibly too low blood pressure with the combo.  I have them nicely balanced and will talk to doc on 6/5. Val From: hyperaldosteronism [mailto:hyperaldosteronism ] On Behalf Of Clarence Grim I knew about ketoconazole etc. and now see Marcolide antibiotics. AKA clarithromyocin. So if you need the C then just decrease the dose of E would be one way to do it. CE Grim, MDOn May 13, 2012, at 11:01 PM, Valarie wrote:clarithromycin ↔ eplerenoneApplies to: Biaxin (clarithromycin), eplerenone (Major contraindication)CONTRAINDICATED: Coadministration with potent inhibitors of CYP450 3A4 may significantly increase the plasma concentrations of eplerenone, which is primarily metabolized by the isoenzyme. In pharmacokinetic studies, administration of eplerenone (100 mg single dose) with ketoconazole (200 mg twice a day) resulted in a 1.7-fold increase in eplerenone peak plasma concentration (Cmax) and a 5.4-fold increase in systemic exposure (AUC).MANAGEMENT: The use of eplerenone with potent inhibitors of CYP450 3A4 (e.g., itraconazole, ketoconazole, nefazodone, delavirdine, ketolide and certain macrolide antibiotics, most protease inhibitors) is considered contraindicated. This is the interaction checker http://www.drugs.com/interactions-check.php?drug_list=997-0,685-337

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Sounds like a plan. May your pressure be low!CE Grim MS, MDSpecializing in DifficultHypertensionOn May 17, 2012, at 17:32, Valarie <val@...> wrote:

I talked to CVS Pharmacy about the eplerenone-clarithromycin contraindication. The only problem is possibly too low blood pressure with the combo. I have them nicely balanced and will talk to doc on 6/5. Val From: hyperaldosteronism [mailto:hyperaldosteronism ] On Behalf Of Clarence Grim I knew about ketoconazole etc. and now see Marcolide antibiotics. AKA clarithromyocin. So if you need the C then just decrease the dose of E would be one way to do it. CE Grim, MDOn May 13, 2012, at 11:01 PM, Valarie wrote:clarithromycin ↔ eplerenoneApplies to: Biaxin (clarithromycin), eplerenone (Major contraindication)CONTRAINDICATED: Coadministration with potent inhibitors of CYP450 3A4 may significantly increase the plasma concentrations of eplerenone, which is primarily metabolized by the isoenzyme. In pharmacokinetic studies, administration of eplerenone (100 mg single dose) with ketoconazole (200 mg twice a day) resulted in a 1.7-fold increase in eplerenone peak plasma concentration (Cmax) and a 5.4-fold increase in systemic exposure (AUC).MANAGEMENT: The use of eplerenone with potent inhibitors of CYP450 3A4 (e.g., itraconazole, ketoconazole, nefazodone, delavirdine, ketolide and certain macrolide antibiotics, most protease inhibitors) is considered contraindicated. This is the interaction checker http://www.drugs.com/interactions-check.php?drug_list=997-0,685-337