(HealthDay News) – For older adults, co-prescription with clarithromycin vs. azithromycin and calcium-channel blockers is associated with increased risk of hospitalization with acute kidney injury, according to a study published online Nov. 9 in the Journal of the American Medical Association. This research was published to coincide with the annual meeting of the American Society of Nephrology (Kidney Week), held from Nov. 5–10 in Atlanta.

Sonja Gandhi, from Western University in London, Canada, and colleagues characterize the risk of acute adverse events in older adults (mean age, 76 years) following co-prescription of clarithromycin (96,226 patients) vs.  azithromycin (94,083 patients) while taking a calcium-channel blocker.

The researchers found that within 30 days of a new prescription, the risk of hospitalization with acute kidney injury was significantly increased for co-prescription of clarithromycin (0.44%) vs. azithromycin (0.22%) with a calcium-channel blocker (absolute risk increase, 0.22%; odds ratio, 1.98). The risk was highest with dihydropyridines, especially nifedipine (absolute risk increase, 0.63%). The risks of hospitalization with hypotension (absolute risk increase, 0.04%; odds ratio, 1.6) and all-cause mortality (absolute risk increase, 0.43%; odds ratio, 1.74) were also increased with co-prescription with clarithromycin.

“These findings support current safety warnings regarding concurrent use of CYP3A4 inhibitors and calcium-channel blockers,” the authors write.

Two authors disclosed financial ties to the pharmaceutical industry.

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