Interactions with clarithromycin

What are the interactions with clarythromycin?

Tell your doctor about all the medicines you are taking.

Clarithromycin can interact with many different medicines so it is very important that you tell your health professional about all the medicines you are taking — including prescription, over-the-counter and complementary medicines (herbal, ‘natural’, and vitamin and mineral supplements). This is because all medicines, including herbal and natural medicines, can cause side effects and may interact with clarithromycin.

Do not take clarithromycin if you are taking medicines containing any of the active ingredients below.

  • Atorvastatin and simvastatin (used to treat high cholesterol): clarithromycin may increase the concentration of atorvastatin or simvastatin in your blood. You may need to stop taking atorvastatin or simvastatin for a while, or change to another medicine.
  • Cisapride (used to treat stomach acid reflux). This medicine is not available in Australia, but clarithromycin and cisapride should not be taken together. This is because both clarithromycin and cisapride can affect your heart rate. Clarithromycin increases the amount of cisapride in the blood, increasing the risk of the effect on your heart rate.
  • Colchicine (used to prevent and treat gout): clarithromycin may increase the amount of colchicine in the blood. This increases the toxicity of colchicine (which can be fatal). These two medicines should not be taken together if possible.
  • Cyclosporin and tacrolimus (used to suppress the immune system, e.g. to prevent transplant rejection): clarithromycin increases the amount of these medicines in the blood, and increases the chance of kidney and nervous system side effects. Clarithromycin should not be taken with either of these two medicines if possible.
  • Digoxin (used to treat irregular heart beat): clarithromycin increases the amount of digoxin in your blood, which can be toxic. You may need to take a different type of antibiotic.
  • Docetaxel and paclitaxel (used to treat cancer): clarithromycin can increase the toxicity of paclitaxel. Clarithromycin should not be taken with either of these two medicines as the interaction can cause permanent damage or even be life-threatening.
  • Ergot alkaloids (e.g. ergotamine, used to treat migraines): clarithromycin increases the amount of these medicines in your blood, which can be toxic. Clarithromycin should not be taken with an ergot alkaloid.
  • Linezolid (an antibiotic used to treat severe infections by specific types of bacteria when other antibiotics have failed): clarithromycin may increase the amount of linezolid in the blood and may increase the risk of toxicity. You may need another antibiotic or a lower dose of linezolid.
  • Rifabutin and rifampicin (antibiotics used to treat bacterial infections): rifabutin increases the breakdown of clarithromycin in the body and reduces the amount in the blood, which may affect its ability to treat infection. Clarithromycin itself may increase the amount of rifabutin in your blood, increasing the risk of side effects.
  • Salmeterol (used to treat asthma): clarithromycin increases the amount of salmeterol in the blood, and increases the chance of side effects. These medicines should not be taken together.
  • Triazolam and midazolam (triazolam is a benzodiazepine used to treat sleeplessness [insomnia]; midazolam is used as a sedative during short medical procedures) Clarithromycin may increase the concentration of triazolam or midozalam in the blood and increase its sedative and other side effects. Clarithromycin should not be taken with either of these two medicines if possible.
  • Vinorelbine (used to treat breast cancer and non-small cell lung cancer): clarithromycin can increase the concentration of vinorelbine in the blood, increasing the risk of side effects of vinorelbine. You may need to take a different type of antibiotic.

Tell your health professional if you are taking any medicines containing the following active ingredients, as they may need to adjust your dose of these medicines.

  • Cabergoline (used to treat Parkinson’s disease): clarithromycin may increase the amount of cabergoline in the blood. This may increase the effect of the medicines and increase the chance of side effects. You may need to take a lower dose of cabergoline.
  • Carbamazepine (used to treat epilepsy and bipolar disorder): clarithromycin may increase the amount of carbamazepine in the blood, and this can increase the chance of side effects. If you take both of these medicines you may need a lower dose of carbamazepine.
  • Oxcarbazepine (used to treat epilepsy): clarithromycin may increase the amount of oxcarbazepine in the blood, which can be toxic. If you need to take clarithromycin, you may need a lower dose of oxcarbazepine.
  • Repaglinide (used to treat type 2 diabetes; please note that repaglindide is no longer available in Australia): clarithromycin may increase the amount of repaglinide in your blood, which increases the risk of low blood glucose levels (hypoglycaemia). Your doctor will need to monitor your blood glucose levels and you may need a lower dose of repaglinide.
  • Sildenafil and vardenafil (used to treat erectile dysfunction): clarithromycin may increase the concentration of these medicines, increasing the risk of side effects. You may need a lower dose of sildenafil or vardenafil
  • Warfarin (used to treat and prevent blood clots): clarithtomycin can increase the blood-thinning effect of warfarin and increase the risk of bleeding. Your dose of warfarin may need to be adjusted and you may need to have additional INR tests and be monitored for signs of bleeding.

Medicinewise tip

To check if your medicine contains this active ingredient, look on the packaging of your medicine for the active ingredient name, or use our Medicines Finder.

Can I drink alcohol if I am taking clarithromycin?

Drinking alcohol in moderation is unlikely to interact with clarithromycin or cause additional side effects.

Find out more about drinking alcohol when you are taking antibiotics.

Will clarithromycin affect my contraceptive?

Clarithromycin won’t affect your hormone contraceptive.

Rifampicin and rifabutin are the only types of antibiotic that are known to interact with some forms of hormone contraceptives, such as the combined contraceptive pill, making it less effective.

Find out more about antibiotics and contraception.

Phone for medicines information

Call NPS Medicines Line on 1300 MEDICINE (1300 633 424) to get information about your prescription, over-the-counter and complementary medicines (herbal, ‘natural’, vitamins and mineral supplements) from a pharmacist. Your call will be answered by healthdirect Australia.

References
  • Rossi S, ed. Australian Medicines Handbook [online]. Adelaide: AMH, July 2012.
  • Sweetman S, ed. Martindale: The complete drug reference [online]. London: Pharmaceutical Press (accessed 18 October 2011).
  • Antibiotic Expert Group. Therapeutic Guidelines: Antibiotic version 14; Clarithromycin. Melbourne: Therapeutic Guidelines Limited, 2012 (accessed 27 March 2012).