Generic
Clarithromycin
Brand Name
Biaxin
Import ID
15
Clarithromycin
| Interaction Color Code | Clinical Bottom Line | Clinical Effects | Drug 1 effect | Drug 2 dose | Drug 2 effect | Management | |
|---|---|---|---|---|---|---|---|
| Rilpivirine (IM) Clarithromycin | Orange: Minimal data to guide interaction | Minimal data to guide interaction: weigh risks and benefits of using this combination | Potential for increased rilpivirine concentrations |
Consider alternative agents. If coadministration is necessary, monitor for adverse effects |
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| Ritonavir Clarithromycin 1038 | Yellow: Adjust dosing | Adjust dosing to avoid increased levels of clarithromycin | Increased clarithromycin effects |
AUC no significant change; Cmax increased 15% |
500 mg BID | Clarithromycin AUC increased 77%; Cmax increased 31%; Cmin increased 182% |
Reduce clarithromycin dose by 50% in patients with CrCl 30-60 mL / min. Reduce clarithromycin dose by 75% in patients with CrCl <30 mL / min. |
| Darunavir Clarithromycin 880 | Yellow: Adjust dosing | Adjust dosing to avoid increased levels of clarithromycin | Increased risk of antibacterial adverse effects |
Cmax decrease 17%, AUC decrease 13%, Cmin increase 1% |
500 mg BID | Cmax increase 26%, AUC increased 57%, Cmin increase 174% |
In patients with CrCl 30-60 mL / min, reduce dose of clarithromycin by 50%. In patients with CrCl <30 mL / min, reduce clarithromycin dose by 75%. Monitor for clarithromycin-related toxicities and / or consider alternative macrolide. |
| Atazanavir Clarithromycin 846 | Orange: Minimal data to guide interaction | Minimal data to guide interaction: risks likely to outweigh benefits | Consider alternative antibiotics |
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| Atazanavir Clarithromycin 756 | Yellow: Adjust dosing | Adjust dosing to avoid increased levels of clarithromycin | Potential for increased clarithromycin effects. (e.g. may cause QTc prolongation). |
Atazanavir AUC increased 28%, Cmax no significant change, Cmin increased 91% |
500 mg BID on days 7-11 and 18-21 | Clarithromycin AUC increased 94%, Cmax increased 50%, Cmin decreased 62%, 14-hydroxyclarithromycin AUC decreased 70%, Cmax decreased 72%, Cmin increased 164% |
Reduce clarithromycin dose by 50% |
| Nevirapine Clarithromycin 641 | Orange: Minimal data to guide interaction | Minimal data to guide interaction: weigh risks and benefits when using this combination | Decreased clarithromycin effects but increased metabolite concentrations |
500 mg BID | Clarithromycin AUC decreased 31%; Cmax decreased 23%; Cmin decreased 56%; 14-hydroxy clarithromycin AUC increased 42%, Cmax increased 47% |
Consider using alternative agents such as Azithromycin |
|
| Etravirine Clarithromycin 561 | Orange: Minimal data to guide interaction | Minimal data to guide interaction: risks likely to outweigh benefits | Increased etravirine effects; decreased clarithromycin effects |
Etravirine AUC increased 42%; Cmax increased 46%; Cmin increased 46% |
500 mg BID | Clarithromycin AUC decreased 37%; Cmax decreased 34%; Cmin decreased 53%; 14-hydroxyclarithromycin AUC increased 21%; Cmax increased 33% |
Use alternative macrolide (consider use of azithromycin) for MAC |
| Efavirenz Clarithromycin 498 | Orange: Minimal data to guide interaction | Minimal data to guide interaction: weigh risks and benefits of using this combination | Risk of QT interval prolongation |
No significant change |
500 mg Q12H x 7 days | Clarithromycin AUC decreased 39%; Cmax decreased 26%;14-hydroxy clarithromycin AUC increased 34%; Cmax increased 49% |
Dose adjustment not established. Monitor for antbiotic efficacy and / or consider using alternative agents |
| Efavirenz Clarithromycin 497 | Orange: Minimal data to guide interaction | Minimal data to guide interaction: weigh risks and benefits of using this combination | Risk of QT interval prolongation |
No significant change |
500 mg Q12H x 7 days | Clarithromycin AUC decreased 39%; Cmax decreased 26%;14-hydroxy clarithromycin AUC increased 34%; Cmax increased 49% |
Dose adjustment not established. Monitor for antbiotic efficacy and / or consider using alternative agents |
| Efavirenz Clarithromycin 496 | Orange: Minimal data to guide interaction | Minimal data to guide interaction: weigh risks and benefits of using this combination | Risk of QT interval prolongation |
No significant change |
500 mg Q12H x 7 days | Clarithromycin AUC decreased 39%; Cmax decreased 26%;14-hydroxy clarithromycin AUC increased 34%; Cmax increased 49% |
Dose adjustment not established. Monitor for antbiotic efficacy and / or consider using alternative agents |
| Elvitegravir Clarithromycin 159 | Yellow: Adjust dosing | Adjust dosing to avoid increased levels of clarithromycin | No dose adjustment necessary if patients CrCl > 60 mL / min. Reduce clarithromycin dose by 50% if CrCl is between 50-60 mL / min. Do not coadminster if CrCl > 50 mL / min. |
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| Maraviroc Clarithromycin 50 | Yellow: Adjust dosing | Adjust dosing to avoid increased levels of maraviroc | Potential maraviroc-associated adverse effects |
Reduce maraviroc dose to 150 mg BID |
