Clariget/Clariget OD

Clariget/Clariget OD Drug Interactions

clarithromycin

Manufacturer:

Getz Pharma

Distributor:

Getz Bros
Full Prescribing Info
Drug Interactions
Clariget: Data available to date indicate that clarithromycin is metabolized primarily by the hepatic cytochrome P-450 3A (CYP3A) isozyme. This is an important mechanism determining many drug interactions.
The metabolism of other drugs by this system may be inhibited by concomitant administration with clarithromycin and may be associated with elevations in serum levels of drug classes known or suspected to be metabolized by the same CYP450 and CYP3A isozyme.
Other Drug Interactions: Elevated digoxin serum concentrations have been reported in patients receiving clarithromycin tablets and digoxin concomitantly. Monitoring of serum digoxin levels should be considered.
There have been post-marketing reports of Torsades de pointes occurring with concurrent use of clarithromycin and quinidine or disopyramide. Serum levels of these medications should be monitored during clarithromycin therapy.
Rhabdomyolysis coincident with the co-administration of clarithromycin and the HMG-CoA reductase inhibitors eg, lovastatin and simvastatin has rarely been reported.
Antiretroviral Drug Interactions: Simultaneous oral administration of clarithromycin tablets and zidovudine to HIV-infected adult patients may result in decreased steady-state zidovudine concentrations. Because clarithromycin appears to interfere with the absorption of simultaneously administered oral zidovudine, this interaction can be largely avoided by staggering the doses of clarithromycin and zidovudine. This interaction does not appear to occur in pediatric HIV-infected patients taking clarithromycin suspension with zidovudine or dideoxyinosine.
A pharmacokinetic study demonstrated that the concomitant administration of ritonavir 200 mg every 8 hrs and clarithromycin 500 mg every 12 hrs resulted in a marked inhibition of the metabolism of clarithromycin.
For patients with renal impairment, the following dosage adjustments should be considered: For patients with CrCl 30-60 mL/min, the dose of clarithromycin should be reduced by 50%. For patients with CrCl <30 mL, the dose of clarithromycin should be decreased by 75%. Doses of clarithromycin >1 g/day should not be co-administered with ritonavir.
Clariget OD: As with other macrolide antibiotics, the use of clarithromycin in patients concurrently taking drugs metabolized by the cytochrome P-450 system (eg, cilostazol, methylprednisolone, anticoagulants eg, warfarin, quinidine, sildenafil, ergot alkaloids, alprazolam, triazolam, midazolam, disopyramide, lovastatin, rifabutin, phenytoin, cyclosporin, vinblastine, valproate and tacrolimus) may be associated with elevations in serum levels of these other drugs.
Digoxin: Elevated digoxin serum concentrations have been reported in patients receiving clarithromycin tablets and digoxin concomitantly. Monitoring of serum digoxin levels should be considered.
Quinidine/Disopyramide: There have been post-marketed reports of Torsades de pointes occurring with concurrent use of clarithromycin and quinidine or disopyramide. Electrocardiogram and serum levels of these medications should be monitored during clarithromycin therapy.
HMG-CoA Reductase Inhibitors: As with other macrolides, clarithromycin has been reported to increase concentrations of HMG-CoA reductase inhibitors (eg, statins). Rhabdomyolysis has also been reported in patients taking these drugs concomitantly.
Theophylline, Carbamazepine: The administration of clarithromycin to patients receiving theophylline or carbamazepine has been associated with an increase in serum theophylline or carbamazepine levels.
Oral Anticoagulants: Concomitant administration of clarithromycin and oral anticoagulants may potentiate the effects of oral anticoagulants. Prothrombin time should be carefully monitored while patients are receiving clarithromycin and oral anticoagulants simultaneously.
Ritonavir: Ritonavir increases AUC, Cmax and Cmin of clarithromycin when administered concurrently. Because of the large therapeutic window for clarithromycin, no dosage reduction should be necessary in patients with normal renal function. However, for patients with renal impairment, the following dosage adjustments should be considered: For patients with CrCl 30-60 mL/min, the dose of clarithromycin should be reduced by 50%. For patients with CrCl <30 mL/min, the dose of clarithromycin should be decreased by 75%. Doses of clarithromycin >1 g/day should not be co-administered with ritonavir.
Efavirenz, Nevirapine, Rifampicin and Rifabutin: Strong inducers of the cytochrome P-450 metabolism system eg, efavirenz, nevirapine, rifampicin and rifabutin may accelerate the metabolism of clarithromycin and thus, lower the plasma levels of clarithromycin. Since the microbiological activities of clarithromycin and 14-OH-clarithromycin are different for different bacteria, the intended therapeutic effect could be impaired during concomitant administration of clarithromycin and enzyme inducers.
Sildenafil, Tadalafil and Vardenafil: Each of these phosphodiesterase inhibitors is metabolized, at least in part, by CYP3A, and CYP3A may be inhibited by concomitantly administered clarithromycin. Reduction in sildenafil, tadalafil and vardenafil dosages should be considered when these drugs are co-administered with clarithromycin.
Triazolam: Drug interactions and CNS effects (eg, somnolence and confusion) with the concomitant use of clarithromycin and triazolam have been reported. Monitoring the patient for increased CNS pharmacological effects is suggested.
Colchicine: When clarithromycin and colchicine are administered together, inhibition of Pgp and/or CYP3A by clarithromycin may lead to increased exposure to colchicine. Patients should be monitored for clinical symptoms of colchicine toxicity.
Itraconazole: Both clarithromycin and itraconazole are substrates and inhibitors of CYP3A. Clarithromycin may increase the plasma levels of itraconazole, while itraconazole may increase the plasma levels of clarithromycin. Patients taking itraconazole and clarithromycin concomitantly should be monitored closely for signs and symptoms of increased or prolonged pharmacological effect.
Zidovudine: Simultaneous oral administration of clarithromycin tablets and zidovudine to HIV-infected adult patients may result in decreased steady-state zidovudine concentrations. This interaction does not appear to occur in pediatric HIV-infected patients taking clarithromycin suspension with zidovudine or dideoxyinosine.
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