Interaction of erythromycin and clarithromycin with orange juice
Abstract: Concomitant
administration of orange juice with fexofenadine has been found to decrease the
bioavailability of fenofenadine to less than
30% via inhibition
of organic-anion transporting
polypeptide (OATP), a drug uptake
transporter expressed in
organs such as liver, kidney and intestine. Erythromycin
and clarithromycin are substrates and inhibitors of CYP3A4, a drug metabolizing
enzyme in the liver and
enterocytes, and P-glycoprotein (P-gp),
a drug efflux
transporter expressed in
the same organs
as OATP. Since
an extensive overlap exists
between substrates and
inhibitors of CYP3A4,
P-gp and OATP
transporters, we want
to study the
effect of coadministration of our
local orange (Siam orange) juice on the bioavailability of the above
antibacterials. We conducted two 2-way cross-over randomized studies, one study
for each antibacterial (500 mg), crossed between administration with orange
juice (200 ml) and with water, in 12-13 healthy subjects per study. The serum
concentrations of the antibacterials were assayed by microbiological method.
The mean (range) ratio of AUC0-t with orange juice/with water were as follows :
erythromycin : total (n=13) 81.7 (9.7-193.8)%, unchanged (n=4)
96.4 (80.5-107.9)%, decreased
(n=6) 31.9 (9.7-49.0)%,
increased (n=3) 161.8 (134.6-193.8)%; clarithromycin: total (n=12) 91.4
(20.6-158.3)%, unchanged (n=5) 103.1 (80.9-123.0)%, decreased (n=4) 34.8
(20.6-64.3)%, increased (n=3) 147.2 (132.9-158.3)%. It
was concluded that
coadministration of Siam
orange juice with
erythromycin or clarithromycin produced unpredictable effects on the
bioavailability of these antibacterials in individual subjects, with marked
decreases in almost half of the subjects,
although in totals the effects were not statistically significant.
Author: Arini Setiawati, Metta
Sinta Sari Wiria, Franciscus D. Suyatna, Juan Tjiu Sion, Marina Hamadian
Journal Code: jpkedokterangg050007