Skip to Content
Be ready for a severe allergy emergency. Read more >>

Ketek Pak (telithromycin) Disease Interactions

There are 6 disease interactions with Ketek Pak (telithromycin):

Major

Telithromycin (Includes Ketek Pak) ↔ Liver Disease

Severe Potential Hazard, Moderate plausibility

Applies to: Liver Disease, Alcoholism

Hepatic dysfunction, including elevated liver enzymes and hepatitis, with or without jaundice, has been reported with the use of telithromycin. Although these events are generally reversible, liver failure resulting in transplantation or death has been reported rarely during postmarketing use. Alcohol use may have been a contributing factor in some of the severe cases. Therapy with telithromycin should preferably be avoided in patients with alcoholism, liver disease, or a prior history of hepatitis/jaundice associated with use of the drug. Patients treated with telithromycin should be instructed to discontinue the drug and seek medical attention promptly if signs and symptoms of hepatic injury develop such as fever, pruritus, rash, anorexia, nausea, vomiting, fatigue, right upper quadrant pain, dark urine, and jaundice.

The pharmacokinetics of telithromycin is not significantly altered in the presence of hepatic impairment due to a compensatory increase in renal elimination. No dosage adjustment is necessary unless renal function is also severely impaired (CrCl < 30 mL/min).

References

  1. Cantalloube C, Bhargava V, Sultan E, Vacheron F, Batista I, Montay G "Pharmacokinetics of the ketolide telithromycin after single and repeated doses in patients with hepatic impairment." Int J Antimicrob Agents 22 (2003): 112-21
  2. "Product Information. Ketek (telithromycin)." Aventis Pharmaceuticals, Bridgewater, NJ.
  3. Clay KD, Hanson JS, Pope SD, Rissmiller RW, Purdum PP 3rd, Banks PM "Brief communication: severe hepatotoxicity of telithromycin: three case reports and literature review." Ann Intern Med 144 (2006): E1-E6
Major

Telithromycin (Includes Ketek Pak) ↔ Myasthenia Gravis

Severe Potential Hazard, High plausibility

Applies to: Myasthenia Gravis

Telithromycin has been reported to exacerbate myasthenia gravis. Case reports suggest that it can occur even within a few hours after the first dose. Life-threatening acute respiratory failure with a rapid onset has occurred in patients with myasthenia gravis receiving telithromycin for respiratory tract infections. Therapy with telithromycin is not recommended in patients with myasthenia gravis unless no other therapeutic alternatives are available. If telithromycin is prescribed, patients must be closely monitored and advised to immediately discontinue the drug and seek medical attention if they experience exacerbation of their symptoms. Supportive measures should be instituted as medically necessary.

References

  1. "Product Information. Ketek (telithromycin)." Aventis Pharmaceuticals, Bridgewater, NJ.
  2. Nieman RB, Sharma K, Edelberg H, Caffe SE "Telithromycin and myasthenia gravis." Clin Infect Dis 37 (2003): 1579
Major

Telithromycin (Includes Ketek Pak) ↔ Qt Interval Prolongation

Severe Potential Hazard, Moderate plausibility

Applies to: Abnormal Electrocardiogram, Arrhythmias, Electrolyte Abnormalities, Hypokalemia, Magnesium Imbalance

Telithromycin may prolong the QTc interval of the electrocardiogram in some patients. QTC prolongation has been associated with an increased risk of ventricular arrhythmias including ventricular tachycardia, ventricular fibrillation, and torsade de pointes. No cardiovascular morbidity or mortality attributable to QTc prolongation occurred with telithromycin treatment in nearly 5000 patients in clinical efficacy trials, including 204 patients who had a prolonged QTc interval at baseline. In addition, a pharmacokinetic study found no significant QT prolongation in 34 healthy volunteers at all heart rates tested following telithromycin administered as repeated doses of 800 mg or as single doses of up to 2400 mg. Nevertheless, therapy with telithromycin should be avoided in patients with preexisting arrhythmia or congenital prolongation of the QTc interval. It should also be avoided in the presence of proarrhythmic conditions such as uncorrected hypokalemia or hypomagnesemia; clinically significant bradycardia; or concomitant use of class IA or III antiarrhythmic drugs or other medications that are known to produce an increase in the QTc interval.

References

  1. Owens RC "QT Prolongation with Antimicrobial Agents : Understanding the Significance." Drugs 64 (2004): 1091-124
  2. "Product Information. Ketek (telithromycin)." Aventis Pharmaceuticals, Bridgewater, NJ.
  3. Iannini PB "Cardiotoxicity of macrolides, ketolides and fluoroquinolones that prolong the QTc interval." Expert Opin Drug Saf 1 (2002): 121-8
View all 4 references
Moderate

Antibiotics (Includes Ketek Pak) ↔ Colitis

Moderate Potential Hazard, Moderate plausibility

Applies to: Colitis/Enteritis (Noninfectious)

Pseudomembranous colitis has been reported with most antibacterial agents and may range in severity from mild to life-threatening, with an onset of up to two months following cessation of therapy. Antibiotic therapy can alter the normal flora of the colon and permit overgrowth of Clostridium difficile, whose toxin is believed to be a primary cause of antibiotic- associated colitis. The colitis is usually characterized by severe, persistent diarrhea and severe abdominal cramps, and may be associated with the passage of blood and mucus. The most common culprits are clindamycin, lincomycin, the aminopenicillins (amoxicillin, ampicillin), and the cephalosporins. Therapy with broad-spectrum antibiotics and other agents with significant antibacterial activity should be administered cautiously in patients with a history of gastrointestinal diseases, particularly colitis. There is some evidence that pseudomembranous colitis, if it occurs, may run a more severe course in these patients and that it may be associated with flares in their underlying disease activity. The offending antibiotic(s) should be discontinued if significant diarrhea occurs during therapy. Stool cultures for Clostridium difficile and stool assay for C. difficile toxin may be helpful diagnostically. A large bowel endoscopy may be considered to establish a definitive diagnosis in cases of severe diarrhea.

References

  1. Moriarty HJ, Scobie BA "Pseudomembranous colitis in a patient on rifampicin and ethambutol." N Z Med J 04/23/80 (1980): 294-5
  2. Thomas E, Mehta JB "Pseudomembranous colitis due to oxacillin therapy." South Med J 77 (1984): 532-3
  3. Harmon T, Burkhart G, Applebaum H "Perforated pseudomembranous colitis in the breast-fed infant." J Pediatr Surg 27 (1992): 744-6
View all 47 references
Moderate

Telithromycin (Includes Ketek Pak) ↔ Hemodialysis

Moderate Potential Hazard, High plausibility

Applies to: hemodialysis

The effect of hemodialysis on removing telithromycin from the body has not been studied. Doses should be given after the dialysis session on dialysis days.

References

  1. "Product Information. Ketek (telithromycin)." Aventis Pharmaceuticals, Bridgewater, NJ.
Moderate

Telithromycin (Includes Ketek Pak) ↔ Renal Dysfunction

Moderate Potential Hazard, High plausibility

Applies to: Renal Dysfunction

Telithromycin is eliminated by both renal and hepatic routes. In a multiple-dose study of subjects with varying degrees of renal impairment, patients classified as having severely impaired renal function (CrCl < 30 mL/min) had a 1.4-fold increase in steady-state peak plasma concentration (Cmax) and a 1.9-fold increase in systemic exposure (AUC) of telithromycin compared to healthy volunteers following administration of 800 mg once daily for 5 days. Renal excretion may serve as a compensatory elimination pathway for telithromycin in situations where metabolic clearance is impaired. In one study, coadministration of ketoconazole (which inhibits metabolism of telithromycin via CYP450 3A4) in 2 patients with severe renal impairment resulted in a 4- to 5-fold increase in telithromycin AUC compared to that in healthy subjects with normal renal function receiving telithromycin alone. Since patients with severe renal impairment are prone to conditions that may impair their metabolic clearance, telithromycin dosage should be reduced to 600 mg once daily in patients with severe renal impairment (CrCl < 30 mL/min), including those undergoing dialysis. The dosage should be further reduced to 400 mg once daily if there is coexisting hepatic impairment.

References

  1. "Product Information. Ketek (telithromycin)." Aventis Pharmaceuticals, Bridgewater, NJ.
  2. Shi J, Montay G, Chapel S, et al. "Pharmacokinetics and safety of the ketolide telithromycin in patients with renal impairment." J Clin Pharmacol 44 (2004): 234-44

Ketek Pak (telithromycin) drug Interactions

There are 671 drug interactions with Ketek Pak (telithromycin)

Drug Interaction Classification

The classifications below are a general guideline only. It is difficult to determine the relevance of a particular drug interaction to any individual given the large number of variables.

Major Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.
Moderate Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.
Minor Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.

Do not stop taking any medications without consulting your healthcare provider.

Disclaimer: Every effort has been made to ensure that the information provided by Multum is accurate, up-to-date and complete, but no guarantee is made to that effect. In addition, the drug information contained herein may be time sensitive and should not be utilized as a reference resource beyond the date hereof. This material does not endorse drugs, diagnose patients, or recommend therapy. Multum's information is a reference resource designed as supplement to, and not a substitute for, the expertise, skill, knowledge, and judgement of healthcare practitioners in patient care. The absence of a warning for a given drug or combination thereof in no way should be construed to indicate that the drug or combination is safe, effective, or appropriate for any given patient. Multum Information Services, Inc. does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. Copyright 2000-2016 Multum Information Services, Inc. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse, or pharmacist.

Hide