Clarithromycin

MEDICATION TYPE

Antibiotic

INDICATIONS

Treatment of community acquired upper and lower respiratory tract infections. Used in low dose in CF and non CF bronchiectasis for anti-inflammatory property. Haemophilus, MSSA, M. abscessus, M. avium infections.

DRUG INTERACTIONS

Interacts with some drugs metabolised by CYP450 isoenzyme system – may increase plasma concentrations of drugs such as: Theophylline, Ciclosporin, tacrolimus, Simvastatin, Warfarin. Contact pharmacist for further advice.

Carbamazepine
Increased plasma carbamazepine concentration.

Ciclosporin
Increases Ciclosporin level.

Cisapride
Inhibit metabolism of Cisapride, and increases risk of Arrythmias – avoid.

Digoxin
Increases plasma digoxin concentration.

Disopyramide
Increased plasma Disopyramide concentration.

Itraconazole
Increases plasma Itraconazole concentration.

Midazolam
Increased plasma Midazolam concentration (increased sedation).

Phenytoin
Increases plasma phenytoin concentration.

Pimozide
Increased risk of Arrythmia- avoid.

Rifabutin 
Increases plasma Rifabutin level(increased risk of uveitis- reduce Rifabutin dose).

Tacrolimus
Increases Tacrolimus level.

Terfenadine
Increases risk of Arrythmias – avoid.

Theophylline
Increases theophylline level.

Warfarin
Increase INR.

Zafirlukast 
Reduced plasma concentrations of Zafirlukast

NOTES

Multiple CYP3A4 interactions (statins, tacrolimus).