Worst Pills, Best Pills Drug E-Alert: Fatal interaction between gout drug and antibiotic

[Guest guest]

Colleagues, the following is FYI and does not necessarily reflect my own

opinion. I have no further knowledge of the topic.

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Antibiotic Clarithromycin (BIAXIN) Can Have Deadly Interaction with

Anti-Gout Drug Colchicine

Using the antibiotic clarithromycin (BIAXIN, BIAXIN XL) in combination

with the gout drug colchicine increases the risk of death because of

colchicine toxicity, a recent stidy shows. Research staff from the

University of Hong Kong published their findings about this dangerous

interaction in the August issue of the journal Clinical Infectious

Diseases., The potential for harm is especially high in patients with

kidney problems.

Both clarithromycin and colchicine are very popular drugs in the U.S.

In 2004, the total number of clarithromycin prescriptions exceeded five

million. More than 2.3 million prescriptions for colchicine were

dispensed during the same year. Colchicine is also available in

combination with another anti-gout medication called probenecid. This

combination is sold as COL-PROBENECID.

Colchicine toxicity manifests itself as abdominal pain, vomiting,

diarrhea, and fever. It can damage the bone marrow’s ability to make

all types of blood cells, technically referred to as pancytopenia. This

decrease in blood cells causes severe anemia and seriously low numbers

of white blood cells. White blood cells are important for fighting

infection.

The researchers identified 116 patients admitted to their hospital

between February 1997 and September 2004 who had been prescribed both

colchicine and clarithromycin. They compared the clinical outcomes of

patients who took the two drugs simultaneously and those who were

prescribed the drugs sequentially, having had a prescription for one

drug started only after the course of therapy with the other drug had

been completed.

In the 88 patients who received the two drugs together, nine (10.2

percent), died. Only one (3.6 percent) of the 28 patients who received

the two drugs sequentially died. The risk of death was greatest in

those with kidney problems and with the loss of the bone marrow’s

ability to make blood cells.

This drug interaction appears to occur because clarithromycin

simultaneously increases the amount of colchicine that is absorbed into

the blood stream and decreases its breakdown by the liver, leading to

the accumulation of dangerous amounts of colchicine in the blood. The

accumulation of colchicine is even greater in patients with kidney

problems because their ability to excrete the drug in the urine is

decreased.

The study’s authors’ straightforward and sound advice is that colchicine

and clarithromycin not be taken together. They also recommend that for

patients that need colchicine and require an antibiotic similar to

clarithromycin, azithromycin (ZITHROMAX) may be substituted.

Azithromycin does not increase the absorption of colchicine or inhibit

its breakdown by the liver.

What You Can Do

You should contact your physician immediately if you are taking

colchicine and clarithromycin together.

--

ne Holden, MS, RD < fivestar@... >

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