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Interaction with other medicinal products and other forms of interaction
Clarithromycin does not interact with oral contraceptives.
The use of the following drugs is strictly contraindicated due to the possible severe consequences of the interactions.
Increased cisapride, pimozide and terfenadine in the blood serum was observed when applied simultaneously with clarithromycin, which may cause QT interval prolongation and appearance of arrhythmias, including ventricular tachycardia, ventricular fibrillation and torsade de pointes. Similar effects were also observed in the combined use astemizole and other macrolides.
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Concomitant use of clarithromycin and ergotamine or dihydroergotamine was associated with the emergence of signs of acute ergotism, which was characterized by vasospasm and ischemia of the extremities and other tissues including the central nervous system.
The influence of other drugs on the pharmacokinetics of clarithromycin.
Influence of the following medicines at concentrations of clarithromycin are known or suspected blood, so may need to change the dose or the use of alternative therapies.
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Potent inducers of cytochrome 450 enzymes, such as efavirenz, nevirapine, rifampin, rifapentine, rifabutin and clarithromycin may accelerate metabolism, reducing its concentration in the blood plasma, but increasing the concentration of 14-OH-clarithromycin - microbiologically active metabolite. Since the microbiological activity of clarithromycin and 14-OH-clarithromycin varies against different bacteria, the expected therapeutic effect can not be achieved through the combined use of clarithromycin and inductors 450 cytochrome.