Clarithromycin with Vinorelbine 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 vinorelbine exposure
Interaction Summary
Concomitant use of clarithromycin and vinorelbine has been associated with increased vinorelbine exposure and myelotoxicity. In a retrospective, cohort study, severe neutropenia (grade 3/4 and 4) was reported when patients with non-small cell lung cancer were treated with clarithromycin while receiving vinorelbine therapy. The postulated mechanism for this interaction is CYP3A4- and/or P-glycoprotein-mediated vinorelbine metabolism by clarithromycin. Therefore, it may be warranted to avoid prescribing clarithromycin in patients who will be receiving vinorelbine chemotherapy. An alternative macrolide antibiotic is not recommended due to the potential for a similar interaction. If clarithromycin use cannot be avoided during vinorelbine therapy, a vinorelbine dose reduction should be considered.
Severity
Major
Onset
Unspecified
Evidence
Established
How To Manage Interaction
Concomitant use of clarithromycin and vinorelbine has been associated with increased vinorelbine exposure and myelotoxicity. Therefore, consider avoiding clarithromycin in patients who will receive vinorelbine chemotherapy. An alternative macrolide antibiotic to clarithromycin is not recommended due to the potential for a similar interaction. If clarithromycin use cannot be avoided during vinorelbine therapy, consider a vinorelbine dose reduction.
Mechanism Of Interaction
Inhibition of CYP3A4- and/or P-glycoprotein-mediated vinorelbine metabolism by clarithromycin
Literature Reports
A) Concomitant use of clarithromycin and vinorelbine resulted in severe neutropenia in a retrospective, cohort study including hospital data from patients with non-small cell lung cancer treated with vinorelbine between May 30, 2003 and January 31, 2008 (n=25). The 25 patients were administered a total of 59 chemotherapy courses that included vinorelbine given weekly (days 1, 8, and 15) or every 2 weeks (days 1 and 15) at 28-day intervals. Out of the 59 chemotherapy courses, clarithromycin was administered during 19 of them. The incidence of grade 3/4 neutropenia episodes was higher in patients administered clarithromycin compared with those not administered clarithromycin (12 patients (63.2%) vs 11 patients (27.5%); p=0.012) representing a greater than 4-fold increased risk of grade 3/4 neutropenia with concomitant clarithromycin use (odds ratio, 4.52; 95% confidence interval, 1.41 to 14.45; p=0.012). The rate of grade 4 neutropenia was also increased in those treated with clarithromycin compared with those not treated with clarithromycin (31.6% vs 2.5%; p=0.0033). Among 4 patients who were treated with both vinorelbine alone and vinorelbine with clarithromycin, lower neutrophil counts were observed with clarithromycin coadministration compared with no clarithromycin coadministration. Authors postulate that the mechanism for this interaction may be CYP3A4- and/or P-glycoprotein-mediated vinorelbine metabolism by clarithromycin .
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.