Clarithromycin with Linezolid Interaction Details
Brand Names Associated with Clarithromycin
- Biaxin® Filmtab®
- Biaxin® Granules
- Biaxin® XL Filmtab
- Biaxin® XL Pac
- Clarithromycin
Brand Names Associated with Linezolid
- Linezolid
- Zyvox®
Medical Content Editor Dr. Brian Staiger, PharmD
Last updated
Nov 13, 2023
Interaction Effect
Increased linezolid exposure
Interaction Summary
A case report described significantly increased linezolid AUC when it was coadministered with clarithromycin as part of a regimen for extensively drug-resistant TB. The proposed mechanism of action was the inhibition of P-glycoprotein-based metabolism of linezolid by clarithromycin. If these agents are coadministered, monitoring for potential linezolid toxicity should be considered and a linezolid dose reduction may be warranted.
Severity
Moderate
Onset
Unspecified
Evidence
Probable
How To Manage Interaction
Concurrent use of both clarithromycin and linezolid may result in increased linezolid exposure. Consider monitoring for potential linezolid toxicity after coadministration of linezolid and clarithromycin and a linezolid dose reduction may be warranted.
Mechanism Of Interaction
Inhibition of P-glycoprotein-mediated linezolid metabolism by clarithromycin
Literature Reports
A) Coadministration of clarithromycin and linezolid resulted in a considerable increase in the AUC of linezolid in a 42-year-old man with smear positive, extensively drug-resistant pulmonary TB that was susceptible only to cycloserine, linezolid, clarithromycin, and clofazimine. The patient was started on linezolid 300 mg twice daily with a later addition of clarithromycin 1000 mg once daily. After the addition of clarithromycin, the AUC of linezolid increased from 29 mg x hr/L to 108 mg x hr/L. The AUC increase was also accompanied by a delay in time to linezolid Cmax. There were no significant changes in liver or renal function to account for the increased linezolid exposure. Clarithromycin treatment was continued but the linezolid dose was decreased to 150 mg twice daily. After 6 months, sputum and smear cultures remain negative, and the patient was discharged. Inhibition of P-glycoprotein-based linezolid metabolism by clarithromycin was postulated as a probable mechanism for this interaction .
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.
Linezolid Overview
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Linezolid is used to treat infections, including pneumonia, and infections of the skin . Linezolid is in a class of antibacterials called oxazolidinones. It works by stopping the growth of bacteria.
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Antibiotics such as linezolid will not work for colds, flu, and other viral infections. Using 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:
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.