Clarithromycin with Amiodarone Interaction Details

Brand Names Associated with Clarithromycin

  • Biaxin® Filmtab®
  • Biaxin® Granules
  • Biaxin® XL Filmtab
  • Biaxin® XL Pac
  • Clarithromycin

Brand Names Associated with Amiodarone

  • Amiodarone
  • Cordarone®
  • Pacerone®

Medical Content Editor
Last updated Feb 27, 2024

Curious for more information about this interaction?

Ask our pharmacists directly!

Reach out to us

Interaction Effect

Increased amiodarone exposure, increased risk of QT interval prolongation and torsade de pointes

Interaction Summary

Prolongation of the QT interval and torsade de pointes (including fatalities) have been reported following administration of clarithromycin. Concomitant therapy with clarithromycin and amiodarone (QT prolonging class III antiarrhythmic agents and a CYP3A4 substrate) should be avoided due to the increased risk of amiodarone exposure resulting in serious cardiac adverse events including QT prolongation and torsade de pointes. Elderly patients may be more susceptible to medication-related changes in the QT interval[1]. Due to the long half-life of amiodarone, this interaction is possible even after the discontinuation of amiodarone [2].

Severity

Major

Onset

Unspecified

Evidence

Theoretical

How To Manage Interaction

Concomitant therapy with clarithromycin and amiodarone (QT prolonging class III antiarrhythmic agents and a CYP3A4 substrate) should be avoided due to the increased risk of amiodarone exposure resulting in serious cardiac adverse events including QT prolongation and torsade de pointes. Elderly patients may be more susceptible to medication-related changes in the QT interval[1]. Due to the long half-life of amiodarone, this interaction is possible even after the discontinuation of amiodarone [2].

Mechanism Of Interaction

Inhibition of CYP3A4-substrate metabolism by clarithromycin; additive QT interval prolongation

Literature Reports

A) Concurrent use of class III antiarrhythmic agents, and other drugs that can prolong the QT interval, such as clarithromycin, is not recommended. Dofetilide should be stopped for at least 2 days before any interacting drug is initiated. If concurrent use cannot be avoided, cautious dosing and telemetric monitoring is advised [3].

References

    1 ) Product Information: VOQUEZNA(TM) TRIPLE PAK(TM) oral kit, vonoprazan oral tablets, amoxicillin oral capsules, clarithromycin oral tablets kit. Phathom Pharmaceuticals (per FDA), Buffalo Grove, IL, 2023.

    2 ) Product Information: Cordarone(R) oral tablets, amiodarone HCl oral tablets. Wyeth Pharmaceuticals Inc (per FDA), Philadelphia, PA, 2016.

    3 ) Yamreudeewong W, DeBisschop M, Martin LG, et al: Potentially significant drug interactions of class III antiarrhythmic drugs. Drug Safety 2003; 26(6):421-438.

Clarithromycin Overview

  • Clarithromycin is used to treat certain bacterial infections, such as pneumonia (a lung infection), bronchitis (infection of the tubes leading to the lungs), and infections of the ears, sinuses, skin, and throat. It also is used to treat and prevent disseminated Mycobacterium avium complex (MAC) infection [a type of lung infection that often affects people with human immunodeficiency virus (HIV)]. It is used in combination with other medications to eliminate H. pylori, a bacterium that causes ulcers. Clarithromycin is in a class of medications called macrolide antibiotics. It works by stopping the growth of bacteria.

  • Antibiotics such as clarithromycin will not work for colds, flu, or other viral infections. Taking antibiotics when they are not needed increases your risk of getting an infection later that resists antibiotic treatment.

See More information Regarding Clarithromycin

Amiodarone Overview

  • Amiodarone is used to treat and prevent certain types of serious, life-threatening ventricular arrhythmias (a certain type of abnormal heart rhythm when other medications did not help or could not be tolerated. Amiodarone is in a class of medications called antiarrhythmics. It works by relaxing overactive heart muscles.

See More information Regarding Amiodarone

Return To Our Drug Interaction Homepage

Feedback, Question Or Comment About This Information?

Ask , our medical editor, directly! He's always more than happy to assist.

Definitions

Severity Categories

Contraindicated

These drugs, generally, should not be used together simultaneously due to the high risk of severe adverse effects. Combining these medications can lead to dangerous health outcomes and should be strictly avoided unless otherwise instructed by your provider.


Major

This interaction could result in very serious and potentially life-threatening consequences. If you are taking this drug combination, it is very important to be under close medical supervision to minimize severe side effects and ensure your safety. It may be necessary to change a medication or dosage to prevent harm.


Moderate

This interaction has the potential to worsen your medical condition or alter the effectiveness of your treatment. It's important that you are monitored closely and you potentially may need to make adjustments in your treatment plan or drug dosage to maintain optimal health.


Minor

While this interaction is unlikely to cause significant problems, it could intensify side effects or reduce the effectiveness of one or both medications. Monitoring for changes in symptoms and your condition is recommended, and adjustments may be made if needed to manage any increased or more pronounced side effects.

Onset

Rapid: Onset of drug interaction typically occurs within 24 hours of co-administration.

Delayed: Onset of drug interaction typically occurs more than 24 hours after co-administration.

Evidence

Level of documentation of the interaction.

Established: The interaction is documented and substantiated in peer-reviewed medical literature.

Theoretical: This interaction is not fully supported by current medical evidence or well-documented sources, but it is based on known drug mechanisms, drug effects, and other relevant information.

How To Manage The Interaction

Provides a detailed discussion on how patients and clinicians can approach the identified drug interaction as well as offers guidance on what to expect and strategies to potentially mitigate the effects of the interaction. This may include recommendations on adjusting medication dosages, altering the timing of drug administration, or closely monitoring for specific symptoms.

It's important to note that all medical situations are unique, and management approaches should be tailored to individual circumstances. Patients should always consult their healthcare provider for personalized advice and guidance on managing drug interactions effectively.

Mechanism Of Interaction

The theorized or clinically determined reason (i.e., mechanism) why the drug-drug interaction occurs.

Disclaimer: The information provided on this page is for informational purposes only and should not be considered medical advice. Always consult with a qualified healthcare professional regarding your specific circumstances and medical conditions.

Where Does Our Information Come From?

Information for our drug interactions is compiled from several drug compendia, including:

The prescribing information for each drug, as published on DailyMED, is also used. 

Individual drug-drug interaction detail pages contain references specific to that interaction. You can click on the reference number within brackets '[]' to see what reference was utilized.

The information posted is fact-checked by HelloPharmacist clinicians and reviewed quarterly.