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Clinical Ergotism With Lingual Ischemia Induced by Clarithromycin-Ergotamine Interaction

Clinical Ergotism With Lingual Ischemia Induced by Clarithromycin-Ergotamine Interaction Abstract The macrolide class of antibiotics, including erythromycin and troleandomycin, is associated with clinically significant adverse drug interactions. This results from macrolide inhibition of cytochrome P-450 metabolism of numerous xenobiotics, resulting in elevated serum drug levels and clinical intoxication. Animal studies, however, suggest that clarithromycin, the newest approved macrolide antibiotic, has less potential for adverse drug reactions. We describe a patient who, on her fifth day of clarithromycin therapy, developed clinical ergotism (ie, hypertension, lingual ischemia, and peripheral cyanosis) several hours after administration of her usual 2-mg dose of ergotamine tartrate. To our knowledge, this is the first report of clinical ergotism precipitated by clarithromycin-ergotamine interaction and suggests that, like other macrolide antibiotics, ergot preparations should be avoided in patients who are taking clarithromycin. (Arch Intern Med. 1996;156:456-458) References 1. Ghali R, De Lean J, Douville Y, Noël HP, Labbé R. Erythromycin-associated ergotamine intoxication: arteriographic and electrophysiologic analysis of a rare cause of severe ischemia of the lower extremities and associated ischemic neuropathy . Ann Vasc Surg. 1993;7:291-296.Crossref 2. Hayton AC. Precipitation of acute ergotism by triacetyloleandomycin . N Z Med J. 1969;69:42. 3. Tinel M, Descatoire V, Larrey D, et al. Effects of clarithromycin on cytochrome P-450: comparison with other macrolides . J Pharmacol Exp Ther. 1989;250:746-751. 4. Wise CM, Agudelo CA, Chmelewski WL, McKnight KM. Temporal arteritis with low erythrocyte sedimentation rate: a review of five cases . Arthritis Rheum. 1991;34:1571-1574.Crossref 5. Berlit P. Clinical and laboratory findings with giant cell arteritis . J Neurol Sci. 1992;111:1-12.Crossref 6. Hunder GG, Bloch DA, Michel BA, et al. The American College of Rheumatology 1990 criteria for the classification of giant cell arteritis . Arthritis Rheum. 1990;33:1122-1128.Crossref 7. Chmelewski WL, McKnight KM, Agudelo CA, Wise CM. Presenting features and outcomes in patients undergoing temporal artery biopsy: a review of 98 patients. Arch Intern Med. 1992;152:1690-1695. 8. Bowdler DA, Knight JR. Lingual claudication and necrosis as a complication of giant cell arteritis . J Laryngol Otol. 1985;99:417-420.Crossref 9. Sofferman RA. Lingual infarction in cranial arteritis . JAMA. 1980;243:2422-2423.Crossref 10. Abbott Laboratories. Product information, Biaxin, clarithromycin . Abbott Park, III: Abbott Laboratories; 1994. 11. Ohmori S, Ishii I, Kuriya SI, et al. Effects of clarithromycin and its metabolites on the mixed function oxidase system in hepatic microsomes of rats . Drug Metab Dispos. 1993;21:358-363. 12. Suwa T, Yoshida H, Yoshitomi S, Kamei K. Metabolic fate of TE-031, IV : metabolism of 14C-TE-031 in rats and dogs. Chemotherapy (Jpn). 1988; 36:227-237. 13. Suwa T, Ohtake T, Urano H, et al. Metabolic fate of TE-031, IX: absorption and excretion in humans . Chemotherapy (Jpn). 1988;36:933-940. 14. Ruff F, Chu SY, Sonders RC, Sennello LT. Effects of multiple doses of clarithromycin on the pharmacokinetics of theophylline. Presented at the 30th Interscience Conference on Antimicrobial Agents and Chemotherapy; 1990; Atlanta, Ga. 15. Albani F, Riva R, Baruzzi A. Clarithromycin-carbamazepine interaction: a case report. Epilepsia . 1993;34:161-162.Crossref 16. Ferrari SL, Goffin E, Mourad M, Wallemacq P, Squifflet JP, Pirson Y. The interaction between clarithromycin and cyclosporine in kidney transplant recipients . Transplantation. 1994;58:725-727.Crossref 17. Honig P, Wortham D, Zamani K, Conner D, Cantilena L. Effect of erythromycin, clarithromycin and azithromycin on the pharmacokinetics of terfenadine . Clin Pharmacol Ther. 1993;53:161. Abstract.Crossref 18. Müller-Schweinitzer E, Weidmann H. Basic pharmacologic properties . In: Berde B, Schild HO, eds. Ergot Alkaloids and Related Compounds: Handbook of Experimental Pharmacology . New York, NY: Springer-Verlag NY Inc; 1978:87-232. 19. Perrin VL. Clinical pharmacokinetics of ergotamine in migraine and cluster headaches . Clin Pharmacokinet. 1985;10:334-352.Crossref 20. Aellig WH, Nüesch E. Comparative pharmacokinetic investigations with tritium-labeled ergot alkaloids after oral and intravenous administration in man . Int J Clin Pharmacol Biopharm. 1977; 15:106-112. 21. Olesen J. A review of current drugs for migraine . J Neurol. 1991;238( (suppl 1) ):S23-S27.Crossref 22. Baumrucker JF. Drug interaction: propranolol and Cafergot . N Engl J Med. 1973;288:916-917. 23. Galer BS, Lipton RB, Solomon S, Newman LC, Spierings E. Myocardial ischemia related to ergot alkaloids: a case report and literature review . Headache. 1991;31:446-450.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

Clinical Ergotism With Lingual Ischemia Induced by Clarithromycin-Ergotamine Interaction

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References (17)

Publisher
American Medical Association
Copyright
Copyright © 1996 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.1996.00440040134015
Publisher site
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Abstract

Abstract The macrolide class of antibiotics, including erythromycin and troleandomycin, is associated with clinically significant adverse drug interactions. This results from macrolide inhibition of cytochrome P-450 metabolism of numerous xenobiotics, resulting in elevated serum drug levels and clinical intoxication. Animal studies, however, suggest that clarithromycin, the newest approved macrolide antibiotic, has less potential for adverse drug reactions. We describe a patient who, on her fifth day of clarithromycin therapy, developed clinical ergotism (ie, hypertension, lingual ischemia, and peripheral cyanosis) several hours after administration of her usual 2-mg dose of ergotamine tartrate. To our knowledge, this is the first report of clinical ergotism precipitated by clarithromycin-ergotamine interaction and suggests that, like other macrolide antibiotics, ergot preparations should be avoided in patients who are taking clarithromycin. (Arch Intern Med. 1996;156:456-458) References 1. Ghali R, De Lean J, Douville Y, Noël HP, Labbé R. Erythromycin-associated ergotamine intoxication: arteriographic and electrophysiologic analysis of a rare cause of severe ischemia of the lower extremities and associated ischemic neuropathy . Ann Vasc Surg. 1993;7:291-296.Crossref 2. Hayton AC. Precipitation of acute ergotism by triacetyloleandomycin . N Z Med J. 1969;69:42. 3. Tinel M, Descatoire V, Larrey D, et al. Effects of clarithromycin on cytochrome P-450: comparison with other macrolides . J Pharmacol Exp Ther. 1989;250:746-751. 4. Wise CM, Agudelo CA, Chmelewski WL, McKnight KM. Temporal arteritis with low erythrocyte sedimentation rate: a review of five cases . Arthritis Rheum. 1991;34:1571-1574.Crossref 5. Berlit P. Clinical and laboratory findings with giant cell arteritis . J Neurol Sci. 1992;111:1-12.Crossref 6. Hunder GG, Bloch DA, Michel BA, et al. The American College of Rheumatology 1990 criteria for the classification of giant cell arteritis . Arthritis Rheum. 1990;33:1122-1128.Crossref 7. Chmelewski WL, McKnight KM, Agudelo CA, Wise CM. Presenting features and outcomes in patients undergoing temporal artery biopsy: a review of 98 patients. Arch Intern Med. 1992;152:1690-1695. 8. Bowdler DA, Knight JR. Lingual claudication and necrosis as a complication of giant cell arteritis . J Laryngol Otol. 1985;99:417-420.Crossref 9. Sofferman RA. Lingual infarction in cranial arteritis . JAMA. 1980;243:2422-2423.Crossref 10. Abbott Laboratories. Product information, Biaxin, clarithromycin . Abbott Park, III: Abbott Laboratories; 1994. 11. Ohmori S, Ishii I, Kuriya SI, et al. Effects of clarithromycin and its metabolites on the mixed function oxidase system in hepatic microsomes of rats . Drug Metab Dispos. 1993;21:358-363. 12. Suwa T, Yoshida H, Yoshitomi S, Kamei K. Metabolic fate of TE-031, IV : metabolism of 14C-TE-031 in rats and dogs. Chemotherapy (Jpn). 1988; 36:227-237. 13. Suwa T, Ohtake T, Urano H, et al. Metabolic fate of TE-031, IX: absorption and excretion in humans . Chemotherapy (Jpn). 1988;36:933-940. 14. Ruff F, Chu SY, Sonders RC, Sennello LT. Effects of multiple doses of clarithromycin on the pharmacokinetics of theophylline. Presented at the 30th Interscience Conference on Antimicrobial Agents and Chemotherapy; 1990; Atlanta, Ga. 15. Albani F, Riva R, Baruzzi A. Clarithromycin-carbamazepine interaction: a case report. Epilepsia . 1993;34:161-162.Crossref 16. Ferrari SL, Goffin E, Mourad M, Wallemacq P, Squifflet JP, Pirson Y. The interaction between clarithromycin and cyclosporine in kidney transplant recipients . Transplantation. 1994;58:725-727.Crossref 17. Honig P, Wortham D, Zamani K, Conner D, Cantilena L. Effect of erythromycin, clarithromycin and azithromycin on the pharmacokinetics of terfenadine . Clin Pharmacol Ther. 1993;53:161. Abstract.Crossref 18. Müller-Schweinitzer E, Weidmann H. Basic pharmacologic properties . In: Berde B, Schild HO, eds. Ergot Alkaloids and Related Compounds: Handbook of Experimental Pharmacology . New York, NY: Springer-Verlag NY Inc; 1978:87-232. 19. Perrin VL. Clinical pharmacokinetics of ergotamine in migraine and cluster headaches . Clin Pharmacokinet. 1985;10:334-352.Crossref 20. Aellig WH, Nüesch E. Comparative pharmacokinetic investigations with tritium-labeled ergot alkaloids after oral and intravenous administration in man . Int J Clin Pharmacol Biopharm. 1977; 15:106-112. 21. Olesen J. A review of current drugs for migraine . J Neurol. 1991;238( (suppl 1) ):S23-S27.Crossref 22. Baumrucker JF. Drug interaction: propranolol and Cafergot . N Engl J Med. 1973;288:916-917. 23. Galer BS, Lipton RB, Solomon S, Newman LC, Spierings E. Myocardial ischemia related to ergot alkaloids: a case report and literature review . Headache. 1991;31:446-450.Crossref

Journal

Archives of Internal Medicine – American Medical Association

Published: Feb 26, 1996

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