Clarithromycin with Rifampin Interaction Details
Brand Names Associated with Clarithromycin
- Biaxin® Filmtab®
- Biaxin® Granules
- Biaxin® XL Filmtab
- Biaxin® XL Pac
- Clarithromycin
Brand Names Associated with Rifampin
- Rifadin®
- Rifamate® (as a combination product containing Isoniazid, Rifampin)
- Rifampin
- Rifater® (as a combination product containing Isoniazid, Pyrazinamide, Rifampin)
- Rimactane®
Medical Content Editor Dr. Brian Staiger, PharmD
Last updated
Nov 08, 2023
Interaction Effect
Decreased serum concentration of clarithromycin
Interaction Summary
Coadministration of clarithromycin and rifampin should be used with caution due to the potential for decreased clarithromycin plasma concentrations. If coadministration of clarithromycin is required, clarithromycin dose adjustments may be warranted. A dose increase of clarithromycin 7.5 mg/kg twice a day of the regular formulation or 15 mg/kg of the slow-release formulation once a day has been suggested .
Severity
Moderate
Onset
Unspecified
Evidence
Established
How To Manage Interaction
Coadministration of clarithromycin and rifampin should be used with caution due to the potential for decreased clarithromycin plasma concentrations. If coadministration of clarithromycin is required, clarithromycin dose adjustments may be warranted. A dose increase of clarithromycin 7.5 mg/kg twice a day of the regular formulation or 15 mg/kg of the slow-release formulation once a day has been suggested .
Mechanism Of Interaction
Increased clarithromycin clearance induced by rifampin
Literature Reports
A) In an 2-arm, open-label, randomized, controlled trial of patients with mycobacterium ulcerans infection, serum concentrations of clarithromycin decreased following rifampin coadministration. In the first comparator arm, 8 patients were administered streptomycin 15 mg/kg and rifampin 10 mg/kg for 8 weeks. Patients in the second comparator arm were administered the same streptomycin/rifampin combination for 4 weeks followed by 4 weeks of treatment with rifampin in combination with once daily clarithromycin 7.5 mg/kg (n=5). Patients had received all study medications for a median of 50 days prior to drawn blood samples. Concomitant administration of clarithromycin with rifampin resulted in a 60% statistically nonsignificant increase in rifampin AUC (25.8 mg x h/L), whereas, rifampin coadministered with streptomycin resulted in a AUC of 15.2 mg h/L. The median AUC for clarithromycin was 2.9 mg x h/L and for its metabolite 14-hydroxy-clarithromycin was 8 mg x h/L, showing a decrease in clarithromycin plasma levels and an increase in the plasma levels of its metabolite .
B) In a study of 9 patients with lung disease due to mycobacterium avium complex, serum concentrations of clarithromycin significantly decreased when rifampicin was coadministered. All patients received clarithromycin (ranging from 400 mg/day to 600 mg/day) for one week followed by a combination of clarithromycin and rifampicin (ranging from 300 mg/day to 450 mg/day). Clarithromycin plasma concentrations decreased from 3.57 mcg/mL +/- 2.49 mcg/mL to 0.74 mcg/mL +/- 0.62 mcg/mL (p=less than 0.05) . Clarithromycin plus its metabolite 14-hydroxy-clarithromycin also showed a decrease in plasma concentration from 4.65 mcg/mL +/- 3.08 mcg/mL to 1.79 mcg/mL +/- 1.09 mcg/mL (p=less than 0.05) following rifampicin administration .
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.
Rifampin Overview
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Rifampin is used with other medications to treat tuberculosis (TB; a serious infection that affects the lungs and sometimes other parts of the body). Rifampin is also used to treat some people who have Neisseria meningitidis (a type of bacteria that can cause a serious infection called meningitis) infections in their noses or throats. These people have not developed symptoms of the disease, and this treatment is used to prevent them from infecting other people. Rifampin should not be used to treat people who have developed symptoms of meningitis. Rifampin is in a class of medications called antimycobacterials. It works by killing the bacteria that cause infection.
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Antibiotics such as rifampin will not work for colds, flu, or 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.