Compatibility «Clarithromycin» and «Itraconazole»

• Interactions Clarithromycin with Itraconazole

  • Dangerous interactions
    • ⓘ Concomitant administration of clarithromycin with lovastatin and simvastatin is contraindicated (see section 'Contraindications') due to the fact that these statins are largely metabolized by the CYP3A4 isoenzyme, and co-administration with clarithromycin increases their serum concentrations, which leads to an increased risk of myopathy, including rhabdomyolysis.
    • ⓘ When itraconazole is co-administered with moderate or potent CYP3A4 inducers, the bioavailability of itraconazole and hydroxyitraconazole may decrease, so that efficacy may be reduced.
  • Negative interactions
    • ⓘ When using clarithromycin and blockers of 'slow' calcium channels, which are metabolized by the CYP3A4 isoenzyme (for example, verapamil, amlodipine, diltiazem), caution should be exercised, since there is a risk of arterial hypotension.
    • ⓘ Clarithromycin and itraconazole are substrates and inhibitors of the CYP3A isoenzyme, which determines the bidirectional interaction of drugs.
    • ⓘ Patients taking itraconazole and clarithromycin at the same time should be carefully examined for symptoms of increased or prolonged pharmacological effects of these drugs.
    • ⓘ Other substances that use this metabolic pathway or alter the activity of CYP3A4 may affect the pharmacokinetics of itraconazole.
    • ⓘ Concomitant use with moderate or potent CYP3A4 inhibitors may increase the bioavailability of itraconazole, leading to more pronounced or prolonged pharmacological effects of itraconazole.
    • ⓘ Itraconazole and its main metabolite hydroxyitraconazole are potent inhibitors of CYP3A4.
    • ⓘ Itraconazole can inhibit the metabolism of drugs metabolized by CYP3A4 and the transport of drugs by P‑glycoprotein and/or BCRP, as a result of which the concentration of these drugs and/or their active metabolites in plasma may increase when taken concomitantly with itraconazole.
    • ⓘ Plasma concentrations decrease more slowly in patients with cirrhosis of the liver or those treated with CYP3A4 inhibitors.
    • ⓘ • CYP3A4 substrates, in which plasma concentrations may increase with prolongation or enhancement of therapeutic and/or undesirable effects until potentially serious situations occur (see the section 'Contraindications').
    • ⓘ • moderate or potent CYP3A4 inducers: administration 2 weeks before and during treatment with itraconazole is not recommended; CYP3A4/P‑gp/BCRP substrates.
    • ⓘ • moderate or potent CYP3A4 inhibitors;.
    • ⓘ • CYP3A4/P‑gp/BCRP substrates for which an increase or decrease in plasma concentrations may lead to a clinically significant risk.
    • ⓘ Use with caution, monitor for adverse reactions to itraconazole and/or clarithromycin^c, it may be necessary to reduce the dose of itraconazole and/or clarithromycin.
    • ⓘ • CYP3A4 inhibitors (including itraconazole) may increase the concentration of hormonal contraceptives in blood plasma.
    • ⓘ ^a For drugs with arrows in parentheses, the assessment is based on the mechanism of drug interactions and information on clinical drug interactions with ketoconazole or other potent CYP3A4 inhibitors and/or P‑glycoprotein or BCRP inhibitors, as well as data from modeling, clinical cases and/or in vitro experiments.
  • Positive interactions
    • ⓘ Rifampicin and phenytoin reduce the bioavailability of itraconazole, cytochrome CYP3A4 inhibitors (ritonavir, indinavir, clarithromycin) increase its bioavailability.
    • ⓘ Clarithromycin - increased concentration (degree unknown)^a,b.
  • Unclear interactions
    • ⓘ Itraconazole.
    • ⓘ Clarithromycin may increase plasma concentrations of itraconazole, while itraconazole may increase plasma concentrations of clarithromycin.
    • ⓘ Itraconazole is primarily metabolized by CYP3A4.
    • ⓘ Clarithromycin.

Decoding the colors of interactions and contraindications

Dangerous	—	a pronounced negative interaction or contraindication.
Negative	—	negative interaction or side effect that may reduce effectiveness.
Positive	—	the interaction can SOMETIMES be used as a positive (often a dose adjustment is needed), or it is an indication of the drug.
No	—	the drugs do NOT interact, which is separately indicated in the instructions.
Unclear	—	the system failed to pre-assess the danger.

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Additional information

• Kiberis checks interactions and evaluates drug compatibility for free online right in the instructions thanks to the latest artificial intelligence technologies. The accuracy of finding is more than 95%, the accuracy of the hazard assessment is more than 80%. The online medical service takes into account all the drug groups of the selected drugs and all their components. And since the database contains 25,000 drugs with detailed instructions, not every pharmacologist can compete with our artificial intelligence. List of popular interactions.
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• The use of information about interactions is only possible as an introduction. This information should not be used to adjust therapy without consulting a specialist.
• The article is written: artificial intelligence Kiberis
• Sources: official instructions for medicines and their active substances, as well as inter-group interactions described in medical studies and textbooks.
• Total analyzed: 169,994,378 possible combinations of drugs and their components were found 412,530 interacting combinations.
• Medicine section: Standard evidence-based medicine
• The date of the last update of the interaction database: 2024-12-19

Category - medicine