Clarithromycin with Bedaquiline Interaction Details
Brand Names Associated with Clarithromycin
- Biaxin® Filmtab®
- Biaxin® Granules
- Biaxin® XL Filmtab
- Biaxin® XL Pac
- Clarithromycin
Brand Names Associated with Bedaquiline
- Bedaquiline
- Sirturo®
Medical Content Editor Dr. Brian Staiger, PharmD
Last updated
Nov 08, 2023
Interaction Effect
Increased risk of QT-interval prolongation; increased bedaquiline exposure
Interaction Summary
Use caution with coadministration of bedaquiline and CYP3A4 inhibitors, such as clarithromycin, because of risk of additive prolongation effects on the QT interval and increased bedaquiline exposure and risk for toxicity. Closely monitor ECGs during coadministration. Avoid prolonged coadministration (ie, more than 14 days) of bedaquiline and strong CYP3A4 inhibitors, unless benefits outweigh the risk. Consider dose adjustments, when possible, and closely monitor clinical effects and serum concentrations of the CYP3A substrate (eg, bedaquiline) . Discontinue bedaquiline and concomitantly administered QT-prolonging drugs if clinically significant ventricular arrhythmia or repeated Fridericia-corrected QT intervals greater than 500 msec occur .
Severity
Major
Onset
Unspecified
Evidence
Theoretical
How To Manage Interaction
Use caution with coadministration of bedaquiline and CYP3A4 inhibitors, such as clarithromycin, because of additive prolongation effects on the QT interval and increased bedaquiline exposure and risk for toxicity. Closely monitor ECGs during coadministration. Avoid prolonged coadministration (ie, more than 14 days) of bedaquiline and strong CYP3A4 inhibitors, unless benefits outweigh the risk. Consider dose adjustments, when possible, and closely monitor clinical effects and serum concentrations of the CYP3A substrate (eg, bedaquiline) . Discontinue bedaquiline and concomitantly administered QT-prolonging drugs if clinically significant ventricular arrhythmia or repeated Fridericia-corrected QT intervals greater than 500 msec occur .
Mechanism Of Interaction
Additive prolongation effects on QT interval; inhibition of CYP3A4-mediated of bedaquiline metabolism by clarithromycin
Literature Reports
A) Although an interaction between bedaquiline and clarithromycin has not been specifically studied, coadministration of bedaquiline (an extensive CYP3A4 substrate) and ketoconazole (a strong CYP3A4 inhibitor) decreased the bedaquiline AUC by 22% when ketoconazole 400 mg/day was added for 4 days to a bedaquiline 400 mg/day regimen .
Clarithromycin Overview
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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.
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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.
Bedaquiline Overview
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Bedaquiline is used along with at least three other medications to treat multi-drug resistant tuberculosis (MDR-TB; a serious infection that affects the lungs and other parts of the body and that cannot be treated with other medications that are usually used to treat the condition) in adults and children 5 years and older who weigh at least 33 lbs (15 kg) that has affected the lungs. Bedaquiline should not be used to treat TB that mainly affects other parts of the body. Bedaquiline is in a class of medications called anti-mycobacterials. It works by killing the bacteria that cause MDR-TB.
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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:
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.