Clarithromycin with Darunavir Interaction Details
Brand Names Associated with Clarithromycin
- Biaxin® Filmtab®
- Biaxin® Granules
- Biaxin® XL Filmtab
- Biaxin® XL Pac
- Clarithromycin
Brand Names Associated with Darunavir
- Darunavir
- Prezista®
Medical Content Editor Dr. Brian Staiger, PharmD
Last updated
Nov 08, 2023
Interaction Effect
Increased clarithromycin exposure
Interaction Summary
Coadministration of darunavir/ritonavir with clarithromycin has resulted in increased clarithromycin plasma concentrations. Caution is advised when darunavir/ritonavir and clarithromycin are administered concomitantly, or consider using an alternative macrolide (eg, azithromycin) . If concomitant use is required in patients with renal impairment, reduce clarithromycin dose by 50% if CrCl is 30 to 60 mL/min and by 75% if CrCl is less than 30 mL/min. No dosage adjustment is necessary in patients with normal renal function . Monitor for clarithromycin-related toxicities . Clarithromycin doses greater than 1000 mg/day with protease inhibitors are not recommended .
Severity
Major
Onset
Unspecified
Evidence
Probable
How To Manage Interaction
Concurrent administration of darunavir/ritonavir and clarithromycin has resulted in increased clarithromycin plasma concentrations. Use caution when these agents are coadministered or consider using an alternative macrolide (eg, azithromycin) . However, if concomitant use of darunavir/ritonavir and clarithromycin is required in patients with renal impairment, reduce clarithromycin dose by 50% if CrCl is 30 to 60 mL/min and by 75% if CrCl is less than 30 mL/min. No dosage adjustment is necessary in patients with normal renal function . Monitor for clarithromycin-related toxicities . Clarithromycin doses greater than 1000 mg/day with protease inhibitors is not recommended .
Mechanism Of Interaction
Inhibition of CYP3A-mediated metabolism of clarithromycin
Literature Reports
A) In a pharmacokinetics study, concurrent administration of clarithromycin and darunavir/ritonavir resulted in increases in clarithromycin plasma concentration. Subjects (n=17) were administered 500 mg clarithromycin orally twice daily concurrently with darunavir 400 mg/ritonavir 100 mg orally twice daily. Results indicated a 26% increase in clarithromycin Cmax (least squares (LS) mean ratio % 1.26; 90% confidence interval (CI), 1.03 to 1.54), a 56% increase in clarithromycin AUC (LS mean ratio % 1.57; 90% CI, 1.35 to 1.84), and a 174% increase in clarithromycin Cmin (LS mean ratio % 2.74; 90% CI, 2.3 to 3.26). Darunavir pharmacokinetics were not significantly altered .
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.
Darunavir Overview
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Darunavir is used with a pharmacokinetic booster (a medication that increases the amount of other medications in the body) such as ritonavir (Norvir) or cobicistat (Tybost), and other medications to treat human immunodeficiency virus (HIV) infection in adults and children 3 years of age and older. Darunavir is in a class of medications called protease inhibitors. It works by decreasing the amount of HIV in the blood. Although darunavir does not cure HIV, it may decrease your chance of developing acquired immunodeficiency syndrome (AIDS) and HIV-related illnesses such as serious infections or cancer. Taking these medications along with practicing safer sex and making other life-style changes may decrease the risk of transmitting the HIV virus to other people.
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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.