Nateglinide and Clarithromycin: Interaction Details
AI-assisted, pharmacist-reviewed · Source data updated Aug 8, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Clarithromycin
Nateglinide
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.
What happens
Increased nateglinide exposure and an increased risk of hypoglycemia
Interaction Deep Dive
Nateglinide is metabolized by CYP2C9 and CYP3A4 enzyme systems1. Coadministration with clarithromycin, a strong CYP3A4 inhibitor, may cause increased exposure to nateglinide resulting in hypoglycemia. Use caution if these agents are coadministered, and carefully monitor blood glucose concentrations 23.
Why it happens (mechanism)
Inhibition of CYP3A4-mediated nateglinide metabolism by clarithromycin
Common questions
Can I take Nateglinide and Clarithromycin together?
Increased nateglinide exposure and an increased risk of hypoglycemia Always confirm with your pharmacist or prescriber before making any change.
How serious is the Nateglinide and Clarithromycin interaction?
It is rated moderate. Can be significant — usually manageable with monitoring.
How quickly could this interaction happen?
The documented onset is "unspecified". The timing of this interaction is not well characterized.
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 Nateglinide or Clarithromycin 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 anything you'd monitor while I'm on both?
References (3)
- Product Information: Starlix(R) oral tablets, nateglinide oral tablets. Novartis Pharmaceuticals Corporation (per FDA), East Hanover, NJ, 2011. DailyMed
- Product Information: BIAXIN(R) Filmtab(R) oral tablets, clarithromycin oral tablets. Abbott Laboratories (per FDA), North Chicago, IL, 2012. DailyMed
- 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 Nateglinide
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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