Editing Clarithromycin (section)

== Interactions ==
Clarithromycin inhibits a liver enzyme, [[CYP3A4]], involved in the metabolism of many other commonly prescribed drugs. Taking clarithromycin with other medications that are metabolized by CYP3A4 may lead to unexpected increases or decreases in [[CYP3A4#Ligands|drug]] levels.<ref name="pmid31628882">{{cite journal |vauthors=Hougaard Christensen MM, Bruun Haastrup M, Øhlenschlaeger T, Esbech P, Arnspang Pedersen S, Bach Dunvald AC, Bjerregaard Stage T, Pilsgaard Henriksen D, Thestrup Pedersen AJ |title=Interaction potential between clarithromycin and individual statins-A systematic review |journal=Basic Clin Pharmacol Toxicol |volume=126 |issue=4 |pages=307–317 |date=April 2020 |pmid=31628882 |doi=10.1111/bcpt.13343 |url=}}</ref><ref name="pmid37874128">{{cite journal |vauthors=Herdegen T, Cascorbi I |title=Drug Interactions of Tetrahydrocannabinol and Cannabidiol in Cannabinoid Drugs: Recommendations for Clinical Practice |journal=Dtsch Ärztebl Int |volume= 120|issue=49 |pages= 833–840|date=December 2023 |pmid=37874128 |doi=10.3238/arztebl.m2023.0223 |pmc=10824494 |s2cid=264438050 |url=}}</ref>

A few of the common interactions are listed below.

===Colchicine===
Clarithromycin has been observed to have a dangerous interaction with [[colchicine]] as the result of inhibition of CYP3A4 metabolism and [[P-glycoprotein]] transport. Combining these two drugs may lead to fatal colchicine toxicity, particularly in people with [[chronic kidney disease]].<ref name="biaxin-filmtab" />

===Statins===
Taking clarithromycin concurrently with certain [[statins]] (a class of drugs used to reduce blood serum [[cholesterol]] levels) increases the risk of side effects, such as muscle aches and muscle break down ([[rhabdomyolysis]]).<ref name="pmid23778904">{{cite journal | vauthors = Patel AM, Shariff S, Bailey DG, Juurlink DN, Gandhi S, Mamdani M, Gomes T, Fleet J, Hwang YJ, Garg AX  | title = Statin toxicity from macrolide antibiotic coprescription: a population-based cohort study | journal = Annals of Internal Medicine | volume = 158 | issue = 12 | pages = 869–76 | date = June 2013 | pmid = 23778904 | doi = 10.7326/0003-4819-158-12-201306180-00004 | s2cid = 21222679 }}</ref>

===Calcium channel blockers===
Concurrent therapy with [[calcium channel blocker]] may increase risk of [[Hypotension|low blood pressure]], [[kidney failure]], and death, compared to pairing calcium channel blockers with [[azithromycin]], a drug similar to clarithromycin but without CYP3A4 inhibition.<ref name="pmid24346990">{{cite journal | vauthors = Gandhi S, Fleet JL, Bailey DG, McArthur E, Wald R, Rehman F, Garg AX | title = Calcium-channel blocker-clarithromycin drug interactions and acute kidney injury | journal = JAMA | volume = 310 | issue = 23 | pages = 2544–53 | date = December 2013 | pmid = 24346990 | doi = 10.1001/jama.2013.282426 | doi-access =  }}</ref> Administration of clarithromycin in combination with verapamil have been observed to cause [[Hypotension|low blood pressure]], [[Bradycardia|low heart rate]], and [[lactic acidosis]].<ref name="biaxin-filmtab" />

===Carbamazepine===
Clarithromycin may double the level of [[carbamazepine]] in the body by reducing its clearance, which may lead to toxic symptoms of carbamazepine, such as [[Diplopia|double vision]], [[Ataxia|loss of voluntary body movement]], and nausea, as well as [[hyponatremia]].<ref name="pmid18033049">{{cite journal | vauthors = Gélisse P, Hillaire-Buys D, Halaili E, Jean-Pastor MJ, Vespignan H, Coubes P, Crespel A | title = [Carbamazepine and clarithromycin: a clinically relevant drug interaction] | journal = Revue Neurologique | volume = 163 | issue = 11 | pages = 1096–9 | date = November 2007 | pmid = 18033049 | doi = 10.1016/s0035-3787(07)74183-8 }}</ref>

===HIV medications===
Depending on the combination of medications, clarithromycin therapy could be contraindicated, require changing doses of some medications, or be acceptable without dose adjustments.<ref name="pmid18094220">{{cite journal | vauthors = Sekar VJ, Spinosa-Guzman S, De Paepe E, De Pauw M, Vangeneugden T, Lefebvre E, Hoetelmans RM | title = Darunavir/ritonavir pharmacokinetics following coadministration with clarithromycin in healthy volunteers | journal = Journal of Clinical Pharmacology | volume = 48 | issue = 1 | pages = 60–5 | date = January 2008 | pmid = 18094220 | doi = 10.1177/0091270007309706 | s2cid = 38368595 }}</ref> For example, clarithromycin may lead to decreased [[zidovudine]] concentrations.<ref name="pmid9257746">{{cite journal | vauthors = Polis MA, Piscitelli SC, Vogel S, Witebsky FG, Conville PS, Petty B, Kovacs JA, Davey RT, Walker RE, Falloon J, Metcalf JA, Craft C, Lane HC, Masur H  | title = Clarithromycin lowers plasma zidovudine levels in persons with human immunodeficiency virus infection | journal = Antimicrobial Agents and Chemotherapy | volume = 41 | issue = 8 | pages = 1709–14 | date = August 1997 | pmid = 9257746 | pmc = 163990 | doi = 10.1128/AAC.41.8.1709 }}</ref>