Clarithromycin with Disopyramide Interaction Details
Brand Names Associated with Clarithromycin
- Biaxin® Filmtab®
- Biaxin® Granules
- Biaxin® XL Filmtab
- Biaxin® XL Pac
- Clarithromycin
Brand Names Associated with Disopyramide
- Disopyramide
- Norpace®
- Norpace® CR
Medical Content Editor Dr. Brian Staiger, PharmD
Last updated
Nov 08, 2023
Interaction Effect
An increased risk of cardiotoxicity (QT prolongation, torsades de pointes, cardiac arrest) and an increased risk of hypoglycemia
Interaction Summary
There have been postmarketing reports of cardiac arrhythmias and torsades de pointes, as well as hypoglycemia, with concomitant use of clarithromycin and disopyramide. Concomitant use is not recommended. If concomitant use cannot be avoided, monitor ECG, serum drug concentrations, and blood glucose levels
Severity
Major
Onset
Delayed
Evidence
Probable
How To Manage Interaction
Concomitant use of clarithromycin and disopyramide is not recommended. If concomitant use cannot be avoided, monitor ECG, serum drug concentrations, and blood glucose levels.
Mechanism Of Interaction
Inhibition of CYP3A-mediated disopyramide metabolism and additive effects on the QT interval
Literature Reports
A) Ventricular arrhythmias have included ventricular fibrillation, uniform ventricular tachycardia, and polymorphous ventricular tachycardia or (torsade de pointes). The mechanism of disopyramide-induced ventricular arrhythmias is thought to be due to a drug-induced prolongation of repolarization that causes a temporal dispersion of refractoriness within the ventricular myocardium or the precipitation of early after-depolarizations causing multiple reentrant circuits or triggered automatic foci. All cases have been associated with significant QT prolongation. Treatment for disopyramide induced ventricular arrhythmias includes drug discontinuation, restoration of electrolyte imbalance with supplemental magnesium therapy, direct current cardioversion, and procedures that decrease the temporal dispersion and refractoriness (atrial or ventricular overdrive pacemakers; isoproterenol infusions) .
B) Several cases of recurrent irregular ventricular tachycardia also known as torsade de pointes have been reported with conventional doses of disopyramide. This condition is more likely to occur with severe repolarization delay and sinus bradycardia or atrioventricular block, especially when disopyramide therapy is combined with other Q-T interval prolonging agents . Others have retrospectively determined that women, irrespective of the presence or absence of other underlying heart conditions, are more at risk than men of developing torsades de pointes, in the setting of prolonged QT interval, following disopyramide therapy .
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.
Disopyramide Overview
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Disopyramide is used to treat certain types of irregular heartbeats). Disopyramide is in a class of medications called antiarrhythmic medications. It works by making your heart more resistant to abnormal activity.
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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.