Drug General Information (ID: DDIRSVF0J4)
Drug Name			Tolazamide		Drug Info		Clarithromycin		Drug Info
Drug Type		Small molecule				Small molecule
Therapeutic Class		Antidiabetic Agents				Antibiotics
Structure

Mechanism of Tolazamide-Clarithromycin Interaction (Severity Level: Moderate)
Competitive binding of plasma proteins Click to Show/Hide Mechanism Graph
Drug Name		Tolazamide				Clarithromycin
Mechanism		Competition for plasma protein binding sites				Competition for plasma protein binding sites
Key Mechanism Factor 1
		Factor Name		Plasma protein binding
		Factor Description		Plasma protein binding refers to the degree of binding of a drug to proteins in the blood, and the lower the degree of binding, the more efficiently the drug can cross cell membranes or diffuse. Plasma protein binding alters the distribution and therapeutic characteristics of the drugs.
Mechanism Description		Increased plasma concentration of Clarithromycin and Tolazamide due to competitive binding of plasma proteins

Recommended Action
Management		Clarithromycin should be prescribed cautiously to diabetic patients with renal impairment who are receiving sulfonylurea therapy, particularly if they are also elderly. Patients should be advised to regularly monitor their blood sugar and counseled on how to recognize and treat hypoglycemia, which may include symptoms such as headache, dizziness, drowsiness, nervousness, confusion, tremor, hunger, weakness, perspiration, and palpitations. The physician should be notified if an interaction is suspected.

References
1	Bussing R, Gende A "Severe hypoglycemia from clarithromycin-sulfonylurea drug interaction." Diabetes Care 25 (2002): 1659-61. [PMID: 12196446]