title: Colchicine-clarithromycin-induced rhabdomyolysis in Familial Mediterranean Fever patients under treatment for Helicobacter pylori.
abstract: Chronic administration of colchicine remains a mainstay of therapy for patients with Familial Mediterranean Fever (FMF). As this medication is a strong CYP3A4 inhibitor, it has the potential to interact with many routinely used medications. One such medication is clarithromycin, itself a strong inhibitor of the same enzyme, and a typical choice for triple therapy eradication of H. pylori. Various sequelae of colchicine-clarithromycin interaction have been documented and can be expected by prescribing physicians, with rhabdomyolysis, though rare, being among the most serious. Review of cases from a tertiary academic medical center and full PubMed/MEDLINE literature review. Despite the prevalence of diseases treated with clarithromycin and the expected drug interaction with colchicine, only two cases in the literature document clinical rhabdomyolysis due to colchicine-clarithromycin interaction. In neither case, however, were patients undergoing treatment for FMF. Herein, we describe the first two cases in the literature of clinical rhabdomyolysis in FMF patients under colchicine therapy after administration of clarithromycin as part of therapy treating H. pylori infection.
authors.affiliation: Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel. orencohen06@gmail.com.
authors.forename: Oren
authors.initials: O
authors.lastname: Cohen
authors.affiliation: Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel. glocketz@me.com.
authors.forename: Garrett
authors.initials: G
authors.lastname: Locketz
authors.affiliation: Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel. alon.hershko@clalit.org.il.|Department of Hematology and Oncology, Meir Medical Center, Kfar Saba, Israel. alon.hershko@clalit.org.il.
authors.forename: Alon Y
authors.initials: AY
authors.lastname: Hershko
authors.affiliation: Department of Hematology and Oncology, Beilinson Hospital, Rabin Medical Center, Petah Tikva, Israel. alexanderg3@clalit.org.il.
authors.forename: Alexander
authors.initials: A
authors.lastname: Gorshtein
authors.affiliation: Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel. yairlevi@post.tau.ac.il.|Department of Hematology and Oncology, Meir Medical Center, Kfar Saba, Israel. yairlevi@post.tau.ac.il.|Department of Medicine E, Meir Medical Center, 59 Tchernihovsky St., 44281, Kfar Saba, Israel. yairlevi@post.tau.ac.il.
authors.forename: Yair
authors.initials: Y
authors.lastname: Levy
mesh_terms: D018435:ATP Binding Cassette Transporter, Subfamily B / Q000037:antagonists & inhibitors / Q000378:metabolism; D000328:Adult; D000900:Anti-Bacterial Agents / Q000009:adverse effects*; D017291:Clarithromycin / Q000009:adverse effects*; D003078:Colchicine / Q000009:adverse effects* / Q000493:pharmacokinetics; D051544:Cytochrome P-450 CYP3A / Q000378:metabolism; D065692:Cytochrome P-450 CYP3A Inhibitors / Q000009:adverse effects; D004347:Drug Interactions; D010505:Familial Mediterranean Fever / Q000175:diagnosis / Q000188:drug therapy*; D005260:Female; D016481:Helicobacter Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000382:microbiology; D016480:Helicobacter pylori / Q000187:drug effects*; D006801:Humans; D007155:Immunologic Factors / Q000009:adverse effects* / Q000493:pharmacokinetics; D008297:Male; D008875:Middle Aged; D019338:Polypharmacy; D012206:Rhabdomyolysis / Q000139:chemically induced* / Q000175:diagnosis
chemical_list: C513055:ABCB1 protein, human; D018435:ATP Binding Cassette Transporter, Subfamily B; D000900:Anti-Bacterial Agents; D065692:Cytochrome P-450 CYP3A Inhibitors; D007155:Immunologic Factors; D051544:Cytochrome P-450 CYP3A; C510163:CYP3A4 protein, human; D017291:Clarithromycin; D003078:Colchicine
keywords: Colchicine; H. pylori; Musculoskeletal disorder; Rhabdomyolysis; Triple therapy