克拉黴素

用途

• Treatment of feline leprosy
• Treatment of Nocardia (N. nova) infections
• Treatment of H. pylori infections
• Treatment of M. tuberculosis-bovis variant infections
• Susceptible infections
• Treatment of Helicobacter mustelae infections
• Treatment of Helicobacter mustelae infections
• Treatment of Rhodococcus equi infection in foals
• Treatment of Rhodococcus equi infection in foals
• Treatment of severe or refractory cases of canine leproid granuloma syndrome
• Susceptible infections
• Susceptible infections

給藥方式

可能的副作用

• Gastrointestinal disturbances (nausea, vomiting, anorexia, diarrhea)
• Pinnal or generalized erythema (specifically noted in cats)
• Transient, mild BUN elevation
• Prolonged QT interval / torsades de pointes (rare)
• Hepatotoxicity (rare)
• Thrombocytopenia (rare)
• Pseudomembranous colitis secondary to Clostridium difficile (reported in humans)

注意事項與禁忌

• Known hypersensitivity to clarithromycin or other macrolide antibiotics (e.g., erythromycin, azithromycin)
• Concurrent use with cisapride (due to risk of fatal cardiac arrhythmias)
• **Pregnancy & Lactation:** FDA Category C. High doses in animal studies showed some teratogenic effects (cleft palate, fetal growth retardation). Use only if benefits outweigh risks. Excreted into milk, though unlikely to be clinically significant. **Hepatic/Renal Impairment:** Use with caution; dose adjustments may be necessary in severe renal or hepatic dysfunction. **Drug Interactions:** Potent CYP3A inhibitor. Always review concurrent medications before prescribing.

藥物相互作用

• Cisapride: Clarithromycin inhibits cisapride metabolism; concurrent use is contraindicated due to risk of severe cardiac arrhythmias.
• Fluconazole: May increase clarithromycin serum levels.
• Digoxin: Clarithromycin may increase serum levels of digoxin.
• Omeprazole: Concurrent use can increase the plasma levels of both drugs.
• Warfarin: May potentiate the effects of oral anticoagulant drugs.
• Zidovudine: Clarithromycin may decrease serum concentrations of zidovudine.
• CYP3A Substrates (Alfentanil, Bromocriptine, Buspirone, Carbamazepine, Methylprednisolone, Midazolam, Alprazolam, Triazolam, Rifabutin, Tacrolimus, Theophylline): Clarithromycin inhibits CYP3A, potentially increasing plasma concentrations and toxicity of these drugs. Therapeutic monitoring or dose reduction may be required.
• Disopyramide: Increased levels and risk of prolonged QT interval.
• Quinidine: Increased levels and risk of prolonged QT interval.

常見問題