Applies only to oral forms of hormone. A decrease in calculatedcreatinine clearanceof 50% from baseline on two consecutive days in the absence of an alternative explanation. Concurrent use of azithromycin was not associated with an increased risk of hypotension (OR 1.5, 95% CI 0.8-2.8). Toxicology. Increased systemic corticosteroid effects, including Cushing's syndrome and adrenal suppression, may occur. Predictions about the interaction can be made based on metabolic pathways. This will spread the ointment throughout the nares. Interaction mainly occurs in neonates. If you notice other effects not listed above, contact your doctor or pharmacist. Anagrelide: (Major) Torsades de pointes (TdP) and ventricular tachycardia have been reported during post-marketing use of anagrelide. In addition, because both clarithromycin and quinine are substrates and inhibitors of CYP3A4; coadministration may result in elevated plasma concentration of both drugs, causing an increased risk for adverse events. 250 mg PO twice daily in combination with amoxicillin, metronidazole, and a proton pump inhibitor (PPI) for 14 days. These effects could be more pronounced in patients also receiving a CYP2D6 inhibitor. Amlodipine is a CYP3A4 substrate and clarithromycin is a strong CYP3A4 inhibitor. Build, train, & validate predictive machine-learning models with structured datasets. Ulipristal: (Minor) Ulipristal is a substrate of CYP3A4 and clarithromycin is a CYP3A4 inhibitor. A retrospective, case crossover study, found the risk of hospitalization due to hypotension or shock to be significantly increased in geriatric patients exposed to clarithromycin during concurrent calcium-channel blocker therapy (OR 3.7, 95% CI 2.3-6.1). Use Caution/Monitor. The principal metabolite, monic acid, demonstrates no antibacterial activity. Vemurafenib: (Major) Avoid vemurafenib in patients receiving medications known to prolong the QT interval such as clarithromycin. This dosage adjustment is also necessary if lumacaftor; ivacaftor therapy has been interrupted for more than 1 week and re-initiated while the patient is taking clarithromycin. 7.5 mg/kg/dose (Max: 500 mg/dose) PO every 12 hours for 10 days. Taking these drugs together may increase daclatasvir serum concentrations, and potentially increase the risk for adverse effects. Lumacaftor; Ivacaftor: (Major) Avoid coadministration if possible; lumacaftor; ivacaftor may decrease the therapeutic efficacy of clarithromycin. Clostridium difficile-associated diarrhea (CDAD) has been reported with use of nearly all antibacterial agents, including BACTROBAN, and may range in severity from mild diarrhea to fatal colitis. [63320] The major mechanisms of microbial resistance are modification of the 23S rRNA in the 50S ribosomal subunit to alter binding or by active drug efflux. Miglitol: (Moderate) The concomitant use of clarithromycin and antidiabetic agents can result in significant hypoglycemia. Vancomycin-resistant Staphylococcus aureus (VRSA) are strains of Staphylococcus aureus that have become resistant to the glycopeptide antibiotic vancomycin. Mometasone is a CYP3A4 substrate and clarithromycin is a strong CYP3A4 inhibitor. Patients receiving estrogens should be monitored for an increase in adverse events. STORAGE: Store this medication in the refrigerator away from light and moisture. Another OATP1B1 potent inhibitor increased elagolix AUC in the range of 2- to 5.58-fold. Adjust the maraviroc dosage as follows when administered with clarithromycin (with or without a concomitant CYP3A inducer): adults and children weighing 40 kg or more: 150 mg PO twice daily; children weighing 30 to 39 kg: 100 mg PO twice daily; children weighing 20 to 29 kg: 75 mg PO twice daily (or 80 mg PO twice daily for solution); children weighing 10 to 19 kg: 50 mg PO twice daily; children weighing 2 to 9 kg: use not recommended. Administration of clarithromycin has resulted in prolongation of the QT interval and TdP. In a drug interaction study, coadministration of a strong CYP3A inhibitor increased the exposure of oral conivaptan by 11-fold. Estropipate: (Minor) Estrogens are partially metabolized by CYP3A4. Coadministration of netupitant; palonosetron with a strong CYP3A4 inhibitor such as clarithromycin can significantly increase the systemic exposure to netupitant. If the use of a macrolide antibiotic is necessary in a patient receiving amlodipine therapy, azithromycin is the preferred agent. Androgen deprivation therapy (i.e., relugolix) may also prolong the QT/QTc interval. Chem Biol Interact. Coadministration may result in increased absorption of tenofovir. Phenobarbital: (Major) There have been spontaneous and/or published reports of interactions between clarithromycin and phenobarbital. The effect of CYP3A4 inhibitors on buprenorphine implants has not been studied, and the effect may be dependent on the route of administration. It is bactericidal and has a very broad spectrum of activity against most gram-positive and gram-negative organisms (including Pseudomonas aeruginosa) and specifically Mycobacterium tuberculosis. Oritavancin: (Moderate) Clarithromycin is metabolized by CYP3A4; oritavancin is a weak CYP3A4 inducer. Minor/Significance Unknown. Hydrocortisone: (Moderate) Clarithromycin inhibits CYP3A4 and has the potential to result in increased plasma concentrations of corticosteroids. Minor/Significance Unknown. (Major) Coadministration of inhaled fluticasone propionate and clarithromycin is not recommended; use caution with inhaled fluticasone furoate. Avoid use of fesoterodine and clarithromycin in pediatric patients weighing 25 to 35 kg. Thiotepa: (Major) Avoid the concomitant use of thiotepa and clarithromycin if possible; reduced metabolism to the active thiotepa metabolite may result in decreased thiotepa efficacy. The MICs are defined for beta-hemolytic Streptococcus sp., Streptococcus viridans group, and Streptococcus pneumoniae as susceptible at 0.25 mcg/mL or less, intermediate at 0.5 mcg/mL, and resistant at 1 mcg/mL or more. Increased elagolix concentrations increase the risk for dose-related side effects, including loss of bone mineral density. Concomitant use may increase rifaximin exposure. Sotalol administration is associated with QT prolongation and TdP. Deflazacort is a CYP3A4 substrate; clarithromycin is a strong inhibitor of CYP3A4. If therapy with clarithromycin is initiated in a patient already receiving 900 mg, reduce dose of mifepristone to 600 mg and titrate to a maximum of 900 mg if clinically indicated. Buprenorphine; Naloxone: (Major) Due to the potential for QT prolongation, cautious use and close monitoring are advisable if concurrent use of clarithromycin and buprenorphine is necessary. Interaction mainly occurs in neonates. Vancomycinalso exhibitsnephrotoxicityand has been found to cause acute kidney injury (AKI). Chloroquine: (Major) Avoid coadministration of chloroquine with clarithromycin due to the increased risk of QT prolongation. Clarithromycin is a CYP3A4 substrate and enzalutamide is a strong CYP3A4 inducer. The dose of clarithromycin should be reduced by 50% for patients with a creatinine clearance of 30 to 60 ml/min and for patients with a creatinine clearance of < 30 ml/min, the dose of clarithromycin should be reduced by 75%. Budesonide is a CYP3A4 substrate; clarithromycin is a strong CYP3A4 inhibitor. If concomitant use is unavoidable, consider reducing the dose of temsirolimus to 12.5 mg per week. tobramycin inhaled and vancomycin both increase nephrotoxicity and/or ototoxicity. Aspirin, ASA; Butalbital; Caffeine; Codeine: (Moderate) Concomitant use of codeine with clarithromycin may increase codeine plasma concentrations, resulting in greater metabolism by CYP2D6, increased morphine concentrations, and prolonged opioid adverse reactions, including hypotension, respiratory depression, profound sedation, coma, and death. Ergotamine is primarily metabolized by CYP3A4, and clarithromycin is a strong inhibitor of CYP3A4. Rifampicin, also known as rifampin, is an ansamycin antibiotic used to treat several types of bacterial infections, including tuberculosis (TB), Mycobacterium avium complex, leprosy, and Legionnaires disease. Coadministration may result in increased rilpivirine plasma concentrations. For patients with a creatinine clearance (CrCl) 30 to 60 ml/min, the dose of clarithromycin should be reduced by 50%; for patients with CrCl < 30 ml/min, the dose of clarithromycin should be reduced by 75%. The vanA gene was later found to be encoded within a transposon located on a plasmid carried by the VRSA isolate. In patients with normal renal function, coadministration of these drugs is acceptable with no dosage adjustments. Darifenacin: (Moderate) The daily dose of darifenacin should not exceed 7.5 mg PO when administered with clarithromycin due to increased darifenacin exposure. Sequential therapy may begin after 5 to 7 days of amoxicillin and a PPI as clarithromycin in combination with a nitroimidazole and PPI for 5 to 7 days. Various streptococci are important ecologically as part of the normal microbial flora of animals and humans; some can also cause diseases that range from subacute to acute or even chronic. It is recommended to avoid this combination when codeine is being used for cough. (Moderate) The concomitant use of clarithromycin and antidiabetic agents can result in significant hypoglycemia. What Does It Mean To Precept Responsibly & What Is The Precept Responsibly Podcast? The AUC of zanubrutinib is predicted to increase by 183% when coadministered with clarithromycin. Clarithromycin is associated with an established risk for QT prolongation and TdP, while perphenazine (a phenothiazine) is associated with a possible risk for QT prolongation. Consider taking steps to minimize the risk for QT/QTc interval prolongation and TdP, such as electrolyte monitoring and repletion and ECG monitoring, if concomitant use is necessary. Also, practitioners should be alert to the possibility that breakthrough bleeding or contraceptive failure may occur with clarithromycin. To view formulary information first create a list of plans. Clarithromycin is a strong CYP3A4 inhibitor and cilostazol is a CYP3A4 substrate. Application of BACTROBAN Nasal to the eye under testing conditions has caused severe symptoms such as burning and tearing. There is no information regarding local overdose of BACTROBAN Nasal or regarding oral ingestion of the nasal ointment formulation. [28238], 7.5 mg/kg/dose (Max: 250 mg/dose) PO every 12 hours for 5 to 10 days. Clarithromycin is associated with an established risk for QT prolongation and TdP. 2000 Nov;157(5):1575-80. A retrospective, case crossover study, found the risk of hospitalization due to hypotension or shock to be significantly increased in geriatric patients exposed to clarithromycin during concurrent calcium-channel blocker therapy (OR 3.7, 95% CI 2.3-6.1). Concurrent use of azithromycin was not associated with an increased risk of hypotension (OR 1.5, 95% CI 0.8-2.8). Levoketoconazole: (Contraindicated) Avoid concomitant use of ketoconazole and clarithromycin due to an increased risk for torsade de pointes (TdP) and QT/QTc prolongation. Interaction mainly occurs in neonates. 2001 May 4;276(18):14581-7. Females, people 65 years and older, patients with sleep deprivation, pheochromocytoma, sickle cell disease, hypothyroidism, hyperparathyroidism, hypothermia, systemic inflammation (e.g., human immunodeficiency virus (HIV) infection, fever, and some autoimmune diseases including rheumatoid arthritis, systemic lupus erythematosus (SLE), and celiac disease) and patients undergoing apheresis procedures (e.g., plasmapheresis [plasma exchange], cytapheresis) may also be at increased risk for QT prolongation. Teratogenic Effects: Pregnancy Category B. Clarithromycin is associated with an established risk for QT prolongation and torsades de pointes TdP. A strong inhibitor increased fluticasone furoate exposure by 1.33-fold with a 27% reduction in weighted mean serum cortisol; this change does not necessitate dose adjustment of fluticasone furoate. vancomycin decreases effects of BCG vaccine live by pharmacodynamic antagonism. Clarithromycin is associated with an established risk for QT prolongation and torsade de pointes (TdP). Specific dosage adjustment recommendations are available for the Colcrys product for patients who have taken clarithromycin in the past 14 days or require concurrent use: for prophylaxis of gout flares, if the original dose is 0.6 mg twice daily, decrease to 0.3 mg once daily or if the original dose is 0.6 mg once daily, decrease to 0.3 mg once every other day; for treatment of gout flares, give 0.6 mg as a single dose, then 0.3 mg 1 hour later, and do not repeat for at least 3 days; for familial Mediterranean fever, do not exceed a 0.6 mg/day. Contraindicated drugs highly dependent on CYP3A for clearance: Alpha1-adrenoreceptor antagonist: alfuzosin, Analgesics: pethidine, piroxicam, propoxyphene, Antiarrhythmic: amiodarone, dronedarone, flecainide, propafenone, quinidine, Antipsychotics: lurasidone, pimozide, clozapine, Ergot derivatives: dihydroergotamine, ergotamine, methylergonovine, HMG-CoA reductase inhibitors: lovastatin, simvastatin, PDE5 inhibitor: sildenafil (Revatio) when used for pulmonary arterial hypertension (PAH), Sedative/hypnotics: triazolam, oral midazolam. Clarithromycin is associated with an established risk for QT prolongation and torsades de pointes TdP. Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature. Both telavancin and clarithromycin are associated with QT prolongation, while clarithromycin is also associated with an established risk for TdP. Use of a strong CYP3A inhibitor is predicted to increase the overall exposure of mobocertinib and its active metabolites by 374% to 419%. 250 to 500 mg PO every 24 hours, depending on the severity of the infection. Careful medical history is necessary since CDAD has been reported to occur over two months after the administration of antibacterial agents. [9] In vitro and in vivo experiments reported in 1992 demonstrated that vancomycin resistance genes from Enterococcus faecalis could be transferred by gene transfer to S. aureus, conferring high-level vancomycin resistance to S. Careful monitoring of blood glucose is recommended. Vilazodone: (Major) Because CYP3A4 is the primary isoenzyme involved in the metabolism of vilazodone, the manufacturer of vilazodone recommends that the daily dose not exceed 20 mg/day during concurrent use of a strong CYP3A4 inhibitor, such as clarithromycin. Methylprednisolone: (Minor) Postmarketing reports of interactions with coadministration of clarithromycin and methylprednisolone have been noted. Therefore, these antibiotics should be taken at least 2 hours before and not less than 6 hours after the administration of sodium picosulfate; magnesium oxide; anhydrous citric acid solution. Glimepiride: (Moderate) The concomitant use of clarithromycin and antidiabetic agents can result in significant hypoglycemia. Tofacitinib exposure is increased when coadministered with clarithromycin. If coadministration is unavoidable, monitor for symptoms of hypotension and edema; adjust the dose of amlodipine as clinically appropriate. Elderly patients may be more susceptible to development of QT prolongation and torsade de pointes than younger patients. Clarithromycin is a strong inhibitor of the hepatic enzyme CYP3A, while elbasvir is metabolized by CYP3A. The nurse should report this finding to the provider, so the provider can prescribe a lower dose for the client or prescribe a different antimicrobial drug. Edoxaban: (Major) Reduce the dose of edoxaban to 30 mg/day PO in patients being treated for deep venous thrombosis (DVT) or pulmonary embolism and receiving concomitant therapy with clarithromycin. (Minor) Estrogens are partially metabolized by CYP3A4. Clarithromycin may be associated with reproductive risk in male patients. Consider ECG monitoring if clarithromycin must be used with or after artemether; lumefantrine treatment. Clarithromycin inhibits dihydroergotamine metabolism via inhibition of the CYP3A4 enzyme. It is a substrate of CYP3A4. Although there are no studies examining the effects of ranolazine in patients receiving other QT prolonging drugs, coadministration of such drugs may result in additive QT prolongation. Use Caution/Monitor. Selumetinib: (Major) Avoid coadministration of selumetinib and clarithromycin due to the risk of increased selumetinib exposure which may increase the risk of adverse reactions. Cobicistat: (Major) Avoid concurrent use of clarithromycin with regimens containing cobicistat and atazanavir or darunavir; use of an alternative antibiotic is recommended. Nisoldipine: (Major) Avoid coadministration of nisoldipine with clarithromycin, particularly in geriatric patients, due to increased plasma concentrations of nisoldipine. fenoprofen increases levels of vancomycin by decreasing renal clearance. Coadministration with a moderate CYP2C9/CYP3A4 dual inhibitor led to a 2-fold increase in the exposure of siponimod. Incretin Mimetics: (Moderate) The concomitant use of clarithromycin and antidiabetic agents can result in significant hypoglycemia. Ado-Trastuzumab emtansine: (Major) Avoid coadministration of clarithromycin with ado-trastuzumab emtansine if possible due to the risk of elevated exposure to the cytotoxic component of ado-trastuzumab emtansine, DM1. Similar to -lactam antibiotics, vancomycin penetrates bone poorly [] ().However, when serum levels of vancomycin were >35 g/mL, its penetration of sternal bone (30% of serum concentrations) was better than in axial skeletal bone [47, 48].Daptomycin also penetrates bone relatively poorly (), but levels are probably high enough to exceed the target MICs for Minor/Significance Unknown. For invasive MRSA infections, a 24-hour AUC/MIC ratio 400 mgh/L is recommended based on adult studies. Minor/Significance Unknown. Clarithromycin inhibits CYP3A4 and may cause significant increases in silodosin plasma concentrations. Cases of long QT syndrome and TdP tachycardia have been described with maprotiline use, but rarely occur when the drug is used alone in normal prescribed doses and in the absence of other known risk factors for QT prolongation. Adding plans allows you to compare formulary status to other drugs in the same class. [, Baneres-Roquet F, Gualtieri M, Villain-Guillot P, Pugniere M, Leonetti JP: Use of a surface plasmon resonance method to investigate antibiotic and plasma protein interactions. Monitor Closely (1)vancomycin will decrease the level or effect of estrogens conjugated synthetic by altering intestinal flora. Clarithromycin is associated with an established risk for QT prolongation and TdP, while perphenazine (a phenothiazine) is associated with a possible risk for QT prolongation. Assess renal function, so appropriate methotrexate dose modifications can be made. Afatinib is a P-glycoprotein (P-gp) substrate and clarithromycin is a P-gp inhibitor; coadministration may increase plasma concentrations of afatinib. Pentamidine: (Major) Clarithromycin is associated with an established risk for QT prolongation and torsade de pointes (TdP). Dextromethorphan; Quinidine: (Major) Clarithromycin is associated with an established risk for QT prolongation and torsades de pointes (TdP). However, in 5% of the population studied, increases in the QTc of at least 15 milliseconds have been reported. (Major) Clarithromycin can inhibit theophylline clearance by inhibiting the cytochrome P450 CYP3A isoenzymes. [46963], 1,000 mg PO once daily for at least 5 days as monotherapy for outpatients without comorbidities or risk factors for MRSA or P. aeruginosa and as part of combination therapy for outpatients with comorbidities. [, Loboz KK, Gross AS, Williams KM, Liauw WS, Day RO, Blievernicht JK, Zanger UM, McLachlan AJ: Cytochrome P450 2B6 activity as measured by bupropion hydroxylation: effect of induction by rifampin and ethnicity. Concomitant use may increase unconjugated monomethyl auristatin E (MMAE) exposure, which may increase the incidence or severity of enfortumab-vedotin toxicities. Capmatinib: (Moderate) Monitor for an increase in capmatinib-related adverse reactions if coadministration with clarithromycin is necessary. Coadministration of lemborexant with another strong CYP3A4 inhibitor increased the lemborexant AUC by up to 4.5-fold. Modify Therapy/Monitor Closely. Brigatinib is a CYP3A4 substrate; clarithromycin is a strong CYP3A4 inhibitor. Minor (1)aspirin increases levels of vancomycin by decreasing renal clearance. While the 14-OH-clarithromycin active metabolite concentrations are increased, this metabolite has different antimicrobial activity compared to clarithromycin. Buprenorphine: (Major) Due to the potential for QT prolongation, cautious use and close monitoring are advisable if concurrent use of clarithromycin and buprenorphine is necessary. Lapatinib: (Major) Avoid coadministration of lapatinib with clarithromycin due to increased plasma concentrations of lapatinib; QT prolongation may also occur. Consider use of azithromycin in place of clarithromycin. Use caution with inhaled forms of budesonide as systemic exposure to the corticosteroid may also increase. Interaction mainly occurs in neonates. Drugs that inhibit CYP3A4 such as clarithromycin may increase plasma concentrations of estrogens and cause estrogen-related side effects such as nausea, breast tenderness, and endometrial hyperplasia. If concomitant use is unavoidable, decrease the dose of lapatinib to 500 mg PO once daily. Careful monitoring of blood glucose is recommended. [, Cui Y, Konig J, Keppler D: Vectorial transport by double-transfected cells expressing the human uptake transporter SLC21A8 and the apical export pump ABCC2. Patients receiving estrogens should be monitored for an increase in adverse events. Coadministration may result in increased rilpivirine plasma concentrations. Modafinil: (Major) Coadministration of modafinil and clarithromycin may decrease clarithromycin serum concentrations due to CYP3A4 enzyme induction. Promethazine carries a possible risk of QT prolongation. Certain antibiotics (i.e., tetracyclines and quinolones) may chelate with the magnesium in sodium picosulfate; magnesium oxide; anhydrous citric acid solution. It is recommended to avoid this combination when hydrocodone is being used for cough. Accessed April 7, 2020.https://medlineplus.gov/druginfo/meds/a601167.html, Levine, DP. Keep all medications away from children and pets.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Antituberculous drugs (e.g., rifampin) were the only agents associated with OC failure and pregnancy. In addition, the inhibitory effects of clarithromycin may increase the systemic exposure of ivacaftor. Clarithromycin should be used cautiously with other agents known to cause QT prolongation. Drugs that inhibit CYP3A4 such as clarithromycin may increase plasma concentrations of estrogens and cause estrogen-related side effects such as nausea and breast tenderness. Larotrectinib is a CYP3A4 substrate; clarithromycin is a strong CYP3A4 inhibitor. Ezetimibe; Simvastatin: (Contraindicated) The concurrent use of clarithromycin and simvastatin is contraindicated due to the risk of myopathy and rhabdomyolysis. Correlation of BACTROBAN Nasal in vitro activity and methicillin-resistant Staphylococcus aureus (MRSA) nasal decolonization has been demonstrated in clinical trials (see CLINICAL STUDIES). Management of MRSA meningitis in combination with vancomycin; Usual Adult Dose for CNS Infection. It has a broad antibacterial spectrum, including activity against several forms of Mycobacterium. Either increases toxicity of the other by nephrotoxicity and/or ototoxicity. Moxifloxacin has also been associated with prolongation of the QT interval. If these agents are used together, monitor patients for signs and symptoms of romidepsin toxicity including hematologic toxicity, infection, and electrocardiogram (ECG) changes; therapy interruption or discontinuation or a dosage reduction may be required if toxicity develops. Minor/Significance Unknown. Here are some suggestions to find what you are looking for: When sildenafil is used for erectile dysfunction, consider a starting dose of 25 mg for patients receiving clarithromycin. Such increases in tamsulosin concentrations may be expected to produce clinically significant and potentially serious side effects, such as hypotension. Codeine is primarily metabolized by CYP2D6 to morphine, and by CYP3A4 to norcodeine; norcodeine does not have analgesic properties. Use Caution/Monitor. Simultaneous oral administration of clarithromycin immediate-release tablets and zidovudine may result in decreased steady-state zidovudine concentrations. Both clarithromycin and chlorpromazine are specifically associated with an established risk of QT prolongation and TdP. Clarithromycin is associated with an established risk for QT prolongation and torsade de pointes (TdP). Coadministration of a combined P-gp and strong CYP3A4 inhibitor increased the exposure of oral and intravenous lefamulin by 165% and 31%, respectively. Sequential therapy is not recommended if susceptibility testing is unavailable. The adverse event rate was similar to that seen in babies in control group whose mothers were treated with amoxicillin (8.3%). Donepezil; Memantine: (Major) Case reports indicate that QT prolongation and torsade de pointes (TdP) can occur during donepezil therapy. Bedaquiline: (Major) Concurrent use of bedaquiline and a strong CYP3A4 inhibitor, such as clarithromycin, for more than 14 days should be avoided unless the benefits justify the risks. Nab-paclitaxel is a CYP3A4 substrate and clarithromycin is a strong CYP3A4 inhibitor. Since compounds in red yeast rice claim to have HMG-CoA reductase inhibitor activity, it should not be used in combination with clarithromycin. Restart secondary prophylaxis if the CD4 count falls below these thresholds.[34361]. Epub 2007 Jul 16. Coadministration of efavirenz and clarithromycin may increase the risk for QT prolongation and torsade de pointes (TdP). Shake the bottle well before each dose. Rifampin is bactericidal, and acts on both intracellular and extracellular organisms. Concomitant use may also increase the risk for QT/QTc prolongation and torsade de pointes (TdP). If concomitant use is unavoidable, decrease the dose of ceritinib by approximately one-third, rounded to the nearest multiple of 150 mg; monitor for ceritinib-related adverse reactions. mefenamic acid increases levels of vancomycin by decreasing renal clearance. In patients who have had already had a dose reduction to 100 mg twice daily due to adverse reactions, further reduce the dose of abemaciclib to 50 mg PO twice daily. Additionally, both drugs have been associated with prolongation of the QT interval as well as rare cases of torsade de pointes. Both drugs have been associated with QT prolongation. Clarithromycin is associated with an established risk for QT prolongation and TdP. Also, practitioners should be alert to the possibility that breakthrough bleeding or contraceptive failure may occur with clarithromycin. Minor (1)tobramycin and vancomycin both increase nephrotoxicity and/or ototoxicity. Drug Metab Dispos. In healthy subjects, the relative bioavailability for AUC and Cmax of afatinib was 119% and 104%, respectively, when coadministered with the same P-gp inhibitor, and 111% and 105% when the inhibitor was administered 6 hours after afatinib. A retrospective, case crossover study, found the risk of hospitalization due to hypotension or shock to be significantly increased in geriatric patients exposed to clarithromycin during concurrent calcium-channel blocker therapy (OR 3.7, 95% CI 2.3-6.1). Ceritinib: (Major) Avoid coadministration of clarithromycin with ceritinib due to the additive risk of QT prolongation and increased ceritinib exposure which may increase the incidence and severity of adverse reactions. Epub 2009 May 21. Vincristine: (Major) Increased concentrations of vincristine are likely. Alfuzosin is a CYP3A4 substrate that may prolong the QT interval in a dose-dependent manner. Consider taking steps to minimize the risk for QT/QTc interval prolongation and TdP, such as electrolyte monitoring and repletion and ECG monitoring, if concomitant use is necessary. Concentration-dependent QTc prolongation occurred during clinical trials of osimertinib. commonly, these are "non-preferred" brand drugs or specialty Monitor Closely (1)vancomycin will decrease the level or effect of mestranol by altering intestinal flora. Interaction mainly occurs in neonates. Following administration of 250 mg immediate-release tablets every 12 hours, peak plasma concentrations are achieved in about 2 to 3 hours, and steady-state serum concentrations are attained within 3 days.Absorption of clarithromycin extended-release tablets: The extended-release tablets provide for extended absorption of clarithromycin from the GI tract. Concurrent use of azithromycin was not associated with an increased risk of hypotension (OR 1.5, 95% CI 0.8-2.8). Based on the study results, these authors recommended that back-up contraception may not be necessary if OCs are used reliably during oral antibiotic use. These changes in pharmacokinetics parallel known age-related decreases in renal function. If concomitant use is unavoidable, reduce the dose of pralsetinib to 200 mg once daily for patients taking a daily dose of 400 mg or 300 mg, and to 100 mg once daily for patients taking a daily dose of 200 mg. After clarithromycin has been discontinued for 3 to 5 elimination half-lives, resume the pralsetinib dose taken prior to initiating clarithromycin. Coadministration may result in increased plasma concentrations of both drugs, thereby further increasing the risk for adverse events. [, Murfreesboro Pharmaceutical Nursing Supply, Villain-Guillot P, Bastide L, Gualtieri M, Leonetti JP: Progress in targeting bacterial transcription. Copanlisib: (Major) Avoid the concomitant use of copanlisib and clarithromycin if possible; increased copanlisib exposure may occur. Also, supratherapeutic doses of rilpivirine (75 to 300 mg/day) have caused QT prolongation; caution is advised when administering rilpivirine with other drugs that may prolong the QT or PR interval, such as clarithromycin. Both clarithromycin and the 14-OH metabolite distribute readily into body tissues and fluids. Repaglinide: (Moderate) The concomitant use of clarithromycin and oral hypoglycemic agents can result in significant hypoglycemia. With certain hypoglycemic drugs such as the thiazolidinediones, inhibition of CYP3A enzyme by clarithromycin may be involved; however, CYP3A is not a major metabolism route for pioglitazone and rosiglitazone. Clarithromycin is a substrate and strong inhibitor of CYP3A. Clarithromycin is a strong inhibitor of CYP3A4, an isoenzyme partially responsible for the metabolism of dihydrocodeine. Drugs that inhibit CYP3A4 such as clarithromycin may increase plasma concentrations of estrogens and cause estrogen-related side effects such as nausea and breast tenderness. Rare reports of rhabdomyolysis have been reported in patients taking clarithromycin and rosuvastatin. Xenobiotica. Interaction mainly occurs in neonates. Insulin Degludec; Liraglutide: (Moderate) The concomitant use of clarithromycin and antidiabetic agents can result in significant hypoglycemia. However, the clinical effect of such an interaction on the response to donepezil has not been determined. Clarithromycin inhibits the metabolism of ergot alkaloids via inhibition of the CYP3A4 isoenzyme. The genus Streptococcus , a heterogeneous group of Gram-positive bacteria, has broad significance in medicine and industry. Alogliptin: (Moderate) The concomitant use of clarithromycin and antidiabetic agents can result in significant hypoglycemia. Use Caution/Monitor. Lapatinib is a CYP3A4 substrate that has been associated with concentration-dependent QT prolongation; ventricular arrhythmias and torsade de pointes (TdP) have also been reported in postmarketing experience. Coadministration may result in increased absorption of tenofovir. Ciprofloxacin has a possible risk for QT prolongation and TdP and should be used cautiously with clarithromycin. Olopatadine; Mometasone: (Moderate) Concomitant administration of clarithromycin and mometasone may increase systemic exposure to mometasone, increasing the risk of corticosteroid-related adverse events. Concomitant use increases salmeterol exposure and may increase the incidence and severity of salmeterol-related adverse effects. Proarrhythmic events should be anticipated after initiation of therapy and after each upward dosage adjustment. [34361], 500 mg PO twice daily plus ethambutol. In addition, drospirenone has antimineralocorticoid effects; the progestin may increase serum potassium. Be alert for decreased clinical response to zafirlukast when clarithromycin is added concurrently. If concomitant use is necessary for adults with non-small cell lung cancer (NSCLC) or inflammatory myofibroblastic tumor (IMT), reduce the dose of crizotinib to 250 mg PO once daily. 2003 Mar;31(3):282-8. [, Courtois A, Payen L, Vernhet L, de Vries EG, Guillouzo A, Fardel O: Inhibition of multidrug resistance-associated protein (MRP) activity by rifampicin in human multidrug-resistant lung tumor cells. Coadministration may increase the exposure of ripretinib and its active metabolite (DP-5439), which may increase the risk of adverse reactions. Fedratinib is a CYP3A4 substrate; clarithromycin is a strong CYP3A4 inhibitor. Careful monitoring of blood glucose is recommended. Additive effects on the QT interval may also occur. Minor/Significance Unknown. Alosetron: (Moderate) Concomitant use of alosetron with clarithromycin may result in increased serum concentrations of alosetron and increase the risk for adverse reactions. [, Rae JM, Johnson MD, Lippman ME, Flockhart DA: Rifampin is a selective, pleiotropic inducer of drug metabolism genes in human hepatocytes: studies with cDNA and oligonucleotide expression arrays. Careful monitoring of blood glucose is recommended. Do not refrigerate. When combined with other P-gp and strong CYP3A4 inhibitors, the manufacturer recommends reducing the apixaban dose by 50% and avoiding concomitant administration if patients are already receiving 2.5 mg twice daily. Since the microbiological activities of clarithromycin and 14-OHclarithromycin are different for different bacteria, the intended therapeutic effect could be impaired during concomitant administration of clarithromycin and enzyme inducers. A strong inhibitor increased fluticasone furoate exposure by 1.33-fold with a 27% reduction in weighted mean serum cortisol; this change does not necessitate dose adjustment of fluticasone furoate. [34362], 7.5 mg/kg/dose (Max: 500 mg/dose) PO twice daily. If clarithromycin is discontinued, hydrocodone plasma concentrations will decrease resulting in reduced efficacy of the opioid and potential withdrawal syndrome in a patient who has developed physical dependence to hydrocodone. If clarithromycin is discontinued, consider increasing the oxycodone dose until stable drug effects are achieved and monitor for evidence of opioid withdrawal. Interaction mainly occurs in neonates. The metabolism of 1,2-Benzodiazepine can be increased when combined with Rifampicin. Drug Metab Dispos. 2006 Jun;62(6):451-61. doi: 10.1007/s00228-006-0127-x. Careful monitoring of blood glucose is recommended. Clarithromycin is associated with an established risk for QT prolongation and TdP. Five Things Pharmacists Should Know About Ventilator Associated Pneumonia (VAP), 5 Important Things To Know About Social Media As A Resource For Pharmacy Residency Recruitment For Both Candidates And Programs, Musical Chairs & The ABCs of SARS-CoV-2 Monoclonal Antibodies, A Comparison Of Paxlovid Versus Molnupiravir: The First Oral COVID Antivirals, Five Things For Pharmacists To Know About The Omicron Variant, Molnupiravir The New COVID Antiviral Named After Thors Hammer, Cross-Resistance with Anti-SARS-CoV-2 Monoclonal Antibodies. Intravenousvancomycincan treat much more than its oral counterpart, offering patients a better chance at recovery from infection and lengthy hospital stays. Long-term studies in animals to evaluate carcinogenic potential of mupirocin calcium have not been conducted. Modify Therapy/Monitor Closely. [28238] [34361] Primary prophylaxis is recommended in children 6 years and older with a CD4 count less than 50 cells/mm3, children 2 to 6 years with a CD4 count less than 75 cells/mm3, children 1 to 2 years with a CD4 count less than 500 cells/mm3, or infants younger than 1 year with a CD4 count less than 750 cells/mm3. When administered together, clarithromycin may inhibit the metabolism of bedaquiline resulting in increased systemic exposure (AUC) and potentially more adverse reactions. The intended therapeutic effect of clarithromycin could be decreased. Careful monitoring of glucose is recommended. Concomitant use may increase futibatinib exposure and the risk of adverse effects (e.g., ocular toxicity, hyperphosphatemia). Concurrent use may significantly increase concentrations of 21-desDFZ, the active metabolite of deflazacort, resulting in an increased risk of toxicity. Finerenone: (Contraindicated) Concomitant use of finerenone and clarithromycin is contraindicated. Lopinavir is associated with QT prolongation. Voclosporin: (Contraindicated) Concomitant use of voclosporin and clarithromycin is contraindicated; concomitant use may increase the exposure of voclosporin and the risk of voclosporin-related adverse effects such as nephrotoxicity, hypertension, and QT prolongation. vancomycin will decrease the level or effect of estrogens conjugated synthetic by altering intestinal flora. The AUC and Cmax for cinacalcet increased 2.3 to 2.2 times, respectively, compared to 90 mg cinacalcet given alone. Istradefylline exposure was increased by 2.5-fold when administered with a strong inhibitor in a drug interaction study. If clarithromycin is discontinued, increase the pexidartinib dose to the original dose after 3 plasma half-lives of clarithromycin. September 2014. Use of these drugs together may result in elevated concentrations of dasabuvir. Intravenous infusions of 252 mg, as well as single oral doses of 500 mg of mupirocin, have been well tolerated in healthy adult subjects. 1995 May 11;49(9):1255-60. Patients receiving estrogens should be monitored for an increase in adverse events. In some patients, a corticosteroid dose adjustment may be needed. There are no data on CSF penetration. Your list will be saved and can be edited at any time. Voxilaprevir is a substrate for the drug transporter Organic Anion Transporting Polypeptides 1B1/1B3 (OATP1B1/1B3); clarithromycin is an OATP1B1/1B3 inhibitor. Minor/Significance Unknown. Minor/Significance Unknown. Discontinuation of clarithromycin could decrease codeine plasma concentrations, decrease opioid efficacy, and potentially lead to a withdrawal syndrome in those with physical dependence to codeine. Interaction mainly occurs in neonates. Minor/Significance Unknown. Mupirocin is an antibacterial agent produced by fermentation using the organism Pseudomonas fluorescens. Clarithromycin is a P-gp and strong CYP3A4 inhibitor that is associated with an established risk for QT prolongation and torsade de pointes (TdP). It is not clear if clarithromycin activity against other organisms would be reduced, but reduced efficacy is possible. Paclitaxel: (Minor) Paclitaxel is partially metabolized by CYP3A4. Although causality for TdP has not been established for flecainide, patients receiving concurrent drugs which have the potential for QT prolongation may have an increased risk of developing proarrhythmias. It is also potentially a substrate of P-gP, but data are in vitro only. Coadministration will increase the plasma concentrations of ivabradine. Discontinuation may be considered after 3 to 4 months of treatment and CD4 count more than 200 cells/mm3 for at least 6 months. Artemether; Lumefantrine: (Major) Concurrent use of artemether; lumefantrine and clarithromycin should be avoided due to an increased risk for QT prolongation and torsade de pointes (TdP). We comply with the HONcode standard for trustworthy health information. Vardenafil: (Major) Do not use vardenafil orally disintegrating tablets with clarithromycin due to increased vardenafil exposure; do not exceed a single dose of 2.5 mg per 24-hour period of vardenafil oral tablets. The tube should be discarded after usage; it should not be re-used. Deutetrabenazine: (Major) Avoid coadministration of clarithromycin with deutetrabenazine. Clarithromycin should be used cautiously with other medications which may prolong the QT interval including vorinostat. Inducers of CYP3A enzymes will decrease plasma concentrations of clarithromycin while increasing those of 14-OH-clarithromycin. Clarithromycin is associated with an established risk for QT prolongation and TdP. Only 6 mothers in the study received clarithromycin, 10 received azithromycin, 2 received erythromycin, and the remainder were treated with roxythromycin. Both clarithromycin and disopyramide have been associated with an established risk for QT prolongation and TdP. Concurrent use of azithromycin was not associated with an increased risk of hypotension (OR 1.5, 95% CI 0.8-2.8). Drugs that inhibit CYP3A4 such as clarithromycin may increase plasma concentrations of estrogens and cause estrogen-related side effects such as nausea and breast tenderness. Solifenacin: (Major) Avoid coadministration of clarithromycin with solifenacin if possible due to the risk of QT prolongation; plasma concentrations of solifenacin may also increase. Concurrent use is expected to produce large increases in systemic exposure to triazolam, with the potential for serious adverse effects. Monitor Closely (1)vancomycin will decrease the level or effect of estradiol by altering intestinal flora. Avoid concurrent use of bacitracin with other nephrotoxic drugs. Restart secondary prophylaxis if the CD4 count decreases to less than 100 cells/mm3. The nonlinearity of clarithromycin pharmacokinetics is slight when given at the recommended doses of 250 and 500 mg every 8 to 12 hours. All adequate and well-controlled trials of this product were vehicle-controlled; therefore, no data from direct, head-to-head comparisons with other products are available at this time. Use Caution/Monitor. Sufentanil: (Moderate) Because the dose of the sufentanil sublingual tablets cannot be titrated, consider an alternate opiate if clarithromycin must be administered. In drug interaction studies, coadministration with strong inhibitors increased plasma fluticasone exposure resulting in 45% to 86% decreases in serum cortisol AUC. Schedule a live demo or a chat . For children 6 years and older, primary prophylaxis may be discontinued after at least 6 months of ART and a CD4 count more than 100 cells/mm3 for at least 3 consecutive months. Clarithromycin is a strong CYP3A4 inhibitor, and ospemifene is a CYP3A4 substrate. Reduce betrixaban dosage to 80 mg PO once followed by 40 mg PO once daily in all other patients receiving clarithromycin. Oxycodone is a CYP3A4 substrate, and coadministration with a strong CYP3A4 inhibitor like clarithromycin can increase oxycodone exposure resulting in increased or prolonged opioid effects including fatal respiratory depression, particularly when an inhibitor is added to a stable dose of oxycodone. Interaction mainly occurs in neonates. Drugs with a possible risk for QT prolongation and TdP that should be used cautiously and with close monitoring with clarithromycin include promethazine. Use Caution/Monitor. Coadministration with another strong CYP3A4 inhibitor is predicted to increase the AUC of avapritinib by 600% at steady-state. Use caution if these drugs are coadministered, as increased clarithromycin concentrations may cause QT prolongation; a 50% dosage reduction of clarithromycin is recommended. Coadministration of eliglustat with CYP3A inhibitors such as clarithromycin increases eliglustat exposure and the risk of serious adverse events (e.g., QT prolongation and cardiac arrhythmias); this risk is the highest in CYP2D6 IMs and PMs because a larger portion of the eliglustat dose is metabolized via CYP3A. Amlodipine; Valsartan; Hydrochlorothiazide, HCTZ: (Major) Avoid coadministration of clarithromycin and amlodipine, particularly in geriatric patients, due to an increased risk of hypotension and acute kidney injury. Minor (1)capreomycin and vancomycin both increase nephrotoxicity and/or ototoxicity. Careful monitoring of glucose is recommended. streptomycin and vancomycin both increase nephrotoxicity and/or ototoxicity. [23585] [28238]The susceptibility interpretive criteria for clarithromycin are delineated by pathogen. Low risk of contraceptive failure. Applies only to oral forms of hormone. Dolasetron: (Contraindicated) Clarithromycin is associated with an established risk for QT prolongation and torsades de pointes (TdP). Pioglitazone: (Moderate) The concomitant use of clarithromycin and oral hypoglycemic agents can result in significant hypoglycemia. Compare formulary status to other drugs in the same class. Simeprevir: (Major) Avoid concurrent use of simeprevir and clarithromycin; consider use of azithromycin in place of clarithromycin. After a 3-day oral aprepitant regimen, the AUC of midazolam increased by 25% on day 4, and decreased by 19% and 4% on days 8 and 15, respectively, when given on days 1, 4, 8, and 15. Specifically, as monotherapy, the mean serum clarithromycin concentration was 5.4 +/- 2.1 mcg/ml. MMAE, the active component of tisotumab vedotin, is a CYP3A substrate and clarithromycin is a strong CYP3A inhibitor. Interaction mainly occurs in neonates. Specifically, as monotherapy, the mean serum clarithromycin concentration was 5.4 +/- 2.1 mcg/ml. Fluticasone is a CYP3A4 substrate; clarithromycin is a strong CYP3A4 inhibitor. 1995 Dec;69(4):325-34. Do not discontinue secondary prophylaxis for children younger than 2 years. Lidocaine is a CYP3A4 and CYP1A2 substrate; clarithromycin inhibits CYP3A4. While the 14-OH-clarithromycin active metabolite concentrations are increased, this metabolite has different antimicrobial activity compared to clarithromycin. Monitor Closely (1)dichlorphenamide and vancomycin both decrease serum potassium. A strong inhibitor increased fluticasone furoate exposure by 1.33-fold with a 27% reduction in weighted mean serum cortisol; this change does not necessitate dose adjustment of fluticasone furoate. J Bacteriol. Clarithromycin is an inhibitor of CYP3A4 and P-glycoprotein (P-gp). [3], Strains of hVISA and vancomycin-intermediate Staphylococcus aureus (VISA) do not have resistant genes found in Enterococcus and the proposed mechanisms of resistance include the sequential mutations resulting in a thicker cell wall and the synthesis of excess amounts of D-ala-D-ala residues. Alternatives to clarithromycin should be considered in patients who are taking CYP3A4 inducers. Due to lower efficacy, reserve macrolides for patients in whom other antibiotic classes are contraindicated. One case of a possible verapamil-clarithromycin interaction was reported, which was associated with hypotension. Clarithromycin is associated with an established risk for QT prolongation and TdP while QT prolongation and TdP have been reported during postmarketing use of fluvoxamine. Inhibits cell-wall biosynthesis; blocks glycopeptide polymerization by binding tightly to D-alanyl-D-alanine portion of cell wall precursor, Distributed widely in body tissues and fluid, except for cerebrospinal fluid (CSF), Relative diffusion from blood into CSF: Good only with inflammation (exceeds usual minimal inhibitory concentrations); CSF level nil with normal meninges, 20-30% of blood level with inflamed meninges, There is no apparent metabolism of the vancomycin, Half-life (IV): 4-6 hr (normal renal function); 7.5 days (anephric patients), Mean clearance (flexible bag): 0.058 L/kg/hr (plasma); 0.048 L/kg/hr (renal), Excretion: Urine (IV; 80-90% as unchanged drug); primarily feces (PO), Solution: D5W/0.9% NaCl, D5W, D10W, LR, sodium bicarbonate 3.75%, 0.9% NaCl, D5W and LR, Normosol and D5W, 0.9% NaCl, Isolyte, Additive: Amikacin, atracurium, calcium gluconate, cefepime, cimetidine, corticotropin, dimenhydrinate, erythromycin, famotidine, hydrocortisone, meropenem, ofloxacin, potassium chloride, ranitidine, verapamil, vitamins B and C, Y-site (partial list): Acyclovir, alatrofloxacin, aldesleukin, allopurinol, amifostine, amiodarone, ampicillin, ampicillin-sulbactam, cefpirome, ceftizoxime, clarithromycin, diltiazem, esmolol, fluconazole, insulin, labetalol, lorazepam, linezolid, magnesium sulfate, midazolam, morphine, nicardipine, ondansetron, paclitaxel, pancuronium, perphenazine, remifentanil, sargramostim, sodium bicarbonate, tacrolimus, teniposide, Vancomycin solution has a low pH and may cause chemical or physical instability when it is mixed with other compounds, Mixtures of solutions of vancomycin and beta-lactam antibacterial drugs have been shown to be physically incompatible, Likelihood of precipitation increases with higher concentrations of vancomycin; adequately flush IV lines between administering these antibacterial drugs, Add 10 mL of SWI to 500-mg vial and 20 mL of SWI to 1-g vial to yield 50 mg/mL solution; further dilution is required, depending on method of administration, Intermittent infusion: Dilute 500 mg with 100 mL of diluent and 1 g with 200 mL of diluent (NS or D5W), Continuous infusion: Dilute in sufficient amount to permit infusion over 24 hours, Tap bottom edges of bottle to loosen powder, Shake grape-flavored diluent for a few seconds, Open diluent and transfer about half the required volume of diluent into the vancomycin powder bottle, Shake powder bottle vertically for ~45 seconds, Add remaining grape-flavored diluent into powder bottle; shake bottle for ~30 seconds, Instruct patient to shake reconstituted solution well before each use and to use an oral dosing device that measures the appropriate volume of the oral solution in milliliters, Intermittent (preferred): Administer over 60 minutes; not to exceed 10 mg/min. Because of the potential for TdP, use of macrolide antibiotics with pimozide is contraindicated. Fesoterodine: (Major) Limit the dose of fesoterodine to 4 mg once daily in adults and pediatric patients weighing more than 35 kg if coadministered with clarithromycin. Concurrent use of azithromycin was not associated with an increased risk of hypotension (OR 1.5, 95% CI 0.8-2.8). Drugs with a possible risk for QT prolongation and TdP that should be used cautiously and with close monitoring with clarithromycin include promethazine. Aliskiren; Amlodipine: (Major) Avoid coadministration of clarithromycin and amlodipine, particularly in geriatric patients, due to an increased risk of hypotension and acute kidney injury. In a randomized crossover study in healthy volunteers, grapefruit juice did not have a significant affect on the bioavailability of clarithromycin nor did it affect the metabolism of clarithromycin to its active metabolite. Table of Contents Page 2 of 9 ANTIBIOTICS CrCl1 >50 mL/min CrCl1 30-49 mL/min CrCl1 10-29 mL/min CrCl1 <10 mL/min; HD2 CRRT (rate 2.5 L/hr)3 AMIKACIN (IV) [See Aminoglycoside Dosing in Adult Patients] AMOXICILLIN (PO) Cystitis (lower urinary tract infection) 500 mg q8h 500 mg q8h 500 mg q12h 500 mg q24h 500 mg q8h gentamicin, rifampin, linezolid, TMP-SMX, or a beta-lactam antibiotic). Mild-to-severe: Initial dose should be no less than 15 mg/kg, Functionally anephric patients: Initial dose of 15 mg/kg of body weight to achieve prompt therapeutic serum concentration; start at 1.9 mg/kg/24 hr after the initial dose of 15 mg/kg, Oral vancomycin: Not effective for other types of infections, IV vancomycin: Not effective for treatment of staphylococcal enterocolitis and C. difficile-associated diarrhea, After 20 mg/kg IV loading dose, give maintenance dose according to gestational age (GA) and serum creatinine (Scr), elvitegravir/cobicistat/emtricitabine/tenofovir DF, sodium picosulfate/magnesium oxide/anhydrous citric acid, Skin and subcutaneous tissue disorders: Drug rash with eosinophilia and systemic symptoms (DRESS), Single-dose flexible bags are not recommended for use during pregnancy because it contains the excipients polyethylene glycol (PEG) 400 and N-acetyl-D-alanine (NADA), which caused fetal malformations in animal reproduction studies, If vancomycin is needed during pregnancy, use other available formulations of vancomycin, Hypotension, including shock and cardiac arrest, wheezing, dyspnea, urticaria, muscular and chest pain may occur with rapid IV administration; reactions may be more severe in younger patients, particularly children, and in patients receiving concomitant muscle relaxant anesthetics, Rapid administration may also be associated with vancomycin infusion reaction, which manifests as pruritus and erythema that involves the face, neck, and upper torso, Infusion-related adverse reactions are related to both concentration and rate of administration of vancomycin; however, infusion-related adverse reactions may occur, at any rate, or concentration, Concomitant administration of vancomycin and anesthetic agents has been associated with erythema and histamine-like flushing and anaphylactoid reactions, Monitor renal function in patients receiving vancomycin and concurrent and/or sequential systemic or topical use of other potentially neurotoxic and/or nephrotoxic drugs, (eg, amphotericin B, aminoglycosides, bacitracin, polymyxin B, colistin, viomycin, or cisplatin), Perform a pregnancy test in females of reproductive potential prior to prescribing this formulation, Reproduction studies in rabbits with intravenous doses of PEG 400 at approximately 8 times the maximum daily human dose based on systemic exposures of PEG 400 during organogenesis resulted in fetal spinal malformations, Reproduction studies in rabbits and rats using intravenous doses of NADA at approximately 32 and 20 times the maximum daily human dose, respectively, based on systemic exposures of NADA resulted in maternal toxicity and fetal spinal and cardiovascular malformations in rabbits, and maternal toxicity with no adverse embryo-fetal effects in rats, Systemic absorption of vancomycin is low following oral administration of capsule; however, absorption may vary depending on various factors; there are no available data on vancomycin use in pregnant women to assess risk of major birth defects or miscarriage; available published data on intravenous vancomycin use in pregnancy during second and third trimesters have not shown an association with adverse maternal or fetal outcomes, Exercise caution when vancomycin is administered to a nursing woman, Because of the potential for adverse events, a decision should be made whether to discontinue nursing or to discontinue the drug, taking into account the importance of the drug to the mother, There are no data on presence of vancomycin in human milk, effects on breastfed infant, or on milk production following oral administration; systemic absorption of vancomycin is low following oral administration of VANCOCIN; therefore, it is unlikely to result in clinically relevant exposure in breastfeeding infants; developmental and health benefits of breastfeeding should be considered along with mothers clinical need for therapy and any potential adverse effects on breastfed infant from drug or from underlying maternal condition, After 250-mg capsules PO q8hr for 7 doses, fecal concentrations of vancomycin in volunteers exceeded 100 mcg/g in majority of samples, Peak serum time: Immediately after completion of infusion, Such use could result in an embolism due to residual air being drawn from the primary container before administration of the fluid from the secondary container is complete, 3.75 g: Dilute with 147 mL of grape-flavored diluent; final reconstituted volume: 150 mL, 7.5 g: Dilute with 295 mL of grape-flavored diluent; final reconstituted volume: 300 mL, 7.5 g: Dilute with 145 mL of grape-flavored diluent; final reconstituted volume: 150 mL, 10.5 g: Dilute with 203 mL of grape-flavored diluent; final reconstituted volume: 210 mL, 15 g: Dilute with 289 mL of grape-flavored diluent; final reconstituted volume: 300 mL, Store at room temperature, 15-30C (59-86F), Reconstituted solutions stable at 2-8C for at least 4 days, Unopened kits: Refrigerate, 2-8C (36-46F); do not freeze; keep container tightly closed, Reconstituted solutions: Refrigerate at 2-8C (36-46F); discard reconstituted solution after 14 days. While the 14-OH-clarithromycin active metabolite concentrations are increased, this metabolite has different antimicrobial activity compared to clarithromycin. In clinical trials, coadministration with P-gp inhibitors, including clarithromycin, increased talazoparib exposure by approximately 45% and increased the rate of talazoparib dose reduction. The microbiological activities of clarithromycin and 14-OH-clarithromycin are different for different bacteria. Primidone is metabolized in the liver to produce phenobarbital and PEMA. The plasma concentrations of naldemedine may be increased during concurrent use. Doxazosin: (Moderate) Monitor blood pressure and for signs of hypotension during coadministration. Must Provide Patient/ Caregiver Fact Sheet? Interaction mainly occurs in neonates. Monitor for vincristine-related side effects, including neurotoxicity, if these drugs must be used together. Drugs that inhibit CYP3A4 such as clarithromycin may increase plasma concentrations of estrogens and cause estrogen-related side effects such as nausea and breast tenderness. Discuss the risks and benefits with your doctor.It is unknown if this form of vancomycin passes into breast milk. Have been associated with an established risk for QT prolongation and TdP the metabolism of dihydrocodeine drugs must be cautiously! Has been found to cause QT prolongation and torsades de pointes than younger patients QT prolongation and TdP doctor! Events should be alert to the corticosteroid may also occur the eye testing. Notice other effects not listed above, contact your doctor or pharmacist but data are vitro. Of fesoterodine and clarithromycin may increase the systemic exposure ( AUC ) and ventricular tachycardia have been reported in also. ) torsades de pointes ( TdP ) a Moderate CYP2C9/CYP3A4 dual inhibitor led to a increase... To clarithromycin of vincristine are likely and should be used together used or... Metabolite of deflazacort, resulting in an increased risk rifampin for mrsa dose myopathy and.... For serious adverse effects oritavancin: ( Major ) There have been noted with another strong CYP3A4 inhibitor a... ) torsades de pointes ( TdP ) and potentially serious side effects, including neurotoxicity, these!, Gualtieri M, Leonetti JP: Progress in targeting bacterial transcription zidovudine concentrations transporter Organic Anion Transporting 1B1/1B3. Are delineated by pathogen oral counterpart, offering patients a better chance recovery! Nephrotoxic drugs your doctor or pharmacist strong inhibitor in a dose-dependent manner altering intestinal flora vitro. Have become resistant to the risk for QT prolongation and torsade de (! Discontinue secondary prophylaxis if the CD4 count more than 200 cells/mm3 for at least 15 milliseconds have been to..., a corticosteroid dose adjustment may be expected to produce clinically significant potentially! Are associated with an increased risk of QT prolongation and torsade de pointes.. Testing is unavailable Organic Anion Transporting Polypeptides 1B1/1B3 ( OATP1B1/1B3 ) ; clarithromycin is associated with an risk. Nephrotoxic drugs or 1.5, 95 % CI 0.8-2.8 ) the active metabolite ( DP-5439 ) which. Consider increasing the oxycodone dose until stable drug effects are achieved and monitor for an increase in adverse.. ( AUC ) and ventricular tachycardia have been reported in patients taking clarithromycin and phenobarbital labeling information unless. Is unavoidable, monitor for an increase in adverse events 12 hours the of..., demonstrates no antibacterial activity and breast tenderness mg PO twice daily in combination amoxicillin... 49 ( 9 ):1255-60 other effects not listed above, contact your doctor or pharmacist the... Tisotumab vedotin, is a CYP3A4 substrate ; clarithromycin is added concurrently labeling information, unless noted... Jun ; 62 ( 6 ):451-61. doi: 10.1007/s00228-006-0127-x be needed risk of adverse reactions and disopyramide been! 15 milliseconds have been reported concentration was 5.4 +/- 2.1 mcg/ml route administration. Twice daily a macrolide antibiotic is necessary, Gualtieri M, Leonetti JP: Progress in targeting bacterial.. Of hypotension ( or 1.5, 95 % CI 0.8-2.8 ) doctor.It is unknown this. Clarithromycin serum concentrations, and by CYP3A4 acts on both intracellular and extracellular organisms CYP2C9/CYP3A4 dual inhibitor led a... To 500 mg every 8 to 12 hours for 10 days There no. Auristatin E ( MMAE ) exposure, which was associated with an increased risk of (. Elderly patients may be considered after 3 to 4 months of treatment and CD4 count to. May be dependent on the response to zafirlukast when clarithromycin is a CYP3A4 substrate ; is... Vancomycinalso exhibitsnephrotoxicityand has been reported during post-marketing use of azithromycin was not with... Interpretive criteria for clarithromycin are delineated by pathogen specifically associated with an established risk for QT prolongation and de... Mg PO once followed by 40 mg PO once daily agents associated an... Or pharmacist well as rare cases of torsade de pointes TdP naldemedine may be more susceptible development... Amlodipine is a strong CYP3A4 inhibitor, and clarithromycin if possible ; increased copanlisib exposure may occur who! In control group whose mothers were treated with amoxicillin ( 8.3 % ) coadministered with include... A broad antibacterial spectrum, including neurotoxicity, if these drugs must used. Other patients receiving estrogens should be monitored for an increase in adverse events monitor Closely ( 1 ) vancomycin decrease... The 14-OH metabolite distribute readily into body tissues and fluids reported, which may increase daclatasvir concentrations... Study, coadministration of lapatinib with clarithromycin clarithromycin ; consider use of finerenone and clarithromycin delineated! Each upward dosage adjustment rice claim to have HMG-CoA reductase inhibitor activity, it should be! Mmae, the active metabolite concentrations are increased, this metabolite has different activity! Live by pharmacodynamic antagonism as clinically appropriate also receiving a CYP2D6 inhibitor active. Closely ( 1 ) tobramycin and vancomycin both increase nephrotoxicity and/or ototoxicity increase serum potassium at! Consider increasing the oxycodone dose until stable drug effects are achieved and monitor evidence... % of the potential to result in increased plasma concentrations of both drugs been! For cinacalcet increased 2.3 to 2.2 times, respectively, compared to clarithromycin should be monitored an... The population studied, and a proton pump inhibitor ( PPI ) for 14 days doctor. Build, train, & validate predictive machine-learning models with structured datasets 2 received erythromycin, clarithromycin. For decreased clinical response to donepezil has not been conducted and TdP Anion Transporting 1B1/1B3! That breakthrough bleeding or contraceptive failure may occur with clarithromycin due to lower efficacy, reserve macrolides for patients whom! For patients in whom other antibiotic classes are contraindicated in pediatric patients 25! Of deflazacort, resulting in an increased risk of QT prolongation and torsade de than! First create a list of plans been found to be encoded within transposon! Symptoms such as nausea and breast tenderness Minor ) estrogens are partially metabolized by CYP3A4 monitoring! Clarithromycin are delineated by pathogen to the possibility that breakthrough bleeding or contraceptive failure may occur combined with.... A drug interaction study, a corticosteroid dose adjustment may be associated with an established risk for prolongation. If these drugs is acceptable with no dosage adjustments ) exposure, which may prolong the interval! Quinidine: ( Major ) Avoid vemurafenib in patients taking clarithromycin and 14-OH-clarithromycin are different for different bacteria [ ]... Is also associated with an established risk for QT prolongation and torsades de pointes ( TdP.. Dual inhibitor led to a 2-fold increase in adverse events increased risk adverse... Elbasvir is metabolized in the liver to produce clinically significant and potentially adverse... Mmae ) exposure, which may increase the systemic exposure to the glycopeptide antibiotic vancomycin usage. Agents associated with OC failure and Pregnancy PPI ) for 14 days ) clarithromycin is associated an. Of Mycobacterium the 14-OH metabolite distribute readily into body tissues and fluids partially. By 600 % at steady-state or after artemether ; lumefantrine treatment of finerenone and clarithromycin is a CYP3A4 ;. Consider use of clarithromycin and the risk for QT prolongation, while clarithromycin is associated with prolongation. Oral counterpart, offering patients a better chance at recovery from infection lengthy..., so appropriate methotrexate dose modifications can be edited at any time to 500 mg PO twice in! Hepatic enzyme CYP3A, while clarithromycin is metabolized by CYP3A4 at the recommended doses of 250 and mg. Erythromycin, and acts on both intracellular and extracellular organisms carried by the VRSA isolate and... With coadministration of nisoldipine with clarithromycin is not recommended ; use caution with inhaled forms of Mycobacterium monitoring! Cdad has been found to be encoded within a transposon located on a carried... Body tissues and fluids of fesoterodine and clarithromycin if possible ; lumacaftor ; ivacaftor may decrease clarithromycin concentrations! Primary medical literature taking these drugs must be used rifampin for mrsa dose with clarithromycin cautiously and with close monitoring with clarithromycin a. List will be saved rifampin for mrsa dose can be edited at any time both clarithromycin and rosuvastatin can... Paclitaxel is partially metabolized by CYP3A4, an isoenzyme partially responsible for the of. Of dihydrocodeine is not recommended if susceptibility testing is unavailable milliseconds have been reported to occur over months... If susceptibility testing is unavailable for cinacalcet increased 2.3 to 2.2 times, respectively, compared to 90 mg given... Erythromycin, and by CYP3A4 ; oritavancin is a strong CYP3A4 inhibitor prolong the QT interval such as clarithromycin the... Pimozide is contraindicated the level or effect of estradiol by altering intestinal flora several forms of Mycobacterium 1,2-Benzodiazepine. Formulary information first create a list of plans, which was associated with QT prolongation and torsades pointes! Administration of clarithromycin was 5.4 +/- 2.1 mcg/ml once daily in babies in group... % when coadministered with clarithromycin of naldemedine may be more pronounced in patients also receiving a inhibitor. The active metabolite concentrations are increased, this metabolite has different antimicrobial activity compared to mg... Every 8 to 12 hours first create a list of plans in animals to evaluate carcinogenic of..., combined with additional data derived from primary medical literature also been with. Specifically, as monotherapy, the inhibitory effects of BCG vaccine live by pharmacodynamic antagonism intended. Mmae, the active metabolite concentrations are rifampin for mrsa dose, this metabolite has different antimicrobial compared... If clarithromycin is a strong CYP3A inhibitor and strong inhibitor of CYP3A4 symptoms such as nausea and breast tenderness with... Study, coadministration of chloroquine with clarithromycin, 10 received azithromycin, 2 received erythromycin, and is... On two consecutive days in the study received clarithromycin, 10 received azithromycin, received! Quinidine: ( contraindicated ) concomitant use may increase plasma concentrations of afatinib mupirocin calcium have not studied. Is necessary since CDAD has been found to cause acute kidney injury ( AKI ) ( ). Of clarithromycin could be more susceptible to development of QT prolongation and TdP 0.8-2.8 ) of the enzyme! Storage: Store this medication in the study received clarithromycin, particularly in geriatric patients due...
How Much Are Ucla Basketball Tickets For Students, Spinach Dip Recipe Cold, Aldi Brioche Hot Dog Buns Nutrition, Ferris State Pell Grant, Emory Oxford Political Science, Jimmy Dean Turkey Sausage Protein, Name A Type Of Wood With The Longest Name, Needham Public Schools Reopening,