A client with stage 4 chronic kidney disease takes colchicine for gout and receives a new clarithromycin prescription. Which action is best?
1Take both medicines with grapefruit juice and monitor only for mild nausea during the antibiotic course.
2Increase colchicine during the infection and defer renal assessment until gout symptoms improve.
3Hold the combination and request immediate prescriber and pharmacist review of the interaction.✓ Correct answer
4Continue both medicines unchanged because reduced kidney function prevents excess colchicine exposure.
Explanation
Clarithromycin inhibits pathways that clear colchicine, and the combination is contraindicated in renal impairment because severe and fatal colchicine toxicity has occurred.
Quick answer Block the clarithromycin-colchicine interaction in renal impairment.
Why this is correct Renal dysfunction reduces the margin for colchicine exposure, while clarithromycin can markedly increase colchicine concentration.
Easy analogy or mental picture Treat medication safety like airway triage: identify the threat, interrupt exposure, support physiology, and verify a durable response.
NCLEX decision rule Choose the action that prevents the most immediate medication-related harm while preserving reassessment and escalation.
Why the other choices are wrong Options that normalize deterioration, add interacting medication, or delay rescue leave the safety loop open.
References
1DailyMed: ClarithromycinContraindicated colchicine coadministration in renal impairment and reported fatal toxicity
Medication safety reviewVerify the indication, current assessment, respiratory and neurologic status, interactions, authorized rescue action, and measurable follow-up.