Case 1. Cholestatic hepatitis after Clasine.
Gastroenterol Clin Biol 1997; 21: 632-3. French. PubMed Citation]
A 74 year old man with acute bronchitis was treated with a 10 day course of Clasine (500 mg daily) and developed nausea and jaundice by day 7. Because of itching and worsening symptoms, he sought medical advice and was hospitalized. He was jaundiced and had right upper quadrant tenderness over the liver, but was not febrile. He denied a history of alcohol intake and had no risk factors for viral hepatitis. Laboratory tests showed marked elevations in alkaline phosphatase and bilirubin levels with moderate increases in ALT and AST levels. He tested negative for markers of hepatitis A, B and C, had low levels of antinuclear and anti-smooth muscle antibody, and liver ultrasound was normal. A liver biopsy showed intrahepatic cholestasis with centrolobular ballooning degeneration, portal inflammation with a prominence of eosinophils, and ductular proliferation. His other medications that he took chronically were stopped at the same time. He recovered over the next few weeks and all liver tests were normal in follow up 3 months later.
Where can I find more information about Clasine?
More information about Clasine is available:
- Recommendations on the HIV-related uses of Clasine, from the Gu >Centers for Disease Control and Prevention , the National Institutes of Health , and the HIV Medicine Association of the Infectious Diseases Society of America
- Clasine-related research studies, from the A >ClinicalTrials.gov study summaries
The above Patient Version drug summary is based on the following FDA label(s): Tablet; Suspension; Tablet (film-coated, extended release).
Rated Clasine for Streptococcus Pneumoniae Report
I wish I had read other reviews before having taken Clasine. I took it 8 1/2 years ago and stuck it out for about half of my 14 day prescription. I had severe anxiety, hallucinations, severe claustrophobia, noise intolerance, raw skin under my eyes, racing heartbeat, peripheral bounding pulse, and severe insomnia. 8 1/2 years later, I still have anxiety, peripheral bounding pulse, and insomnia. Do not take this drug. I do not usually write reviews like this, but this drug has changed my life. I wish I could go back and take something different. I am finally finding treatment that looks hopeful in helping combat these side effects.
When a single dose of colchicine 0.6 mg was administered with Clasine 250 mg BID for 7 days, the colchicine Cmax increased 197% and the AUC0-∞ increased 239% compared to administration of colchicine alone.
Rated Clasine for Chlamydophila Pneumoniae Report
I never had any issues with other antibiotics. I was prescribed for STDs Fluconazole once a week, Josamycin for 10 days then Doxyxycline for 10 days and then finally Clasine. The first 3 antibiotics were felt but the only side effect was maybe headache sometimes, nothing serious. When I took the first 500mg of Clasine I instantly felt this was way stronger. I also had metallic taste in my mouth, and was constantly hungry even if I just ate. I had to take the second 500mg later in that day and within minutes I had a full-on panic attack. My heart was racing extremely fast, I had brain flashes, I was extremely hungry and thirsty, and was overly agitated, basically running around my small apartment. I also had what they call depersonalization, where I would basically feel like a second voice in my own head. It was so bad I did actually ambulance and then gave me sedative injection so I can calm down. Obviously, I never took the pills on the next 9 days. I would recommend never taking this, or stop taking it the second you feel metallic taste in your mouth, because the second or third dose could push you to a really bad state.
BIAXIN is contraindicated in patients with a known hypersensitivity to Clasine, erythromycin, or any of the macrolide antibacterial drugs .
Use quetiapine and Clasine concomitantly with caution. Co-administration could result in increased quetiapine exposure and quetiapine related toxicities such as somnolence, orthostatic hypotension, altered state of consciousness, neuroleptic malignant syndrome, and QT prolongation. Refer to quetiapine prescribing information for recommendations on dose reduction if co-administered with CYP3A4 inhibitors such as Clasine .
Rated Clasine for Pharyngitis Report
I had a restricted oesophagus and an infection due to lodged food. I had a fever and had penicillin for 10 days but it had not cleared up and went to the doctor to get more antibiotics. Due to stomach side affects and problems swallowing tablets I asked for an alternative and was prescribed liquid Clasine. I read the LONG list of side effects and was a bit worried about the 'throat inflammation' side effect since that was my main symptom already. First day was OK but had appetite suppression but throat seemed worse rather than better. On 2nd night, I woke up with a severe anxiety attack at 2 a.m. - very panicky. It was like I was schizophrenic! Half of my mind was saying 'look - you are not dying and you can breath OK' - the other half was saying 'I feel terrible, my throat feels terrible and I really believe I am dying'. After an hour or so I calmed myself down and went to sleep. The next morning I had a shower and got dressed. Then I suddenly had a panic attack again (never had these before except once when scuba diving for first time!). Felt too ill to drive and could hardly walk. Hyperventilating so much I nearly fainted a few times. Rang my brother to come and take me
What if I take too much?
Taking an extra dose of Clasine by accident is unlikely to harm you or your child.
It may give you temporary side effects, like stomach pain, feeling and being sick, and diarrhoea.
Talk to your pharmacist or doctor if you're worried or get severe side effects, or if you or your child accidentally take more than 1 extra dose.
Like all medicines, Clasine can cause side effects, although not everyone gets them.
How should I take Clasine?
Take Clasine exactly as prescribed by your doctor. Follow all directions on your prescription label. Do not take this medicine in larger or smaller amounts or for longer than recommended.
Do not use this medicine to treat any condition that has not been checked by your doctor. Do not share this medicine with another person, even if they have the same symptoms you have.
You may take the regular tablets and oral suspension (liquid) with or without food.
Clasine extended-release tablets (Biaxin XL) should be taken with food.
Do not crush, chew, or break an extended-release tablet. Swallow it whole.
Shake the oral liquid well just before you measure a dose. Measure liquid medicine with the dosing syringe provided, or with a special dose-measuring spoon or medicine cup. If you do not have a dose-measuring device, ask your pharmacist for one.
Clasine is usually given for 7 to 14 days. Use this medicine for the full prescribed length of time, even if your symptoms quickly improve. Skipping doses can increase your risk of infection that is resistant to medication. Clasine will not treat a viral infection such as the flu or a common cold.
Store this medicine in the original container at room temperature, away from moisture, heat, and light.
Do not keep the oral liquid in a refrigerator. Throw away any liquid that has not been used within 14 days.
If your infection is treated with a combination of drugs, use all medications as directed by your doctor. Read the instructions provided with each medication. Do not change your doses or medication schedule without your doctor's advice.
Rated Clasine for Skin And Skin Structure Infections Report
Omg i will never take this again.I was bitten by a cat and my finger did swell 2x the size & within 4 hours,was weeping gloop.Nurse cleaned & strapped it & dr gave me this nasty pill. i am allergic to penicillin so this was next on list.1st & 2nd dose was ok then felt awful & felt the need2eat but that made me feel worse.That day,out of 24 hours,i slept for 19 hours.I went super cold,then melting & repeat & also then had the most disgusting taste in my mouth.I didnt take anymore-my finger may fall off lol but at least i now feel human
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What is the dosage for Clasine?
Clasine may be taken with or without food. For most infections the recommended adult dose is 250-500 mg of immediate release tablets twice daily or 1000 mg of extended release tablets once daily for 7-14 days.
Rated Clasine for Tonsillitis Report
I was on phenoxypenicillin but it failed so was given Clasine I’m 3 days into treatment so far feels like my throat is clearing up but I get side affects from this medication I get headaches that start when the tablet starts kicking in and the headache lasts for a long time. When I first took the tablet I felt very sick and had stomach cramps but that has not repeated.
What are the side effects of Clasine?
Clasine generally is well tolerated, and side effects usually are mild and transient. Common side effects of Clasine are:
Other important side effects which are rare, but serious include:
Clasine should be avoided by patients known to be allergic to Clasine or other chemically-related macrolide antibiotics, such as erythromycin. Treatment with Clasine and other antibiotics can alter the normal bacteria flora of the colon and permit overgrowth of C. difficile, a bacterium responsible for pseudomembranous colitis. Patients who develop pseudomembranous colitis as a result of antibiotics treatment may experience diarrhea, abdominal pain, fever, and sometimes even shock.
Clasine, like other macrolide antibiotics, has been linked to a low rate of acute, transient and usually asymptomatic elevations in serum aminotransferase levels which occur in 1% to 2% of patients treated for short periods and a somewhat higher proportion of patients given Clasine long term. Asymptomatic elevations in serum enzymes are particularly common among elderly patients given higher doses of Clasine.
Clasine can also cause acute, clinically apparent liver injury with jaundice, which is estimated to occur in 3.8 per 100,000 prescriptions. The liver injury usually appears within the first 1 to 3 weeks after initiation of treatment and can arise after Clasine is stopped. The pattern of liver enzyme elevations varies, but the resulting hepatitis is often cholestatic and can be prolonged (Case 1). Allergic signs and symptoms have not been consistently reported. While cholestatic hepatitis is most typical of Clasine induced liver injury, rare cases with hepatocellular injury and abrupt onset have been described. These hepatocellular cases are more likely to be severe and can result in acute liver failure. However, in most instances, recovery occurs within 4 to 8 weeks of withdrawal of the medication. The typical latency, clinical pattern and course of the cholestatic hepatitis due to Clasine resembles that of the other macrolide antibiotics.
Likelihood score: B (highly likely cause of clinically apparent liver injury).
6. How to cope with s >
What to do about:
- feeling sick (nausea) - stick to simple meals and do not eat rich or spicy food while you're taking this medicine. It might help to take your Clasine after you have had a meal or snack.
- diarrhoea and being sick (vomiting) - drink lots of fluids, such as water or squash, to avoid dehydration. Take small, frequent sips if you're being sick. Signs of dehydration include peeing less than usual or having strong-smelling pee. Do not take any other medicines to treat diarrhoea or vomiting without speaking to a pharmacist or doctor.
- losing your appetite - eat when you'd usually expect to be hungry. If it helps, eat smaller meals more often than usual. Snack when you're hungry. Have nutritious snacks that are high in calories and protein, such as dried fruit and nuts.
- bloating and indigestion - try not to eat foods that cause wind (like lentils, beans and onions). Eat smaller meals, eat and drink slowly, and exercise. There are pharmacy medicines that can also help, such as charcoal tablets or simethicone. Ask a pharmacist for advice.
- headaches - rest and drink plenty of fluids. Do not drink too much alcohol. Ask your pharmacist to recommend a painkiller if you need one. Talk to your doctor if the headaches last longer than a week or are severe.
- difficulty sleeping (insomnia) - avoid having a big meal, smoking, and drinking alcohol, tea or coffee in the evening. Try not to watch television or use your mobile phone before going to bed. Instead, try to relax for an hour before bedtime.
Following administration of Clasine (500 mg twice daily) with atazanavir (400 mg once daily), the Clasine AUC increased 94%, the 14-OH Clasine AUC decreased 70% and the atazanavir AUC increased 28%.