Clarithromycin with Aripiprazole Interaction Details

Brand Names Associated with Clarithromycin

Brand Names Associated with Aripiprazole

Medical Content Editor Dr. Brian Staiger, PharmD
Last updated Nov 08, 2023

Interaction Effect

Increased ARIPiprazole exposure and an increased risk of QT interval prolongation

Interaction Summary

Coadministration with CYP3A4 inhibitors that also prolong the QT interval may produce additive effects on the QT interval that can lead to serious cardiac adverse effects, including torsade de pointes. Reduce the dosage of ARIPiprazole when used concomitantly with strong CYP3A4 inhibitors. In patients taking concomitant ARIPiprazole with strong CYP3A4 inhibitors for more than 14 days, reduce the dosage of ARIPiprazole . Avoid use of ARIPiprazole two-month injection when administered concomitantly with a strong CYP3A4 inhibitor for more than 14 days . No dosage adjustment is recommended in patients taking strong CYP3A4 inhibitors for less than 14 days. Once therapy with strong CYP3A4 inhibitor is discontinued, the dose of ARIPiprazole should then be increased .

Severity

Major

Onset

Unspecified

Evidence

Probable

How To Manage Interaction

Reduce the immediate-release ARIPiprazole dose to one-half of its usual dose in patients receiving CYP3A4 inhibitors and to one-quarter in patients receiving both CYP3A4 and CYP2D6 inhibitors or in CYP2D6 poor metabolizers receiving strong CYP3A4 inhibitors. If inhibitor use exceeds 14 days, reduce ARIPiprazole 400 mg IM dose to 300 mg, 300 mg IM to 200 mg with concomitant use of CYP3A4 inhibitors; reduce 400 mg IM to 200 mg, 300 mg IM to 160 mg with concomitant use of both CYP3A4 and CYP2D6 inhibitors. For CYP2D6 poor metabolizers receiving a CYP3A4 inhibitor, reduce dosage to 200 mg IM. No dosage adjustment is recommended in patients receiving inhibitor for less than 14 days. Once therapy with the inhibitor is discontinued, the dose of ARIPiprazole should be increased . Avoid use of ARIPiprazole, extended-release two-month injection in patients taking both strong CYP3A4 and CYP2D6 inhibitors for more than 14 days and in CYP2D6 poor metabolizers taking CYP3A4 inhibitors. In patients taking only strong CYP3A4 inhibitors, 720 mg once every 2 months dose is recommended. No dosage adjustment is recommended in patients with strong CYP3A4 inhibitors for less than 14 days .

Mechanism Of Interaction

Inhibition of CYP3A4-mediated metabolism of ARIPiprazole; additive QT interval prolongation

Literature Reports

A) During drug interaction studies, coadministration of ketoconazole 200 mg/day for 14 days with single dose ARIPiprazole 15 mg resulted in a 63% and 77% increase in the AUC of ARIPiprazole and its active metabolite, respectively. Studies have not yet been conducted with higher ketoconazole doses (e.g., 400 mg/day) .

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.

Aripiprazole Overview

• Aripiprazole is used to treat the symptoms of schizophrenia (a mental illness that causes disturbed or unusual thinking, loss of interest in life, and strong or inappropriate emotions) in adults and teenagers 13 years of age and older. It is also used alone or with other medications to treat episodes of mania or mixed episodes (symptoms of mania and depression that happen together) in adults, teenagers, and children 10 years of age and older with bipolar disorder (manic-depressive disorder; a disease that causes episodes of depression, episodes of mania, and other abnormal moods). Aripiprazole is also used with an antidepressant to treat depression when symptoms cannot be controlled by the antidepressant alone. Aripiprazole is also used to treat children 6 to 17 years of age who have autistic disorder (a developmental problem that causes difficulty communicating and interacting with others). Aripiprazole may help control irritable behavior such as aggression, temper tantrums, and frequent mood changes in these children. Aripiprazole is also used to treat children 6 to 18 years of age who have Tourette's disorder (a condition characterized by the need to perform repeated motions or to repeat sounds or words). Aripiprazole is in a class of medications called atypical antipsychotics. It works by changing the activity of certain natural substances in the brain.

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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:

• Gold Standard Drug Database
• Micromedex
• Lexicomp
• DrugBank

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.