Clindamycin and Imatinib: 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
Imatinib
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. Imatinib (Gleevec) can slow down a liver enzyme called CYP3A4, which is one of the main pathways your body uses to break down clindamycin. If clindamycin is cleared more slowly, more of it can build up in your body, which could raise the chance of side effects.
The good news is that this concern is theoretical, meaning it's based on how these drugs work rather than on lots of real-world reports. Please don't stop or change either medicine on your own. Just let your pharmacist or doctor know you take both so they can keep an eye on you and adjust things if needed.
Mechanism: Imatinib inhibits CYP3A4, the primary enzyme metabolizing clindamycin. Reduced clearance may increase clindamycin exposure (AUC/Cmax) and the risk of concentration-related adverse effects.
- Direction: Increased clindamycin exposure (imatinib is the inhibitor; clindamycin the substrate).
- Severity/Evidence: Rated major, but substantiation is theoretical; onset unspecified.
- Magnitude: Not quantified.
- Management: Use with caution; monitor for clindamycin-related adverse effects (GI intolerance, diarrhea). Dose may be individualized by the care team; consider alternatives if clinically warranted.
What happens
Increased CYP3A4 substrate with NTI exposure and an increased risk of CYP3A4 substrates with NTI-related adverse reactions
Interaction Deep Dive
Use imatinib together with CYP3A4 substrates that have a narrow therapeutic index carefully, since this combination can raise the exposure of the NTI CYP3A4 substrate and may heighten the likelihood of adverse reactions associated with these narrow therapeutic index CYP3A4 substrates1.
Why it happens (mechanism)
Inhibition of CYP3A4-substrate metabolism by imatinib
How to manage this interaction
What your care team may do:
- Keep both medicines going as prescribed unless they tell you otherwise.
- Watch you more closely for clindamycin side effects, such as stomach upset or diarrhea.
- Adjust and individualize your dose if needed, or choose a different antibiotic when appropriate.
What you can do: Make sure your pharmacist and prescriber know you take both drugs. Report any new or worsening side effects, especially significant or persistent diarrhea. Don't start, stop, or change either medication on your own.
Management is individual — confirm any change with your pharmacist or prescriber.
Literature reports
1 report — tap to read
a) When imatinib was given together with simvastatin (a CYP3A4 substrate), simvastatin mean Cmax rose 2-fold and AUC rose 3.5-fold 1.
Common questions
Can I take Clindamycin and Imatinib together?
Imatinib may slow the breakdown of clindamycin, potentially raising clindamycin levels and side effects; this concern is theoretical, so keep taking both as prescribed and let your care team monitor you and adjust if needed. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Clindamycin and Imatinib 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 Imatinib interaction managed?
What your care team may do: Keep both medicines going as prescribed unless they tell you otherwise. Watch you more closely for clindamycin side effects, such as stomach upset or diarrhea. Adjust and individualize your dose if needed, or choose a different antibiotic when appropriate. What you can do: Make sure your pharmacist and prescriber know you take both drugs. Report any new or worsening sid… 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 Imatinib 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: IMKELDI oral solution, imatinib oral solution. Shorla Oncology Inc. (per FDA), Cambridge, MA, 2024. DailyMed
Keep reading about Imatinib
Keep reading about Clindamycin
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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