Prescrire Int. 2012 Jul;21(129):182.
Macrolides that inhibit cytochrome P450 isoenzyme CYP 3A4 can lead to the accumulation of calcium channel blockers metabolised by the same isoenzyme and therefore an increase in their dose-related adverse effects. A Canadian case-control study examined the relationship between macrolide use and hospitalisation for hypotension (including shock) among 7100 elderly patients who were also taking a calcium channel blocker. The results showed more exposure to certain macrolides immediately prior to hospitalisation for hypotension than during an earlier control period; these macrolides included erythromycin (odds ratio (OR) = 5.8; 95% confidence interval: 2.3 to 15) and clarithromycin (OR = 3.7, 95% CI: 2.3 to 6.1). No such increase was found with azithromycin. In practice, patients treated with a calcium channel blocker should not be prescribed erythromycin or clarithromycin, but rather an antibiotic with similar efficacy but a lower risk of interaction.
抑制细胞色素P450同工酶CYP 3A4的大环内酯类药物可导致经同一同工酶代谢的钙通道阻滞剂蓄积，进而增加其剂量相关不良反应。一项加拿大病例对照研究调查了7100名正在服用钙通道阻滞剂的老年患者中，使用大环内酯类药物与因低血压（包括休克）住院之间的关系。结果显示，与早期对照期相比，在因低血压住院前近期接触某些大环内酯类药物的情况更多；这些大环内酯类药物包括红霉素（比值比（OR）=5.8；95%置信区间：2.3至15）和克拉霉素（OR = 3.7，95% CI：2.3至6.1）。阿奇霉素未发现此类增加情况。在实际应用中，接受钙通道阻滞剂治疗的患者不应开具红霉素或克拉霉素，而应使用疗效相似但相互作用风险较低的抗生素。
