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Benzos Urgent advice on drug interaction risk benzos

C

CocaColbenzo

Greenlighter
Joined
Aug 26, 2017
Messages
21
Well the hospital prescribed me a new antibiotic to treat my infected open fracture surgery. They prescribed me Clarithromycin. Now the problem, I'm also taking Lorazepam 1mg daily.

From a quick google search Clarithromycin and Lorazepam come under "Serious Interaction" category.

When taken together, both levels of Clarithromycin and Lorazepam are increased.

It appears that Clarithromycin is one of the strongest inhibitors of CYP3A4!

Am i right in thinking this medication MUST be changed immediately? I only taken 1/3 of my normal Lorazepam today and i feel like i taken more than the normal dose.

Why a hospital would do this, i have no idea 8o

I would really appreciate any quick replies on this, because the infection is serious and i have no antibiotics in my body currently!
 
It is a pretty strong inhibitor so probably should be changed. Why they wrote it? Probably its on their protocol for whatever infection you have or they tested the bacteria and its susceptible. In the latter case, they may not want to change if its the only or best option.
 
Kittycat5 said:
It is a pretty strong inhibitor so probably should be changed. Why they wrote it? Probably its on their protocol for whatever infection you have or they tested the bacteria and its susceptible. In the latter case, they may not want to change if its the only or best option.
Click to expand...

They haven't tested the bacteria yet.

I'm also taking 60mg codeine every 4 hours which would also become greatly stronger with this medication right? Surely that could be dangerous?

I mean if its not then i guess i could just put up with it.

Lorazepam + Codeine + CYP3A4 = sounds a very bad idea. But I'm open to opinion from people who know more about this than myself.
 
Codeine isnt as big a deal. Its conversion to morphine is mediated by 2D6 not 3A4 and while blocking 3A4 could potentially lead to more codeine sticking around to form morphine, I dont think its clinically important.

Are you penicillin allergic?
 
CocaColbenzo said:
Well the hospital prescribed me a new antibiotic to treat my infected open fracture surgery. They prescribed me Clarithromycin. Now the problem, I'm also taking Lorazepam 1mg daily.

From a quick google search Clarithromycin and Lorazepam come under "Serious Interaction" category.

When taken together, both levels of Clarithromycin and Lorazepam are increased.

It appears that Clarithromycin is one of the strongest inhibitors of CYP3A4!

Am i right in thinking this medication MUST be changed immediately? I only taken 1/3 of my normal Lorazepam today and i feel like i taken more than the normal dose.

Why a hospital would do this, i have no idea 8o

I would really appreciate any quick replies on this, because the infection is serious and i have no antibiotics in my body currently!
Click to expand...

Your doctors are capable to make tests to evaluate if a medication will be harmful to you. Have you spoken to them about your concerns?

You should take antibiotics the soonest possible from my perspective.
 
Thats not great advice Erikmen. Doctors from top to bottom miss drug interactions and while personally I think if the course is short, this particular interaction isnt that bad, the patient who it is intended for is already worrying and would be more likely to stop or completely skip taking the antibiotic.
 
Kittycat5 said:
Codeine isnt as big a deal. Its conversion to morphine is mediated by 2D6 not 3A4 and while blocking 3A4 could potentially lead to more codeine sticking around to form morphine, I dont think its clinically important.

Are you penicillin allergic?
Click to expand...

Interesting thanks. No I'm not penicillin allergic. Although the moron doctor who i keep seeing in the hospital is sure that i am allergic to penicillin. He bases this off the fact that i got a rash on my hands when bedridden for a while in hospital. I kindly explained to him, that i have taken penicillin for years for chest infections without problem and that the rash was likely caused by getting urine on my hands with prolonged exposure when i had to use bottles for the toilet.

Being a student nurse, i have personally witnessed patients who developed the same rash when bedridden.

Erikmen said:
Your doctors are capable to make tests to evaluate if a medication will be harmful to you. Have you spoken to them about your concerns?

You should take antibiotics the soonest possible from my perspective.
Click to expand...

No i haven't spoken to the doctor because i can't. All i can do is go back to the hospitals A&E department and tell them my concerns. I already had to do this yesterday, because they prescribed me a antibiotic before the Clarithromycin, that was not even for treating my type of injury.

This will now be the 3rd painful trip to the hospitals A&E department and over $180 in taxis this week alone. I plan to just go to my local hospital and hope they will help!
 
I haven't got the drug yet. They gave me 1000mg of it yesterday at the hospital then said to return today to claim the prescription.

Honestly, I'm really pissed about this because Clarithromycin is a excellent antibiotic. If i did continue the course, how much stronger should i expect the 1mg Lorazepam to be with CYP3A4 enzyme being inhibited. Because if its anything like grapefruit juice, then its like 4 to 5 times stronger isn't it?
 
Its stronger than WGFJ. Id have to double check but pretty sure clarithromycin is the highest level of inhibitor according to the FDA which means it increases AUC like 2.5 to 3 times. Theres plenty of excellent ABs, in fact they all are if appropriate. This is a skin infection? Or actually in the bone?
 
Ok correction as I looked it up. FDA defines a strong inhibitor as one who increases AUC 5 fold. Both clarith and WGFJ are listed as such but clarith is a pure substance and used in some of their Drug Interaction studies as the prototypical inhibitor of CYP3A isoenzymes.
 
Kittycat5 said:
Its stronger than WGFJ. Id have to double check but pretty sure clarithromycin is the highest level of inhibitor according to the FDA which means it increases AUC like 2.5 to 3 times. Theres plenty of excellent ABs, in fact they all are if appropriate. This is a skin infection? Or actually in the bone?
Click to expand...

They don't know if its a skin or bone infection. They just removed the cast and noticed the green discharge coming from around the wound and metal wire. A doctor came in and said yeah we will prescribe antibiotics. So they know very little about the type of bacteria and the severity of it.

I don't find this very reassuring. Because if the infection isn't treated it could very well turn into sepsis.
 
You better act with a bit of urgency then. Idk, if you can contact them by like one or two hours from now and get a resolution, fine. If not it really would be better to just take the drug and lower your lorazepam dose until they sort it out. I was getting all pharmacisty there but ultimately its everyones job to manage risks and heal. Some things outweigh the others and a bone infection and sepsis are certainly two.
 
Kittycat5 said:
You better act with a bit of urgency then. Idk, if you can contact them by like one or two hours from now and get a resolution, fine. If not it really would be better to just take the drug and lower your lorazepam dose until they sort it out. I was getting all pharmacisty there but ultimately its everyones job to manage risks and heal. Some things outweigh the others and a bone infection and sepsis are certainly two.
Click to expand...

No sorry i didn't mean that i didn't find what you was saying reassuring, that was directed at the hospital. I don't really find the hospitals protocol on infection management very reassuring. In my opinion they should have atleast identified whether it was in the bone or not.

But i do see what you mean. Thanks for the help.
 
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