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Medical Forum / Diseases and Disorders / Sinusitis / March 2008Macrolide antibiotics: inhibitors of corticosteroid clearance
Macrolide Antibiotics "Antibiotics: Macrolide antibiotics have been reported to cause a significant decrease in corticosteroid clearance." http://www.nextmd.com/DRUGS/MACROLIDE_ANTIBIOTICS.asp AZITHROMYCIN Zithromax CLARITHROMYCIN Biaxin DIRITHROMYCIN Dynabac Erythromycin http://www.webhealthcentre.com/ref/drugix/DI0055.asp > x-no-archive: yes > [quoted text clipped - 16 lines] > Erythromycin > http://www.webhealthcentre.com/ref/drugix/DI0055.asp Oops, links don't work. I'll find new ones and repost. In any case, you'd want to be VERY careful about long term use of these drugs. Susan >> AZITHROMYCIN >> Zithromax [quoted text clipped - 14 lines] > In any case, you'd want to be VERY careful about long term use of these > drugs. Perhaps you can explain this to us idiots?  SignaturePosted via a free Usenet account from http://www.teranews.com > x-no-archive: yes > [quoted text clipped - 15 lines] > > Erythromycinhttp://www.webhealthcentre.com/ref/drugix/DI0055.asp Can't get to the pages, but I would assume that the need for clearance inferred would presuppose the use of same steroids, or conversely would imply the conservation of endogenous steroid hormones. > Can't get to the pages, but I would assume that the need for clearance > inferred would presuppose the use > of same steroids, or conversely would imply the conservation of > endogenous steroid hormones. Definitely inhibits clearance of steroid drugs. I'm curious but not yet sure about endogenous, which would be of great concern, given how damaging elevated levels of cortisol are. Susan > x-no-archive: yes > > Macrolide Antibiotics > > "Antibiotics: Macrolide antibiotics have been reported to cause a > significant decrease in corticosteroid clearance." Evidently, this has been known for a long time, Susan. See, for example: http://www.erj.ersjournals.com/cgi/reprint/10/5/971.pdf Macrolides are potent inhibitors of cytochrome P450 3A4-7 enzymes, which the liver needs in order to metabolize many so-called "substrate" drugs. Before this was fully understood, several patients experienced fatal heart problems from taking macrolides together with minimally sedating antihistamines. Other serious interactions occur with various psychotherapeutic drugs. I ran into that problem about 15 years ago. (Good thing I had a psychopharmacologist who understood this metabolic issue; NEVER take psychotherapeutic drugs prescribed to you by a general practitioner.) I'll bet the reduced steroid clearance of which you speak, is just another example of those pesky cytochrome P450 interactions. *Every* patient should be familiar with this P450 interaction chart and how to interpret it. Print it out and keep it in your wallet or purse! http://medicine.iupui.edu/flockhart/table.htm It's basically a spreadsheet of how your liver works. :-) SignatureSteven L. Email: sdlitvin@earthlinkNOSPAM.net Remove the NOSPAM before replying to me. >Macrolides are potent inhibitors of cytochrome P450 3A4-7 enzymes, which >the liver needs in order to metabolize many so-called "substrate" drugs. Quinolones (Levaquin, Cipro, Avelox, and friends) are P450 inhibitors, too, though for different pathways (that's why they tell you not to drink caffeinated stuff while you're on them; they also interfere with some blood thinners). And if you suffer an adverse reaction to a quinolone, your liver function can be screwed up for quite some time. >> Macrolides are potent inhibitors of cytochrome P450 3A4-7 enzymes, which >> the liver needs in order to metabolize many so-called "substrate" drugs. [quoted text clipped - 4 lines] > some blood thinners). And if you suffer an adverse reaction to a > quinolone, your liver function can be screwed up for quite some time. What I always got a kick out of was that even some *foods*, like grapefruit juice, have bizarre P450 interactions too. A number of patients on MAOI antidepressants got caught that way, when they learned the hard way of a P450 interaction between grapefruit juice and MAOIs. The interaction table I posted, has an entry for grapefruit juice. SignatureSteven L. Email: sdlitvin@earthlinkNOSPAM.net Remove the NOSPAM before replying to me. > The interaction table I posted, has an entry for grapefruit juice. Yes, I've seen that listed on all of my references, too. But we haven't had discussions about grapefruit juice as a tx for sinusitis here. Susan > x-no-archive: yes > >> The interaction table I posted, has an entry for grapefruit juice. > > Yes, I've seen that listed on all of my references, too. But we haven't > had discussions about grapefruit juice as a tx for sinusitis here. Who the hell knows what sinusitis sufferers eat. :-) I'm sure with all this talk about Vitamin C, some of them have tried grapefruit juice, or eating grapefruits--if only to break up the monotony of orange juice. My mom used to feed me lots of grapefruit when I was a kid. Grapefruit juice is rich in Vitamin C, which sinus sufferers might find attractive. The trouble is, it's also a potent cytochrome P450 inhibitor--which most patients don't have a clue about. SignatureSteven L. Email: sdlitvin@earthlinkNOSPAM.net Remove the NOSPAM before replying to me. > Grapefruit juice is rich in Vitamin C, which sinus sufferers might find > attractive. The trouble is, it's also a potent cytochrome P450 > inhibitor--which most patients don't have a clue about. We used to be so fortunate to have a Cushing's patient who was also a pharmacist posting on that group, and she did great research, too. It's almost impossible to find a drug or herb that doesn't alter HPA function and cortisol levels. I've even been flattened by adrenal suppression caused by moisturizers with lactic acid or salicylic acid in them. Susan >> x-no-archive: yes >> [quoted text clipped - 4 lines] > > Who the hell knows what sinusitis sufferers eat. :-) Usually, it doesn't matter--we can't taste anything anyway... >> x-no-archive: yes >> [quoted text clipped - 28 lines] > > It's basically a spreadsheet of how your liver works. :-) I was well aware of all the above Steven, as I've been reading about drugs that interfere with pituitary/adrenal hormone testing for a long time. But I doubt anyone else here was aware of it, so I posted it here. FYI, Cushing's patients virtually all suffer periodic acute and/or chronic sinus infection, no doubt due to the immune suppression caused by excess cortisol and/or increased pro inflammatory CRH. IMO, one would want to avoid creating an environment mimicking this pit/adrenal disorder. Susan |
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