Clarithromycin with Salmeterol Interaction Details
Brand Names Associated with Clarithromycin
- Biaxin® Filmtab®
- Biaxin® Granules
- Biaxin® XL Filmtab
- Biaxin® XL Pac
- Clarithromycin
Medical Content Editor Dr. Brian Staiger, PharmD
Last updated
Nov 08, 2023
Interaction Effect
Increased salmeterol exposure and an increased risk of salmeterol-related adverse effects (including cardiovascular adverse effects)
Interaction Summary
Salmeterol exposure increased 16-fold when administered concomitantly with ketoconazole. Concomitant use of salmeterol with strong CYP3A inhibitors is not recommended due to an increased risk of systemic corticosteroid adverse effects. Concomitant administration of salmeterol is not recommended during and 2 weeks after itraconazole treatment as it may result in increased salmeterol plasma concentrations resulting in more salmeterol-related adverse effects .
Severity
Major
Onset
Unspecified
Evidence
Theoretical
How To Manage Interaction
Concomitant use of salmeterol with strong CYP3A inhibitors is not recommended due to an increased risk of cardiovascular adverse effects (eg, angina, hypo- or hypertension, tachycardia). Concomitant administration of salmeterol is not recommended during and 2 weeks after itraconazole treatment as it may result in increased salmeterol plasma concentrations resulting in more salmeterol-related adverse effects .
Mechanism Of Interaction
Inhibition of CYP3A-mediated metabolism of salmeterol
Literature Reports
A) In a placebo-controlled, crossover, drug interaction study of 20 healthy participants, coadministration of ketoconazole, a strong CYP3A4 inhibitor, at a dose of 400 mg/day with salmeterol at a dose of 50 mcg twice daily for 7 days led to a significant 16-fold increase in salmeterol AUC (ratio with and without ketoconazole 15.76; 90% confidence interval (CI), 10.66 to 23.31) and a significant 1.4-fold increase in salmeterol Cmax (90% CI, 1.23 to 1.68) compared with salmeterol plus placebo. These increases were mainly due to increased bioavailability of the swallowed portion of the dose. Out of the 20 participants, 3 discontinued the study due to beta-agonist-mediated systemic adverse effects; QTc prolongation occurred in 2 participants and palpitations with sinus tachycardia occurred in one. Concomitant use of ketoconazole and salmeterol did not significantly affect mean heart rate, mean blood potassium, mean blood glucose, or mean QTc. However, concomitant use was associated with a higher rate of increases in QTc duration compared with salmeterol and placebo .
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.
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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.