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Elderly on Both Calcium-channel Blockers and Antibiotics Can Raise Risk of Acute Kidney Injury

Filed November 11th, 2013 Laurie

Older adults taking a calcium-channel blocker such as Norvasc with the antibiotic clarithromycin face an increased 30-day risk of hospitalization with acute kidney injury, according to a study published by JAMA Internal Medicine.

The results of the study will be presented at the American Society of Nephrology’s Kidney Week 2013.

Clarithromycin and erythromycin are commonly used antibiotics that are clinically important inhibitors of the enzyme CYP3A4. Calcium-channel blockers are metabolized by this enzyme. If CYP3A4 activity is inhibited, dangerous concentrations of clarithromycin and erythromycin can build up in the blood, which can result in potential acute kidney injury, according to

Norvasc (amlodipine) was the most commonly prescribed calcium-channel blocker (more than 50 percent of patients), reported.

Researchers found that patients taking a combination of clarithromycin and a calcium-channel blocker had a higher risk of hospitalization with acute kidney injury compared with patients taking azithromycin and a calcium-channel blocker, according to

When examined by type of calcium-channel blocker, the risk of hospitalization with acute kidney injury was highest among patients taking clarithromycin and nifedipine (absolute risk increase, 0.63 percent). Patients prescribed 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), reported.

“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 wrote.

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