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Biaxin: Beware Of Drug Interactions

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Biaxin, also known by its generic name, clarithromycin, is most commonly used as an antibiotic to treat infections of the lung, bronchus, ear, sinus, skin, and throat.  Many of you may know Biaxin in a different context, however: as part of your treatment for myeloma.    It is a component of many regimens, several of which are still in clinical trials (thalidomide + Biaxin + dexamethasone (dex); Biaxin + Revlimid + dex [BiRd]; thalidomide + Biaxin + Revllimid + dex [T-BiRd]; pomalidomide + Biaxin + dex.).


Biaxin made its debut in the myeloma world in the early '90s, when thalidomide was the only "novel therapy."  Doctors noticed that patients who were receiving Biaxin treatment for an infection (or to prevent infection) while they were being treated with thalidomide and dex responded better to treatment than those who were receiving thalidomide and dex but not Biaxin.  Researchers concluded that the synergy between thalidomide, Biaxin, and dexamethasone was responsible for the improved response rate.  Biaxin made the so-called "thal/dex" regimen more effective.  A recent phase II Mayo Clinic study of Biaxin + Revlimid + low-dose dexamethasone  vsersus Revlimid + low-dose dexamethason alone in patients with newly diagnosed myeloma [Gay et al, Am. J Hematol. 2010 Sep;85(9):664-9] demonstrated that "there is significant additive value when clarithromycin is added to Rd."  A phase III trial is planned to confirm these results. 

In fact, Biaxin interacts with many other drugs, not just those used to treat myeloma.  The National Center for Biotechnology Information (NCBI), part of the National Institutes of Health, has a large compendium of information on drugs.  In their entry for clarithromycin, there is a long list of drugs with which clarithromycin has interactions.  Patients are cautioned to:

molecule.jpgpills.jpgMany other medications may also interact with clarithromycin, so tell your doctor about all the medications you are taking, even those that do not appear on this list. Your doctor may need to change the doses of your medications or monitor you carefully for side effects.

This information about Biaxin is important in its own right, for those of you who are taking it, but should also serve as a warning about drugs in general.  MANY DRUGS CAUSE UNDESIRED OR UNANTICIPATED INTERACTIONS WHEN THEY ARE COMBINED.  

You should make it a practice to have your pharmacist check on drug-drug interactions no matter which medications you're taking, and no matter which days of the week or which times of day you take them. They don't have to be literally taken in combination.  This includes vitamins and supplements, not just prescription drugs.  

There is computer software available to pharmacists so that they can perform due diligence and prevent you from having problems with drug interactions.   Present you pharmacist with a complete list of all medications, vitamins, and supplements that you're taking.  This is part of being a good patient-  just ask blogger Mike Katz, The Good Patient.


This is extremely important information, and I'm glad that someone is getting the word out. If this is mixed with some conflicting drugs the consequences could be awful.

It is both tragic and ironic that the two classes of diseases resonate among themselves, each one adding to the burden of the other. This is more so in the third world where even the provision of potable water which was supposed to be realized by 1978 is still but a mirage.
Poverty is fueled by uncontrolled population growth, as the poor segments of society tend to have more children to help in odd jobs to earn income. the indiscriminate onslaught of HIV has further complicated the equation.
The solution lies at the very basics. Medical care and management of NCDs is much more expensive than for CDs yet governments are pouring scarce donor funds into the former while ignoring the latter.

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