Clindamycin and Mavorixafor: 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
Mavorixafor
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.
These two medicines can interact. Mavorixafor (Xolremdi) slows down a liver enzyme called CYP3A4 that helps break down clindamycin. When that enzyme is slowed, clindamycin can build up a bit more in your body, which may raise the chance of side effects like stomach upset or diarrhea.
The good news is this is very manageable. Your care team knows about this and can watch you a little more closely and adjust things if needed. Please don't stop or change either medicine on your own, just keep taking them as prescribed and let your pharmacist or doctor know if you notice new or worsening side effects.
Mechanism: Mavorixafor is a moderate CYP3A4 inhibitor; clindamycin is a CYP3A4 substrate. Inhibition reduces clindamycin metabolism, increasing its systemic exposure (AUC/Cmax) and potential for concentration-related adverse effects (GI toxicity, including C. difficile-associated diarrhea).
- Direction: increased clindamycin effect/exposure.
- Magnitude: reference midazolam study showed Cmax 1.1-fold and AUC 1.7-fold increases; clindamycin-specific data not established.
- Onset: unspecified. Evidence: probable. Severity on file: major.
Management: monitor for clindamycin-related adverse reactions more frequently during concomitant use. Dose may be individualized by the care team.
What happens
Increased CYP3A4 substrate with NTI exposure and an increased risk of CYP3A4 with NTI-related adverse events
Interaction Deep Dive
When mavorixafor, an inhibitor of CYP3A4, is given together with a CYP3A4 substrate that has a narrow therapeutic index (NTI), the exposure to that NTI substrate may rise, potentially heightening the likelihood of adverse events tied to the NTI substrate. For CYP3A4 substrates in which even small shifts in substrate concentration can produce serious adverse reactions, watch more closely for substrate-related adverse reactions during concurrent use with mavorixafor. A drug interaction study in healthy subjects found that giving mavorixafor 400 mg alongside midazolam (a CYP3A4 substrate) raised Cmax by 1.1-fold and AUC by 1.7-fold1.
Why it happens (mechanism)
Inhibition of CYP3A4-mediated metabolism by mavorixafor
How to manage this interaction
If you are prescribed both, here is what typically happens and what you can do:
- Keep taking both as prescribed unless your prescriber tells you otherwise.
- Your care team may monitor you more closely for clindamycin side effects, especially stomach or digestive symptoms.
- Your dose may need to be adjusted and individualized by your team.
- Report new or worsening symptoms such as persistent diarrhea, abdominal pain, or nausea to your pharmacist or doctor promptly.
This interaction is well recognized and your care team can manage it with monitoring and tailored dosing.
Management is individual — confirm any change with your pharmacist or prescriber.
Literature reports
1 report — tap to read
a) In a drug interaction study conducted in healthy subjects, giving mavorixafor (a CYP3A4 inhibitor) 400 mg together with midazolam (a CYP3A4 substrate) raised the Cmax by 1.1-fold and the AUC by 1.7-fold, respectively 1.
Common questions
Can I take Clindamycin and Mavorixafor together?
Mavorixafor can raise clindamycin levels by slowing its breakdown, so watch more closely for side effects like diarrhea; keep taking both as prescribed and report new symptoms to your care team. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Clindamycin and Mavorixafor 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 Mavorixafor interaction managed?
If you are prescribed both, here is what typically happens and what you can do: Keep taking both as prescribed unless your prescriber tells you otherwise. Your care team may monitor you more closely for clindamycin side effects, especially stomach or digestive symptoms. Your dose may need to be adjusted and individualized by your team. Report new or worsening symptoms such as persistent diarrhea,… Management is individual — always follow your own care team's guidance.
How strong is the evidence for this interaction?
The evidence is graded "probable". Good supporting evidence, though not definitively proven.
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 Mavorixafor 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: XOLREMDI(TM) oral capsules, mavorixafor oral capsules. X4 Pharmaceuticals, Inc. (Per FDA), Boston, MA, 2024. DailyMed
Keep reading about Mavorixafor
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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