Clindamycin and Berotralstat: Interaction Details
AI-assisted, pharmacist-reviewed · AI content regenerated Jul 11, 2026 · Source data updated Jul 1, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Berotralstat
Clindamycin
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. Berotralstat (Orladeyo) gently slows down a liver enzyme called CYP3A4. Clindamycin is partly broken down by that same enzyme. So when you take them together, your body may clear clindamycin a little more slowly, and the drug can build up a bit higher than usual.
In plain terms, that could mean a stronger chance of clindamycin side effects, like an upset stomach or diarrhea. I want to be honest that this concern is theoretical, meaning it's based on how the drugs work rather than lots of real-world reports. The good news: your care team can easily keep an eye on this and adjust things if needed. Just let them know you take both.
Mechanism: Berotralstat 150 mg is a moderate CYP3A4 inhibitor. Clindamycin is a CYP3A4 substrate, so inhibition may reduce its metabolism and increase exposure (AUC/Cmax), potentially raising substrate-related adverse effects (notably GI toxicity). Neither drug requires bioactivation, so effect is enhanced, not reduced.
- Direction: increased clindamycin exposure and adverse-reaction risk
- Onset: unspecified
- Evidence: theoretical (based on enzyme kinetics, not clinical outcome data)
- Magnitude: not quantified
Management: Monitor for clindamycin-related adverse effects. Dose may be individualized and titrated by the care team as clinically indicated.
What happens
Increased CYP3A4 substrate exposure and an increased CYP3A4 substrate-related adverse reactions
Interaction Deep Dive
When berotralstat 150 mg (which acts as a moderate inhibitor of CYP3A4) is taken together with a CYP3A4 substrate that has a narrow therapeutic index, exposure to the substrate may rise, potentially heightening the likelihood of adverse reactions linked to those substrates. Perform appropriate monitoring and adjust the dose through titration as needed1.
Why it happens (mechanism)
Inhibition of CYP3A4-substrate metabolism by berotralstat
How to manage this interaction
The reassuring part: this is something your care team can manage. Keep taking both medications exactly as prescribed unless your prescriber tells you otherwise.
- Let your pharmacist and doctor know you take both berotralstat and clindamycin.
- Your team may watch you a little more closely for clindamycin side effects, especially stomach upset or diarrhea.
- If needed, your clindamycin dose may be adjusted and individualized by your care team.
- Report any new or worsening symptoms, particularly persistent or severe diarrhea, to your provider.
Management is individual — confirm any change with your pharmacist or prescriber.
Common questions
Can I take Clindamycin and Berotralstat together?
Berotralstat may raise clindamycin levels and side effects by slowing its breakdown; the concern is theoretical, and your care team can manage it with monitoring and dose adjustment if needed. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Clindamycin and Berotralstat 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 Clindamycin and Berotralstat interaction managed?
The reassuring part: this is something your care team can manage. Keep taking both medications exactly as prescribed unless your prescriber tells you otherwise. Let your pharmacist and doctor know you take both berotralstat and clindamycin. Your team may watch you a little more closely for clindamycin side effects, especially stomach upset or diarrhea. If needed, your clindamycin dose may be adjus… 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 Clindamycin or Berotralstat 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: ORLADEYO® oral capsules, oral pellets, berotralstat oral capsules, oral pellets. BioCryst Pharmaceuticals Inc (per manufacturer), Durham, NC, 2025. DailyMed
Keep reading about Berotralstat
Keep reading about Clindamycin
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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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