Prednisone with Clarithromycin Interaction Details

Brand Names Associated with Prednisone

Brand Names Associated with Clarithromycin

Medical Content Editor Dr. Brian Staiger, PharmD
Last updated Nov 08, 2023

Interaction Effect

Increased predniSONE plasma concentrations and an increased risk for predniSONE side effects

Interaction Summary

Concomitant use of clarithromycin, a CYP3A4 inhibitor, and predniSONE may result in increased predniSONE plasma levels, thus potentially increasing the risk for predniSONE side effects. Case reports have described psychotic behavior, including paranoid delusions and progressive mental deterioration, following concomitant use of clarithromycin and predniSONE . Conversely, clarithromycin was not found to alter prednisolone clearance or mean prednisolone plasma concentrations in 6 asthmatic patients .

Severity

Moderate

Onset

Delayed

Evidence

Probable

How To Manage Interaction

Concomitant use of clarithromycin and predniSONE may result in increased predniSONE plasma concentrations, thereby increasing the risk for predniSONE side effects. Dosage adjustments may be warranted in patients concurrently receiving clarithromycin and drugs primarily metabolized by CYP3A4 .

Mechanism Of Interaction

Inhibition of CYP3A4-mediated predniSONE metabolism by clarithromycin

Literature Reports

A) A 50-year-old man with a history of severe emphysema was treated with 20 mg daily of predniSONE for approximately one month before he was started on clarithromycin 500 mg twice daily for purulent bronchitis. Shortly after starting the clarithromycin, the patient began to exhibit paranoid delusions and dangerous behavior, including firing a weapon at the front door of his home in an attempt to kill one of the prowlers that he believed to be outside his home. The treatment team made a provisional diagnosis of steroid-induced psychotic disorder for the following reasons: 1) the proximity of time of coadministration of the predniSONE and clarithromycin, 2) the stable nature of the patient's previous treatment with predniSONE in the absence of clarithromycin, and 3) the relatively low dosage of steroid being administered. It is theorized that the interaction between predniSONE and clarithromycin may result from inhibition of the enzymatic system responsible for metabolizing predniSONE .

B) A 30-year-old woman with no prior history of mental illness was started on clarithromycin 1000 mg daily and predniSONE 20 mg daily for acute sinusitis. After 2 days, she increased her predniSONE dose to 40 mg daily. After 5 days, for unknown reasons, she discontinued both medications. She presented with a 1-week history of progressive mental decompensation, including disorganized thoughts and behavior, pressured speech, increased energy, decreased need for sleep, and labile affect. She was admitted to a hospital for observation, and no antipsychotics or mood stabilizers were given. Her mental status returned to normal over 5 days, and no evidence of psychiatric illness was present at follow-up 1 and 4 months later. The authors proposed that clarithromycin inhibited the CYP3A4 metabolic pathway of prednisolone .

C) Six adult patients with asthma were given methylprednisolone or predniSONE 40 mg/1.73 m(2) on 2 consecutive days prior to the initiation of clarithromycin 500 mg twice daily for 9 days. On days 8 and 9 of clarithromycin, participants again received methylprednisolone or predniSONE. Clarithromycin did not significantly alter the plasma concentrations or clearance of prednisolone. Conversely, clarithromycin caused a 65% reduction in methylprednisolone clearance and significantly higher plasma concentrations .

Prednisone Overview

• Prednisone is used alone or with other medications to treat the symptoms of low corticosteroid levels (lack of certain substances that are usually produced by the body and are needed for normal body functioning). Prednisone is also used to treat other conditions in patients with normal corticosteroid levels. These conditions include certain types of arthritis; severe allergic reactions; multiple sclerosis (a disease in which the nerves do not function properly); lupus (a disease in which the body attacks many of its own organs); and certain conditions that affect the lungs, skin, eyes, kidneys blood, thyroid, stomach, and intestines. Prednisone is also sometimes used to treat the symptoms of certain types of cancer. Prednisone is in a class of medications called corticosteroids. It works to treat patients with low levels of corticosteroids by replacing steroids that are normally produced naturally by the body. It works to treat other conditions by reducing swelling and redness and by changing the way the immune system works.

Clarithromycin Overview

• 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.

• 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:

• Gold Standard Drug Database
• Micromedex
• Lexicomp
• DrugBank

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.