Original article
Inhibition of methylprednisolone elimination in the presence of erythromycin therapy

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Abstract

Methylprednisolone elimination is reduced in the presence of treatment with troleandomycin (TAO), a macrolide antibiotic. To assess whether a similar interaction occurs with a more commonly used and less hepatotoxic macrolide antibiotic, erythromycin, we evaluated methylprednisolone pharmacokinetics before and after a 1 wk course of erythromycin base in nine adolescent patients with chronic asthma. These data were compared to results of studies of the troleandomycin methylprednisolone interaction evaluated in 10 adolescent asthmatic patients. Methylprednisolone clearance and apparent volume of distribution were significantly decreased and mean residence time and half-life significantly increased in the presence of both erythromycin and troleandomycin. The latter caused greater inhibition of methylprednisolone elimination. A nonlinear pattern of methylprednisolone disposition was observed in the presence of concomitant macrolide antibiotic administration. Addition of erythromycin base to methylprednisolone therapy results in inhibition of methylprednisolone elimination and may potentially increase the beneficial and adverse effects of this corticosteroid.

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Supported in part by grants No. HL-30513 from the Heart, Lung and Blood Institutes, No. 24211 from the National Institutes of General Medical Sciences, and No. AI-14198 from the National Institutes of Allergy and Infectious Diseases (Multidisciplinary Study of Asthma).

Present address: Department of Pediatrics, University of North Carolina, Chapel Hill.

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