Macrolides and potassium

[pattismith]

@Jesse2233 , @Vojta , @Learner1

I had a special experimentation with Clarithromycin these days, and I had to share with you what I learnt about it...

Toxicity of some Macrolides is increased by hypokalemia or borderline low blood potassium level.

I found cases reported about increased risk of cardiac toxicity of azithro and clarythro in patients with low blood potassium.

I suspect I had myself side effects from these antibiotics because of borderline/low potassium, and I wanted to warn you.

My opinion now is that blood potassium (and magnesium and calcium) should be tested prior any macrolide treatment, and hypokalemia should be corrected and monitored.


https://ejcrim.com/index.php/EJCRIM/article/view/375
http://www.sciencedirect.com/science/article/pii/S0014299913002562
http://www.cfp.ca/content/60/11/1012.short

 

[pamojja]

I suspect I had myself side effects from these antibiotics because of borderline/low potassium, and I wanted to warn you.

Interesting you mention. Just today was given Clarithromycin precautionary for a tooth extraction (my only root-canal treated ..gone).

The problem here again is which blood test to rely on in such a situation? For example in my case serum potassium has been in avg. 4.5 mmol/mol (with supplementation), whole blood K in the lower half of normal, in hair tissue repeatedly below normal.

 

[Learner1]

My opinion now is that blood potassium (and magnesium and calcium) should be tested prior any macrolide treatment, and hypokalemia should be corrected and monitored.

My potassium usually looks fine, but I am currently on azithro. What exact tests should be run to check?

 

[pattismith]

Interesting you mention. Just today was given Clarithromycin precautionary for a tooth extraction (my only root-canal treated ..gone).

The problem here again is which blood test to rely on in such a situation? For example in my case serum potassium has been in avg. 4.5 mmol/mol (with supplementation), whole blood K in the lower half of normal, in hair tissue repeatedly below normal.

I was put on Clarithro because I was badly bitten by a nasty cat last saturday...

I'm not a doctor, so I can't give you any advise, I only can give my personnal datas and my individual experience which may be reproducible or not.

I suppose that every patients that experimented side effects from Macrolides (myalgia, weakness, headaches, pains) may be in my subgroup and should be monitored.

I will never recommand any potassium supplementation without monitoring, because Potassium can be very quickly toxic and potentially acutely deadly toxic.

What I can say is that side effects of Clarithromycin (those side effects are very similar to hypokalemia symptoms) have disappeared for me when my K blood level were above 4.1 mmol/l

My potassium usually looks fine, but I am currently on azithro. What exact tests should be run to check?

What is your potassium level?
My own level looked fine too, but I had massive side effects from Clarithro that disappeared when I supplemented with pharmaceutical potassium...

I will later document my case report, because it may be useful for others.

To be honest, I was warned several times on PR about potassium deficiencies, and I already knew it was a concern for me because my previous tests were low, so I thank people here on PR that put me on that road ( @Gondwanaland , @Chocolove )

 

[Learner1]

I've seen all the warnings and know that too much can be bad. These are last week's resilts, which are typical:

Potassium, Serum 4.8 mmol/L
Range 3.5 - 5.2

Do I believe this or what other test do I ask my doctor to run?

 

[pattismith]

I've seen all the warnings and know that too much can be bad. These are last week's resilts, which are typical:

Potassium, Serum 4.8 mmol/L
Range 3.5 - 5.2

Do I believe this or what other test do I ask my doctor to run?

your potassium is pretty nice, you may not experienced the bad reaction I had with Macrolides, I hope so!

 

[pattismith]

This is the first potassium testing I have made before supplementing in the table below.

A month before, I had stopped an antibiotic course with Doxy and Azithro that lasted 4 months.
It released me from spinal pains.
But I was exhausted, with many side effects that never resolved after the end of the course:
burning muscles, twitching muscles, heavy legs and arms, weakness.

Then I started potassium supplementation and I improved slowly, and I stopped when the bottle was empty a few weeks ago.


6 days ago I started Clarithromycin. It was during a tiring week end.
The first day I noticed a metallic taste.
The second day I noticed increasing burning muscles
The third day I noticed headache

I also noticed an improvement when I drunk some mineral water rich in potassium, so I started some pharmaceutical potassium (600mg) with progressive release on the fourth day.
I took 1 tablet in the evening.

The fifth morning every Clarithromycin associated side effects had disappeared.
My potassium was 4.26.

The sixth morning, the metallic taste was back.
My potassium was 3.88
I took a new tablet at 6h30 AM
My potassium raised quickly above 4.1.
The metallic tasted disappear 5 hours after the tablet.

Today the metallic taste was back when I woke up.
My potassium was 3.9
I took again 1 tablet....

My understanding of all this is that my potassium level needs to be above 4.1 to protect me against Clarithromycin side effects.

If I had known this when I suffered so much during my four months course of Azithro/doxy,
potassium monitoring and supplementing would have protected me against very bad damages.
I wish others will take advange of my trial and won't do the same error.

I wish doctors would be aware of Macrolides damages associated to borderline/low plasma potassium.
I doubt that it is the case ( even Lyme and CFS/ME doctors).

 

[Learner1]

Would NAC, B5, or NT Factor help, too?

 

[CFS_for_19_years]

@pattismith, How are you able to get instant readings on potassium? Are you doing this at home?

It's good that you discovered the way low potassium affects you when taking antibiotics.

 

[pattismith]

@Learner1 , some supplements may help with potassium issues, but I am not aware of which...

@pattismith, How are you able to get instant readings on potassium? Are you doing this at home?

It's good that you discovered the way low potassium affects you when taking antibiotics.

I have testing machines at my work, so I have instant readings.

 

[pattismith]

In this document about a disease called Hypokalemic Periodic Paralysis (produced by a Na or a Ca channelopathy),
it is explained that

What drugs do worsen HypoPP?
antibiotics which reduce neuromuscular transmission:
aminoglycosides: Strepto-, Neo-, Kana-, and Clindamycin
Macrolides: Erythromycin, Telithromycin, Azithromycin
Fluoroquinolones: Ciprofloxacin and others

It means that Macrolides by inhibiting neuromuscular transmission, induce sensitivization to potassium variations in predisposed patients...

 

[Chocolove]

Potassium testing is not readily available for most and there are many who need it. I good home unit is not available to my knowledge. I have searched.

 

[pattismith]

Potassium testing is not readily available for most and there are many who need it. I good home unit is not available to my knowledge. I have searched.

Yes I know, it's a real problem.

maybe we should look into Hypokalemic Periodic Paralysis web sites. These patients need to monitor their potassium, so maybe we could learn something from them?

 

[Chocolove]

There are some videos showing personal devices using either blood or saliva, but I'm not sure those are actually medically approved for human use. Such as:

It really is essential since many of the symptoms of high potassium and low potassium are the same, and both situations could be fatal.

 

[pattismith]

There are some videos showing personal devices using either blood or saliva, but I'm not sure those are actually medically approved for human use. Such as:

It really is essential since many of the symptoms of high potassium and low potassium are the same, and both situations could be fatal.

I agree with you! I can't understand why no portable potassium analyzer is available like those we find for glucose or lactates...

Maybe this analyzer in the video would work I don't know...It's said that it's for water only, so it would be better to centrifugate the blood before testing I guess...

 

[pamojja]

Maybe this analyzer in the video would work I don't know...It's said that it's for water only, so it would be better to centrifugate the blood before testing I guess...

Me too doubt it measures it accurate this way.

https://labtestsonline.org/understanding/analytes/potassium/tab/test/

Is there anything else I should know?
Potassium levels can be falsely elevated by a variety of circumstances surrounding specimen collection and specimen processing. For example, if someone is clenching and relaxing his or her fist, the potassium level in the blood may increase. If blood samples are delayed in getting to the lab or if the blood tubes are subjected to vigorous shaking or rough handling in transit, potassium may leak from red blood cells and falsely elevate the potassium in the serum. A healthcare practitioner may question elevated potassium results when the numbers do not fit the clinical condition. If there are any questions as to how the blood was collected, the healthcare practitioner may request that the test be repeated to verify results.

Already too fast a draw can falsify a potassium serum result. To squeeze the finger like in this video is bound to give wrong results. Had one such wrongly collected specimen with a > 8.5 mmol/mol result!

 

[pattismith]

Me too doubt it measures it accurate this way.
Already too fast a draw can falsify a potassium serum result. To squeeze the finger like in this video is bound to give wrong results. Had one such wrongly collected specimen with a > 8.5 mmol/mol result!

Yes I think the blood must be collected from a vein via a needle and a syringe. This is why multiple punctures can quickly become a problem, because veins don't like it...

 

[Chocolove]

http://www.periodicparalysis.org/forum/viewtopic.php?t=194 In regard to testing saliva rather than blood.

In re to ratios for saliva to serum k conversion:
http://hkpp.org/saliva-to-serum-k

 

[Chocolove]

Salivary and serum potassium levels
The serum and salivary potassium values were increased significantly with cases compared to controls. A slightly negative correlation was detected between serum and salivary potassium concentration [r = −0.03, P = 0.88, Table 1]. Diagnostic accuracy of salivary potassium was 89% and area under the curve in ROC was 0.9, suggestive of excellent diagnostic accuracy [Table 2].

Dent Res J (Isfahan). 2017 Jan-Feb; 14(1): 13–18.

PMCID: PMC5356383
Diagnostic accuracy of salivary creatinine, urea, and potassium levels to assess dialysis need in renal failure patients
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5356383/

 

[pattismith]

http://www.periodicparalysis.org/forum/viewtopic.php?t=194 In regard to testing saliva rather than blood.

thank you chocolove, nice finding!

The Laqua Twin is a bit pricey, but you don't have to buy any strip, so it makes up...