Ciclosporin/clarithromycin interaction
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Acute kidney injury in a child: case report A 12-year-old girl developed acute kidney injury during the concomitant use of ciclosporin and clarithromycin [routes and dosages not stated]. The girl, who was receiving ciclosporin, prednisone and azathioprine for idiopathic nephrotic syndrome, began receiving standard doses of clarithromycin for bronchitis. She subsequently presented with generalised oedema, albuminuria and signs of acute kidney damage [duration of treatment to reaction onset not stated]. Lung auscultation revealed dry rales. Laboratory investigations included the following: creatinine 1.46 mg%, urea 107 mg%, creatinine clearance 51.98 mL/min/1.73m2%, total protein 4.4 mg%, albumin 1.6 g%, total cholesterol 392 mg%, triglycerides 594 mg% and a whole blood ciclosporin concentration of 270.1 ng/mL. She was diagnosed with recurrent nephrosis, respiratory tract infection and acute kidney injury due to an interaction between ciclosporin and clarithromycin. Ciclosporin and clarithromycin were discontinued, and she received amoxicillin/clavulanic acid, human albumin supplement and dehydration therapy. Ciclosporin was restarted following normalisation of her creatinine and urea levels, and her nephrotic syndrome remitted. At last followup, her creatinine and urea levels were normal and her whole blood ciclosporin concentration was within the therapeutic range. Author comment: As a result of a drug interaction between ciclosporin and clarithromycin, therapeutic levels of ciclosporin were exceeded, leading to a sudden deterioration in kidney function manifested in elevated serum levels of urea and creatinine and reduced creatinine clearance. Fornalczyk K, et al. Acute kidney injury in a child with idiopathic nephrotic syndrome in the course of drug interaction between cyclosporine A and macrolide - Case report. Family Medicine and Primary Care Review 12: 530-532, No. 2, Jun 803057209 2010 [Polish; summarised from a translation] - Poland
0114-9954/10/1360-0001/$14.95 © 2010 Adis Data Information BV. All rights reserved
Reactions 16 Jul 2011 No. 1360
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