Clarithromycin with Ranolazine Interaction Details
Brand Names Associated with Clarithromycin
- Biaxin® Filmtab®
- Biaxin® Granules
- Biaxin® XL Filmtab
- Biaxin® XL Pac
- Clarithromycin
Brand Names Associated with Ranolazine
- Ranexa®
- Ranolazine
Medical Content Editor Dr. Brian Staiger, PharmD
Last updated
Nov 08, 2023
Interaction Effect
An increase in ranolazine steady state plasma concentrations and an increased risk of cardiotoxicity (QT prolongation, torsades de pointes, cardiac arrest)
Interaction Summary
Exposure to ranolazine was increased by 220% when coadministered with the strong CYP3A4 inhibitor ketoconazole. Neurological adverse effects were reported in a 74-year-old man following initiation of ranolazine with concomitant clarithromycin . Use of clarithromycin, a strong CYP3A4 inhibitor, with ranolazine is contraindicated since concomitant use may increase ranolazine plasma levels . Additionally, additive effects on QT interval prolongation are possible.
Severity
Contraindicated
Onset
Unspecified
Evidence
Theoretical
How To Manage Interaction
Use of clarithromycin, a strong CYP3A4 inhibitor, with ranolazine is contraindicated since concomitant use may increase ranolazine plasma levels. Additionally, additive effects on QT interval prolongation are possible.
Mechanism Of Interaction
Inhibition of cytochrome P450-3A mediated ranolazine metabolism
Literature Reports
A) A 74-year-old man treated for acute exacerbation of obstructive airway disease with clarithromycin and piperacillin/tazobactam developed neurologic adverse effects following initiation of ranolazine 500 mg twice daily to manage angina while his other cardiac medications were put on hold due to bradycardia and orthostatic hypotension. Mild confusion and visual hallucinations developed on day 3 of therapy as his chest condition was otherwise improving. By day 7, dysarthria, dysmetria, and ambulation difficulties due to ataxia occurred. Frontal assessment battery (FAB) scores had declined since admission, but there was no focal neurological deficit and other neurological examination results were unchanged. Ranolazine was discontinued and neurological signs and symptoms improved markedly, returning to baseline, within 2 days. No rechallenge was undertaken. Symptoms had not recurred following discharge .
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.
Ranolazine Overview
-
Ranolazine is used alone or with other medications to treat chronic angina (ongoing chest pain or pressure that is felt when the heart does not get enough oxygen). Ranolazine is in a class of medications called anti-anginals. The exact way that ranolazine works is not known at this time.
Return To Our Drug Interaction Homepage
Feedback, Question Or Comment About This Information?
Ask Dr. Brian Staiger, PharmD, our medical editor, directly! He's always more than happy to assist.
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.