# A client with stage 4 chronic kidney disease takes colchicine for gout and receives a new clarithromycin prescription. Which action is best?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=522101&lang=en  
> language: en  
> subject: Adverse Effects/Contraindications/Interactions  
> category: PPT

## Question

A client with stage 4 chronic kidney disease takes colchicine for gout and receives a new clarithromycin prescription. Which action is best?

## Option

1. Take both medicines with grapefruit juice and monitor only for mild nausea during the antibiotic course.
2. Increase colchicine during the infection and defer renal assessment until gout symptoms improve.
3. Hold the combination and request immediate prescriber and pharmacist review of the interaction. **✔ Correct answer**
4. Continue both medicines unchanged because reduced kidney function prevents excess colchicine exposure.

**Correct answer: 3**

## Explanation

Clarithromycin inhibits pathways that clear colchicine, and the combination is contraindicated in renal impairment because severe and fatal colchicine toxicity has occurred.

## In-depth explanation

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.

Memory hook
Cue, risk, action, response, recurrence check.

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

## Clinical scenario

Medication safety review
Verify the indication, current assessment, respiratory and neurologic status, interactions, authorized rescue action, and measurable follow-up.

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