Clarithromycin with Pravastatin Interaction Details

Brand Names Associated with Clarithromycin

Brand Names Associated with Pravastatin

Medical Content Editor Dr. Brian Staiger, PharmD
Last updated Nov 11, 2023

Interaction Effect

Increased pravastatin exposure and an increased risk of myopathy or rhabdomyolysis

Interaction Summary

Drug interaction studies demonstrated that the coadministration of clarithromycin and pravastatin increased pravastatin exposure significantly. Therefore, if concurrent therapy of clarithromycin and pravastatin is required, limit the dose of pravastatin to 40 mg once daily. Patients should be monitored for signs and symptoms of myopathy or rhabdomyolysis (muscle pain, tenderness, or weakness accompanied by malaise or fever). If myopathy or rhabdomyolysis is diagnosed or suspected, monitor creatine phosphokinase (CPK) levels and temporarily withhold or discontinue use if CPK levels show a marked increase.

Severity

Moderate

Onset

Unspecified

Evidence

Probable

How To Manage Interaction

Use caution when prescribing clarithromycin to patients who take pravastatin. Concurrent use may increase the risk of myopathy or rhabdomyolysis. Limit the dose of pravastatin to 40 mg once daily when used concomitantly with clarithromycin. Monitor the patient for signs and symptoms of myopathy or rhabdomyolysis (muscle pain, tenderness, or weakness with malaise or fever). If myopathy or rhabdomyolysis is diagnosed or suspected, monitor creatine phosphokinase (CPK) levels and temporarily withhold or discontinue use if CPK levels show a marked increase.

Mechanism Of Interaction

Unknown

Literature Reports

A) In drug interaction studies, the concomitant administration of clarithromycin and pravastatin resulted in an increase in pravastatin AUC and Cmax by 110% and 128%, respectively. Patients received clarithromycin 500 mg twice daily for 9 days concurrently with pravastatin 40 mg once daily for 8 days .

B) In a large population-based cohort study of older adults (N=101,523; mean age, 74 years), the concomitant use of clarithromycin with a statin not metabolized by CYP3A (rosuvastatin, 76%; pravastatin, 21%; fluvastatin, 3%) resulted in hospital admission rates for acute kidney injury and hyperkalemia of 0.34% and 0.06%, respectively. The admission rates with concomitant use of azithromycin with the same statins were 0.23% and 0.03%, respectively. The all-cause mortality rate was 0.39% in the clarithromycin group and 0.3% in the azithromycin group .

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.

Pravastatin Overview

• Pravastatin is used together with diet, weight-loss, and exercise to reduce the risk of heart attack and stroke and to decrease the chance that heart surgery will be needed in people who have heart disease or who are at risk of developing heart disease. Pravastatin is also used to reduce the amount of fatty substances such as low-density lipoprotein (LDL) cholesterol ('bad cholesterol') and triglycerides in the blood and to increase the amount of high-density lipoprotein (HDL) cholesterol ('good cholesterol') in the blood. Pravastatin is in a class of medications called HMG-CoA reductase inhibitors (statins). It works by slowing the production of cholesterol in the body to decrease the amount of cholesterol that may build up on the walls of the arteries and block blood flow to the heart, brain, and other parts of the body.

• Accumulation of cholesterol and fats along the walls of your arteries (a process known as atherosclerosis) decreases blood flow and, therefore, the oxygen supply to your heart, brain, and other parts of your body. Lowering your blood level of cholesterol and fats with pravastatin has been shown to prevent heart disease, angina (chest pain), strokes, and heart attacks.

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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.