The time Anna stayed up all night

Almost precisely a decade ago, a young Atlanta lawyer named Anna was returning to work, after being treated for an extraordinary sleep disorder. Her story has been told here at Emory and by national media outlets.

Neurologist David Rye and nurse practitioner Kathy Parker had treated Anna first with conventional stimulants, which were spectacularly unsatisfactory. Parker and Rye eventually landed on something less conventional: flumazenil, an antidote for sedatives that was scarce and difficult to administer. After wrangling with the FDA and with flumazenil’s manufacturer, a longer-term solution came into view. At that time, Anna was unique: the only person taking flumazenil chronically for a sleep disorder.

Then she developed bronchitis. To treat her bronchitis, Anna’s internist had prescribed the antibiotic clarithromycin, known commercially as Biaxin. After taking it, she developed insomnia and couldn’t sleep for three days. 

Inspired by the report of Anna’s experience, neuroscientists Andy Jenkins and Paul Garcia investigated clarithromycin’s cellular effects and presented their results at a 2009 conference. Garcia and Jenkins found that clarithromycin is different from flumazenil, which was originally developed as an antidote to benzodiazepines, the class of drugs that includes Valium and Xanax.

In 2018, the FDA issued a warning about the risks of clarithromycin in people with heart disease. Paul Garcia and colleagues went on to probe clarithromycin’s effects on neurons and GABA signaling, but how much it gets into the central nervous system and how it works in the body are still unclear.

Dr. Rye and Dr. Garcia are NS faculty members and Dr. Jenkins is a faculty member in the MSP and NS programs.

Click here to view the full story in Lab Land - The Emory Health Sciences Research Blog.