Clarithromycin and Sertraline: Interaction Details
AI-assisted, pharmacist-reviewed · AI content regenerated Jul 11, 2026 · Source data updated Jul 2, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Clarithromycin
Sertraline
No brand names on record
How we grade severity & evidence
Severity levels
- Contraindicated: These should generally not be used together.
- Major: Potentially serious — often needs a change or close monitoring.
- Moderate: Can be significant — usually manageable with monitoring.
- Minor: Usually limited clinical impact.
Evidence grades
- Established: Well documented — supported by controlled studies or strong clinical data.
- Probable: Good supporting evidence, though not definitively proven.
- Suspected: Some evidence suggests this interaction, but it is not well established.
- Possible: Limited or conflicting evidence; the interaction may occur.
- Theoretical: Predicted from the drugs' pharmacology; not yet confirmed in people.
Ratings come from the documented interaction literature and are reviewed by a pharmacist. They describe the documented risk of the combination, not what will necessarily happen to you — your dose, timing, and health picture all matter.
Here's what's going on. Clarithromycin (Biaxin) is an antibiotic that can slow down how your body breaks down some other medicines. Sertraline is an antidepressant. When you take them together, sertraline levels can rise a bit, and both drugs can have a small effect on your heart's rhythm (called the QT interval). Together, that effect could add up.
The good news is this concern is mostly theoretical, and clarithromycin is usually a short course. Your care team can manage it, sometimes by choosing a different antibiotic or keeping a closer eye on you. Please don't stop either medicine on your own. Just check with your pharmacist or doctor.
Mechanism: Additive QT prolongation plus clarithromycin's CYP3A4 inhibition reducing sertraline clearance, raising its plasma exposure. Neither drug is a prodrug; the interaction increases sertraline effect/exposure.
- Direction: Increased sertraline AUC/Cmax; additive QTc risk.
- Severity/Evidence: Major severity, but evidence is theoretical. Sertraline is a relatively weak QT prolonger and a minor CYP3A4 substrate, so clinical magnitude is often modest.
- Onset: Unspecified.
- Management: Avoid coadministration where feasible; consider an alternative antibiotic. If combined, assess baseline QTc and electrolytes (K+, Mg2+), review other QT-prolonging agents, and monitor.
What happens
Increased risk of QT interval prolongation, increased exposure of CYP3A4 substrate and risk for toxicity
Interaction Deep Dive
Do not give clarithromycin together with other CYP3A4 substrates that prolong the QT interval, since doing so may raise the plasma levels of the CYP3A4 substrate, potentially heightening the risk of adverse reactions such as QT interval prolongation1.
Why it happens (mechanism)
Additive QT interval prolongation; inhibition of CYP3A4-substrate metabolism by clarithromycin
How to manage this interaction
What your care team may do:
- Consider whether a different antibiotic could be used instead of clarithromycin, since guidance is to avoid this combination when possible.
- If both are needed, they may monitor you more closely, including checking your heart rhythm and electrolytes.
- Review any other medicines you take that can affect heart rhythm.
What you can do: Keep taking both exactly as prescribed unless told otherwise. Tell your pharmacist or doctor about all your medicines, and report symptoms like fainting, dizziness, or a fluttering or pounding heartbeat right away.
Management is individual — confirm any change with your pharmacist or prescriber.
Literature reports
1 report — tap to read
a) The use of clarithromycin has been linked to lengthening of the QT interval and to uncommon instances of arrhythmia. During postmarketing surveillance, cases of torsades de pointes have been reported spontaneously in patients taking clarithromycin. Deaths have been reported 1.
Common questions
Can I take Clarithromycin and Sertraline together?
Clarithromycin can raise sertraline levels and both may nudge your heart rhythm, so your care team may pick a different antibiotic or watch you more closely. Keep taking both as prescribed and check with your pharmacist or doctor. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Clarithromycin and Sertraline interaction?
It is rated major. Potentially serious — often needs a change or close monitoring.
How quickly could this interaction happen?
The documented onset is "unspecified". The timing of this interaction is not well characterized.
How is the Clarithromycin and Sertraline interaction managed?
What your care team may do: Consider whether a different antibiotic could be used instead of clarithromycin, since guidance is to avoid this combination when possible. If both are needed, they may monitor you more closely, including checking your heart rhythm and electrolytes. Review any other medicines you take that can affect heart rhythm. What you can do: Keep taking both exactly as prescribed… Management is individual — always follow your own care team's guidance.
How strong is the evidence for this interaction?
The evidence is graded "theoretical". Predicted from the drugs' pharmacology; not yet confirmed in people.
From our Q&A
Real reader questions about these medications, each personally answered by our pharmacist:
Questions for your pharmacist
- Does my dose of Clarithromycin or Sertraline need adjusting while I take them together?
- What symptoms should prompt me to call you or my prescriber right away?
- Does the timing of my doses matter for this combination?
- Is there a safer alternative to one of these medications for me?
References (1)
- Product Information: VOQUEZNA(TM) TRIPLE PAK(TM) oral kit, vonoprazan oral tablets, amoxicillin oral capsules, clarithromycin oral tablets kit. Phathom Pharmaceuticals (per FDA), Buffalo Grove, IL, 2023. DailyMed
Keep reading about Clarithromycin
Keep reading about Sertraline
These medications also interact with supplements
Prescription drugs aren't the whole picture — herbal and dietary supplements can interact with them too. From the evidence-graded Natural Medicines database:
major · moderate · minor — check everything you take with our drug–supplement interaction checker.
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