Drug interactions- summary-

Azole antifungals + Telithromycin
Coadministration with itraconazole resulted in increase in Cmax and AUC of telithromycin

CYP3A4 eg carbamazepine, phenobarbital, phenytion, rifampin + Telithromycin
Coadminstratioon is likely to result in subtherapeutic levels of telithromycin.
Avoid coadministration

Telithromycin + antiarrhythmic agents eg amiodarone, bretylium, disopyramide, dofetilide
procainamide, quinidine, salotol
Risk of life threatening cardiac arrhythmias. Avoid coadministration

Telithromycin + benzodiapines eg midazolam
Coadministration resulted an increase in AUC of midazolam,
Monitor closely and adjust midazolam dose as needed

Telithromycin + Carbamazepine-eg cyclospoine, hexobarbital, phenytoin, sirolimus
tacrolymus
Elevation in serum levels of these drugs

Telithromycin + Cisapride
Coadministration is contraindicated

Telithromycin + Colchicine
Increased serum colchine levels with toxicity

Telithromycin + Digoxin
Monitor digoxin levels and adverse reactions when used with telithromycin

Telithromycin + Ergot alkaloids
Coadministration not recommended

Community acquired pneumonia ( CAP )

Adverse reactions-

CNS - dry mouth, fatigue, increased sweating, insomnia, somnolence vertigo

Dermatologic - rash

GI - abdominal distention,abdominal pain, anorexia, constipation,dyspepsia, flatulance,
       gastritis, gastroenteritis, GI upset, glossitis, stomatitis, watery stools

GU - vaginal candidiasis, vaginitis, vaginosis fungal

Haematogical - hepatitis with or without jaundice,

Special senses- blurred vision, diplopia, or difficulty in focusing

Lab test abnormalities- abnormal liver function tests, including increased liver enzymes

Hypersensitivity reactions-

Special Precautions-

Hepatotoxicity - acute hepatic failure and severe liver injury in some cases fatal reported.
Patients with signs and symptoms of hepatitis must be adviced to discontinue telithromycin
annd imediately seek medical attention.

Myasthenia gravis- telithromycin contraindicated in patients with patients with myasthenia gravis
Excaberation of myasthenia gravis reported and some reports included fatal and life-threatening
acute respiratory failure.

Cardiac effects- telithromycin has the potential to prolong the QTC interval of electrocardogram,
and in some cases may lead to increased risk of ventricular arrhthmias

Visual disturbances- telithromycin may cause visual disturbances particularly of slowing
the ability to accomodate and ability to release accomodation

Renal /hepatic function impairment -in the case of severe renal function impairment,
Reduced dosage of telithromycin is recommended

Hazardous tasks- advice patients not to drive or operate machinery in cases where they
experience visual disturbances or loss of consciousness while taking telithromycin

Pregnancy- administer during pregnancy only if the benefits outweigh the potetial risks to
the fetus.

Lactation- excercise caution when telithromycin is administered to breast-feeding mother

Children- safety and efficacy for use in children not established

Indication-

Community acquired pneumonia ( CAP )

Dosage-

800mg orally once every 24 hours for 7 to 10 days

1. Advice patients of liver injury associated with telithromycin which in some cases may be severe.
   Symtoms of liver injury - nausea, fatigue, anorexia, jaundice, dark urine, light colored stools,
   tender abdomen

2. Antibiotics drugs including telithromycin should be used to treat bacterial infections. They
    do not treat viral infections eg, common cold

3. Avoid taking telithromycin if receiving class 1A antiarrhythmics agents eg, quinidine,
   procainamide or class III eg dofetilide,

4. Inform your doctor of any family history of QTc prologationor clinically significant bradycardia

5. Telithromycin is contraindicated in patients with myasthenia gravis

6. Avoid simvastatin, Lovastatin, or atorvastatin if receiving telithromycin. If telithromycin is
  prescribed stop therapy  with atorvastatin, simvastatin, lovastatin

7. Telithromycin tablets can be taken with or without food

8. Minimise activites such as driving , operating machinery during the period of treatment
   with telithromycin

Pharmacology-
Telithromycin belongs to to the ketolide class of antibacterials and is structurally related
to macrolide family of antibiotics

Can be taken with or without food

Pregnancy-
Administer during pregnancy only if the benefits outweigh the potential risks to
the fetus.

Lactation-
Excercise caution when telthromycin is administered to breast-feeding mother

Children-
Safety and efficacy for use in children not established