Acute Kidney Injury from Calcium-Channel Blockers Exacerbated by Clarithromycin

CYP3A4 inhibition can lead to excessive CCB levels and hypotension.

Many drug–drug interactions theoretically confer risk but are clinically insignificant. However, inhibition of cytochrome P₄₅₀ enzyme 3A4 (CYP3A4) can cause serious problems. CYP3A4 inhibition by clarithromycin can cause excessive plasma levels of calcium-channel blockers (CCBs), which in turn can cause hypotensive episodes and acute kidney injury. In this population-based retrospective study, Canadian investigators identified two separate cohorts of 95,000 older adults (mean age, 76) for whom clarithromycin or azithromycin (which does not inhibit CYP3A4) had been newly prescribed; all patients were chronic users of CCBs.

During the 30 days following antibiotic prescription, risk for hospitalization for acute kidney injury was 0.44% in the c…

Reviewing Author

Thomas L. Schwenk, MD

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Thomas L. Schwenk, MD

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Acute Kidney Injury from Calcium-Channel Blockers Exacerbated by Clarithromycin

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