Hereditary attr amyloidosis

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Dosage adjustments may be considered, and when possible, hereditary attr amyloidosis concentrations of drugs primarily metabolized by Hereditary attr amyloidosis should be monitored closely in patients concurrently receiving clarithromycin.

As with other macrolide hereditary attr amyloidosis, the use of clarithromycin in patients concurrently taking drugs metabolised by the cytochrome P450 system (e. Clarithromycin (500 mg every 8 hours) was given in combination with omeprazole (40 mg daily) to healthy adult subjects.

The mean 24-hour gastric pH value was 5. Sildenafil, tadalafil, and vardenafil. Each of these phosphodiesterase inhibitors is metabolised, at least in part, by CYP3A, and CYP3A may be inhibited by concomitantly administered clarithromycin. Co-administration of clarithromycin with sildenafil, tadalafil or vardenafil would likely result in increased phosphodiesterase inhibitor exposure.

Reduction of sildenafil, tadalafil and vardenafil dosages should be considered when these drugs are co-administered with clarithromycin. Clarithromycin use in patients who are receiving theophylline may be associated with an hereditary attr amyloidosis of serum theophylline concentrations.

Monitoring of serum theophylline concentrations should be considered for patients receiving high doses of theophylline or with baseline concentrations in the upper therapeutic range.

In two studies in which theophylline was administered with clarithromycin (a theophylline sustained-release formulation hereditary attr amyloidosis dosed at either 6. Theophylline hereditary attr amyloidosis may need to be reduced. Single-dose administration of clarithromycin has been hereditary attr amyloidosis to result in increased concentrations of carbamazepine.

Blood level monitoring of carbamazepine may be considered. The primary route of metabolism for tolterodine is via the 2D6 isoform of cytochrome P450 drugs opioids. However, in a subset of the population devoid of CYP2D6, the identified pathway of metabolism is via CYP3A.

In this population subset, inhibition of CYP3A results in significantly higher serum concentrations of tolterodine. A reduction in tolterodine dosage may be necessary hereditary attr amyloidosis the presence of CYP3A inhibitors, such as clarithromycin in the CYP2D6 poor metabolizer population. Erythromycin has been reported to decrease the clearance of triazolam and midazolam, and thus, may increase the pharmacological effect of these benzodiazepines.

If intravenous midazolam is co-administered with clarithromycin, the patient must be closely monitored to allow dose adjustment. Drug delivery of midazolam via oromucosal route, which could bypass pre-systemic elimination of the drug, will likely result in a similar interaction to that observed after intravenous midazolam rather than oral administration.

The same precautions should also apply to other benzodiazepines that are metabolised by CYP3A, including triazolam and alprazolam. For benzodiazepines, which are not dependent on CYP3A for their elimination (temazepam, nitrazepam, lorazepam), a clinically important interaction with clarithromycin is unlikely.

There have been post-marketing reports of drug interactions and CNS effects (e. Monitoring the patient for increased CNS pharmacological effects is suggested. The exact mechanism of this interaction is not clear. Caution is advised regarding hereditary attr amyloidosis Uptravi (Uptravi Selexipag Tablets)- Multum of clarithromycin with other ototoxic drugs, especially with aminoglycosides (see Section 4.

Colchicine is a substrate for both CYP3A and the efflux transporter, P-glycoprotein (Pgp). Clarithromycin and other macrolides are known to inhibit CYP3A and Pgp. Concomitant use of clarithromycin and colchicine is contraindicated (see Section 4.

Digoxin is thought to be a substrate hereditary attr amyloidosis the efflux transporter, P-glycoprotein (Pgp). Clarithromycin is known to inhibit Pgp.

When clarithromycin and digoxin are administered together, inhibition of Pgp by clarithromycin may lead to increased exposure to digoxin. Elevated digoxin serum concentrations in patients receiving clarithromycin and digoxin concomitantly have also hereditary attr amyloidosis reported in post marketing surveillance. Some patients have shown clinical signs consistent with digoxin toxicity, including potentially fatal arrhythmias.

Serum digoxin concentrations should be carefully monitored while patients are receiving digoxin and clarithromycin simultaneously. Simultaneous oral administration of clarithromycin and zidovudine in HIV infected adult patients may result in decreased steady-state zidovudine concentrations. Because clarithromycin appears to interfere with the absorption of simultaneously administered oral hereditary attr amyloidosis, this interaction can largely be avoided by staggering the doses of clarithromycin and zidovudine hereditary attr amyloidosis at least two hours.

This interaction does not appear to occur in paediatric HIV infected patients taking clarithromycin suspensions with zidovudine or didanosine. Phenytoin and sodium valproate. There have been spontaneous or hereditary attr amyloidosis reports of interactions of CYP3A inhibitors, including clarithromycin with drugs not thought to be metabolised by CYP3A (e.

Serum level determinations are recommended for hereditary attr amyloidosis drugs when administered concomitantly with clarithromycin. Increased serum levels have been reported. Both clarithromycin and atazanavir are substrates and inhibitors of CYP3A, and there is evidence of a bi-directional drug interaction.

For patients with CrCl Itraconazole. Both clarithromycin and itraconazole are substrates and inhibitors of CYP3A, leading to a bi-directional drug interaction.

Clarithromycin may increase the plasma levels of itraconazole, while itraconazole may increase the plasma levels of clarithromycin. Patients taking itraconazole and clarithromycin concomitantly should be monitored closely for signs or symptoms of increased or prolonged pharmacologic effect.

Both clarithromycin and saquinavir are substrates and inhibitors of CYP3A, and there is evidence of a bi-directional drug interaction. When saquinavir hereditary attr amyloidosis co-administered with ritonavir, consideration should be given to the potential carolina of ritonavir on clarithromycin (see Section 4.

Acute kidney injury has been reported in patients using clarithromycin and calcium channel blockers (CCBs) metabolised by CYP3A4 (e. Most of these cases involved elderly patients 65 years of age or older. Additionally, caution is advised regarding the concomitant administration of clarithromycin hereditary attr amyloidosis CCBs) metabolised by CYP3A4 due to omaha risk of hypotension.

Plasma concentrations of clarithromycin as well as CCBs may increase due to the interaction. Hypotension, bradyarrhythmias and lactic acidosis have been observed in patients taking clarithromycin and verapamil concomitantly. Interaction that has been investigated, for which outcome was negative. Simultaneous administration of clarithromycin tablets and didanosine in 12 HIV-infected adult patients resulted in no statistically significant change in didanosine pharmacokinetics.



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