Clarithromycin with Cariprazine Interaction Details
Brand Names Associated with Clarithromycin
- Biaxin® Filmtab®
- Biaxin® Granules
- Biaxin® XL Filmtab
- Biaxin® XL Pac
- Clarithromycin
Brand Names Associated with Cariprazine
- Cariprazine
- Vraylar®
Medical Content Editor Dr. Brian Staiger, PharmD
Last updated
Nov 08, 2023
Interaction Effect
Increased exposure to cariprazine and its active metabolite, didesmethylcariprazine
Interaction Summary
Coadministration of cariprazine (a CYP3A4 substrate) and a strong CYP3A4 inhibitor may increase the plasma concentrations of both cariprazine and its active metabolite, didesmethylcariprazine. During drug interaction studies, coadministration of cariprazine and ketoconazole (a strong CYP3A4 inhibitor) resulted in an increase in the AUC and Cmax of both cariprazine and didesmethylcariprazine. Therefore, when initiating treatment with a strong CYP3A4 inhibitor in patients already receiving cariprazine, reduce the current cariprazine dose by 50%. For patients taking cariprazine 4.5 mg/day, reduce to 1.5 mg or 3 mg daily. For patients taking 1.5 mg/day, change dosing interval to every other day. When initiating cariprazine therapy in a patient already taking a strong CYP3A4 inhibitor, administer cariprazine 1.5 mg on days 1 and 3. Thereafter, administer 1.5 mg/day and increase as needed to a maximum of 3 mg/day. Dosage adjustments may be required if treatment with either drug is discontinued.
Severity
Major
Onset
Unspecified
Evidence
Theoretical
How To Manage Interaction
Coadministration of cariprazine (a CYP3A4 substrate) and a strong CYP3A4 inhibitor may increase the plasma concentrations of both cariprazine and its active metabolite, didesmethylcariprazine. When initiating treatment with a strong CYP3A4 inhibitor in patients already receiving cariprazine, reduce the current cariprazine dose by 50%. For patients taking cariprazine 4.5 mg/day, reduce to 1.5 mg or 3 mg daily. For patients taking 1.5 mg/day, change dosing interval to every other day. When initiating cariprazine therapy in a patient already taking a strong CYP3A4 inhibitor, administer cariprazine 1.5 mg on days 1 and 3. Thereafter, administer 1.5 mg/day and increase as needed to a maximum of 3 mg/day. Dosage adjustments may be required if treatment with either drug is discontinued.
Mechanism Of Interaction
Inhibition of CYP3A4-mediate cariprazine metabolism
Literature Reports
A) During drug interaction studies, coadministration of cariprazine 0.5 mg/day and ketoconazole 400 mg/day resulted in a 4-fold and 3.5-fold increase in cariprazine AUC and Cmax, respectively. Both the AUC and Cmax of didesmethylcariprazine, the active metabolite of cariprazine, increased by 1.5-fold with concurrent use .
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.
Cariprazine Overview
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Cariprazine is used to treat schizophrenia (a mental illness that causes disturbed or unusual thinking, loss of interest in life, and strong or inappropriate emotions). Cariprazine is also used to treat episodes of depression in people with bipolar I disorder (manic depressive disorder; a disease that causes episodes of mania, episodes of depression and other abnormal moods). It is also used as a short term treatment for episodes of mania or mixed episodes (symptoms of mania and depression that happen together) in people with bipolar I disorder. Cariprazine is also used along with other medications to treat depressive symptoms in adults with major depressive disorder (MDD). Cariprazine 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:
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.