Re: Eplerenone + Biaxin ATTN Dr. Grim

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I hate to change it.  My BP has been holding steady avg 128/75.  From what I read, the only problem with clarithromycin with eplerenone is that the action of epler is greater than it would be without the clarith.  When my doc ordered 200 mg eplerenone, CVS Pharmacy resisted and said I shouldn't have over 100 mg.  At the time, I was on 150 mg spiro but had problems with it.  I've been taking 75 mg since Oct of 2010.   All this time, I thought my BP drop was from getting better from Lyme treatment.  I went off clarith for a few days and BP started rising into the 140's.  I've tried decreasing epler dose to 50 and BP gets too high.  Do you understand any other issues with the combination?  Val From: hyperaldosteronism [mailto:hyperaldosteronism ] On Behalf Of Clarence GrimI 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=997-0,685-337From: 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: My doc just switched me to doxy from Biaxin because of the newly-emerged Biaxin-eplerenone contraindication.

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Not aware of other issues. Sounds like a trial and see situation.Might send some reviews of use of eplerenone in PA to Pham. Don't have one in right on my computer. CE Grim MDOn May 14, 2012, at 4:45 PM, Valarie wrote: I hate to change it. My BP has been holding steady avg 128/75. From what I read, the only problem with clarithromycin with eplerenone is that the action of epler is greater than it would be without the clarith. When my doc ordered 200 mg eplerenone, CVS Pharmacy resisted and said I shouldn't have over 100 mg. At the time, I was on 150 mg spiro but had problems with it. I've been taking 75 mg since Oct of 2010. All this time, I thought my BP drop was from getting better from Lyme treatment. I went off clarith for a few days and BP started rising into the 140's. I've tried decreasing epler dose to 50 and BP gets too high. Do you understand any other issues with the combination? Val From: hyperaldosteronism [mailto:hyperaldosteronism ] On Behalf Of Clarence GrimI 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=997-0,685-337From: 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: My doc just switched me to doxy from Biaxin because of the newly-emerged Biaxin-eplerenone contraindication.