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Macrolides and potassium

Discussion in 'Antivirals, Antibiotics and Immune Modulators' started by pattismith, Nov 23, 2017.

  1. pattismith

    pattismith Senior Member

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    @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
     
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  2. pamojja

    pamojja Senior Member

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    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.
     
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  3. Learner1

    Learner1 Professional Patient

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

    pattismith Senior Member

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

    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

    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 )
     
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  5. Learner1

    Learner1 Professional Patient

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    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?
     
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  6. pattismith

    pattismith Senior Member

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

    pattismith Senior Member

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    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.

    upload_2017-11-24_20-3-19.png


    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).
     
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  8. Learner1

    Learner1 Professional Patient

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    Would NAC, B5, or NT Factor help, too?
     
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  9. CFS_for_19_years

    CFS_for_19_years Hoarder of biscuits

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    @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.
     
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  10. pattismith

    pattismith Senior Member

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

    I have testing machines at my work, so I have instant readings.:thumbsup:
     
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  11. pattismith

    pattismith Senior Member

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    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...

     
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  12. Chocolove

    Chocolove Tournament of the Phoenix - Rise Again

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    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.
     
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  13. pattismith

    pattismith Senior Member

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    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?
     
  14. Chocolove

    Chocolove Tournament of the Phoenix - Rise Again

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    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.
     
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  15. pattismith

    pattismith Senior Member

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    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...
     
  16. pamojja

    pamojja Senior Member

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    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!
     
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  17. pattismith

    pattismith Senior Member

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    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...
     
    Last edited: Nov 26, 2017
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  18. Chocolove

    Chocolove Tournament of the Phoenix - Rise Again

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  19. Chocolove

    Chocolove Tournament of the Phoenix - Rise Again

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    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/
     
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  20. pattismith

    pattismith Senior Member

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