Clarithromycin with Conivaptan Interaction Details

Brand Names Associated with Clarithromycin

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

Interaction Effect

Increased exposure of conivaptan and the CYP3A substrate

Interaction Summary

Concomitant use of conivaptan (strong CYP3A inhibitor and CYP3A substrate) and a strong CYP3A inhibitor that is also a CYP3A substrate is contraindicated, as this may result in increased exposure of one or both agents. The Cmax and AUC of conivaptan increased 4- and 11-fold, respectively, with the concomitant administration of oral conivaptan hydrochloride 10 mg and ketoconazole 200 mg. Conivaptan increased the AUC of CYP3A substrates midazolam, simvastatin, and amlodipine. Do not initiate the CYP3A substrate sooner than 1 week after completion of conivaptan therapy.

Severity

Contraindicated

Onset

Unspecified

Evidence

Theoretical

How To Manage Interaction

Concomitant use of conivaptan and a strong CYP3A inhibitor that is also a CYP3A substrate is contraindicated, as this may result in increased exposure of one or both agents. Do not initiate the CYP3A substrate sooner than 1 week after completion of conivaptan therapy.

Mechanism Of Interaction

Inhibition of CYP3A-mediated conivaptan metabolism; inhibition of the CYP3A substrate metabolism

Literature Reports

A) The strong CYP3A inhibitor conivaptan 40 mg/day IV increased the AUC of midazolam, a CYP3A substrate, by approximately 100% with a 1-mg IV dose and by 200% with a 2-mg oral dose .

B) Conivaptan 30 mg/day IV tripled the AUC of simvastatin, a CYP3A substrate .

C) Conivaptan 40 mg orally twice daily doubled the AUC and half-life of amlodipine, a CYP3A substrate .

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.

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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.