HDCN Article Review/Hyperlink

Steinman MA, Steinman TI

Clarithromycin-associated visual hallucinations in a patient with chronic renal failure on CAPD

Am J Kidney Dis (Jan) 27:143-146 1996

Uremia does not cause visual hallucinations. Steinman and Steinman report a 56-year- old CAPD patient who developed visual hallucinations after starting clarithromycin for bronchitis. Reports of hallucinations caused by clarithromycin have not been previously published. However, these authors discovered that several reports of hallucinations in patients receiving this antibiotic have been verbally communicated to the manufacturer of the drug. Two of the patients had chronic renal failure. Erythromycin, a related macrolide, has been associated with rare hallucinations, confusion, seizures, and vertigo. The authors suggest that decreased renal clearance or impaired plasma protein binding of the drug may have increased serum concentration of total and unbound antibiotic. In addition, since clarithromycin and related antibiotics influence cytochrome P450, the potential for drug interactions is also present.

Comment: This report should alert nephrologists to the previously unreported side effect of visual hallucinations in patients with chronic renal failure receiving the new macrolide antibiotics. (George R. Aronoff, M.D.)