Macrolides(continued)
▶Clarithromycinis predicted to moderately increase the
exposure tocilostazol. Adjustcilostazoldose.oStudy
▶Erythromycinslightly increases the exposure tocilostazol.
Adjustcilostazoldose.oStudy
▶Clarithromycinis predicted to moderately increase the
exposure tocinacalcet. Adjust dose.oStudy
▶Erythromycinpotentially increases the risk of toxicity when
given withclozapine.rAnecdotal
▶Clarithromycinis predicted to markedly increase the exposure
tocobimetinib. Avoid or monitor for toxicity.rStudy
▶Erythromycinis predicted to increase the exposure to
cobimetinib.rTheoretical
▶Azithromycinis predicted to increase the exposure to
colchicine. Avoid or adjustcolchicinedose.rTheoretical
▶Clarithromycinis predicted to increase the exposure to
colchicine. Avoid potent inhibitors of CYP3A4 or adjust
colchicinedose.rStudy
▶Erythromycinis predicted to increase the exposure to
colchicine. Adjustcolchicinedose with moderate inhibitors of
CYP3A4.rStudy
▶Clarithromycinis predicted to increase the exposure to
corticosteroids(beclometasone)(risk with beclometasone is
likely to be lower than with other corticosteroids).o
Theoretical
▶Clarithromycinis predicted to increase the exposure to
corticosteroids(betamethasone, budesonide, ciclesonide,
deflazacort, dexamethasone, fludrocortisone, fluticasone,
hydrocortisone, methylprednisolone, mometasone,
prednisolone, prednisone, triamcinolone). Avoid or monitor
side effects.rStudy
▶Erythromycinis predicted to increase the exposure to
corticosteroids(methylprednisolone). Monitor and adjust dose.
oStudy
▶Macrolides(clarithromycin, erythromycin)increase the
anticoagulant effect ofcoumarins. Monitor INR and adjust
dose.rAnecdotal
▶Clarithromycinis predicted to moderately increase the
exposure tocrizotinib. Avoid.oStudy→Also seeTABLE 9
p. 849
▶Macrolidesare predicted to increase the exposure to
dabigatran.oTheoretical
▶Clarithromycinis predicted to increase the exposure to
dabrafenib. Use with caution or avoid.oStudy
▶Clarithromycinis predicted to moderately increase the
exposure todaclatasvir. Adjustdaclatasvirdose.o
Study
▶Clarithromycinis predicted to markedly to very markedly
increase the exposure todarifenacin. Avoid.rStudy
▶Erythromycinis predicted to slightly increase the exposure to
darifenacin.oStudy
▶Clarithromycinis predicted to markedly increase the exposure
todasatinib. Avoid.rStudy→Also seeTABLE 9p. 849
▶Erythromycinis predicted to increase the exposure to
dasatinib.rStudy→Also seeTABLE 9p. 849
▶Clarithromycinvery slightly increases the exposure to
delamanid.rStudy→Also seeTABLE 9p. 849
▶Macrolidesincrease the concentration ofdigoxin.r
Anecdotal
▶Macrolides(clarithromycin, erythromycin)increase the risk of
QT-prolongation when given withdomperidone. Avoid.r
Study
▶Clarithromycinincreases the exposure todopamine receptor
agonists(bromocriptine).rStudy
▶Erythromycinis predicted to increase the exposure to
dopamine receptor agonists(bromocriptine).rTheoretical
▶Macrolides(clarithromycin, erythromycin)are predicted to
increase the concentration ofdopamine receptor agonists
(cabergoline). Avoid.rStudy
▶Clarithromycinis predicted to increase the exposure to
dutasteride. Monitor side effects and adjust dose.o
Theoretical
▶Erythromycinis predicted to moderately increase the exposure
todutasteride.nStudy▶Erythromycinslightly increases the exposure toedoxaban.
Adjustedoxabandose.rStudy
▶Macrolides(azithromycin, clarithromycin)are predicted to
slightly increase the exposure toedoxaban.rTheoretical
▶Efavirenzdecreases the exposure toclarithromycin.o
Study→Also seeTABLE 9p. 849
▶Clarithromycinslightly to moderately increases the exposure
toelbasvir. Avoid.oStudy
▶Clarithromycinis predicted to markedly increase the exposure
toeletriptan. Avoid.rStudy
▶Erythromycinmoderately increases the exposure toeletriptan.
Avoid.oStudy
▶Macrolides(clarithromycin, erythromycin)are predicted to
increase the exposure toeliglustat. Avoid or adjust dose—
consult product literature.rStudy
▶Clarithromycinis predicted to increase the risk of ergotism
when given withergometrine. Avoid.rTheoretical
▶Erythromycinis predicted to increase the risk of ergotism
when given withergometrine.rTheoretical
▶Clarithromycinis predicted to increase the risk of ergotism
when given withergotamine. Avoid.rTheoretical
▶Erythromycinis predicted to increase the risk of ergotism
when given withergotamine.rTheoretical
▶Clarithromycinis predicted to slightly increase the exposure to
erlotinib. Use with caution and adjust dose.oStudy
▶Macrolides(azithromycin, erythromycin)are predicted to
increase the exposure toerlotinib.oTheoretical
▶Etravirinedecreases the exposure toclarithromycin.r
Study
▶Clarithromycinis predicted to increase the concentration of
everolimus. Avoid.rStudy
▶Erythromycinis predicted to increase the concentration of
everolimus. Avoid or adjust dose.oStudy
▶Clarithromycinis predicted to moderately increase the
exposure tofesoterodine. Adjustfesoterodinedose with potent
inhibitors of CYP3A4; avoid in hepatic and renal impairment.
rStudy
▶Erythromycinis predicted to increase the exposure to
fesoterodine. Adjustfesoterodinedose with moderate
inhibitors of CYP3A4 in hepatic and renal impairment.n
Study
▶Macrolidesare predicted to increase the exposure to
fidaxomicin. Avoid.oStudy
▶Clarithromycinis predicted to increase the exposure to
fosaprepitant.oTheoretical
▶Clarithromycinis predicted to increase the exposure to
gefitinib.oStudy
▶Erythromycinis predicted to increase the exposure togefitinib.
oTheoretical
▶Clarithromycinis predicted to moderately to markedly increase
the exposure tograzoprevir. Avoid.rStudy
▶Clarithromycinis predicted to increase the exposure to
guanfacine. Adjustguanfacinedose,p. 231.oStudy
▶Erythromycinis predicted to increase the concentration of
guanfacine. Adjustguanfacinedose,p. 231.oTheoretical
▶H 2 receptor antagonists(cimetidine)slightly increase the
exposure toerythromycin.oStudy
▶HIV-protease inhibitors(atazanavir)are predicted to increase the
exposure toclarithromycin. Adjust dose in renal impairment.
rStudy
▶HIV-protease inhibitors(atazanavir, darunavir, fosamprenavir,
lopinavir, ritonavir, tipranavir)are predicted to increase the
exposure toerythromycin.rTheoretical
▶HIV-protease inhibitors(darunavir, fosamprenavir, lopinavir)
(boosted with ritonavir) are predicted to increase the
exposure toclarithromycin. Adjust dose in renal impairment.
rStudy
▶HIV-protease inhibitors(ritonavir)increase the exposure to
clarithromycin. Adjust dose in renal impairment.rStudy
▶HIV-protease inhibitors(tipranavir)(boosted with ritonavir)
increase the exposure toclarithromycinandclarithromycin
increases the exposure toHIV-protease inhibitors(tipranavir)
(boosted with ritonavir). Monitor; adjust dose in renal
impairment.rStudy948 Macrolides—Macrolides BNFC 2018 – 2019
Interactions|Appendix 1A1