Compatibility «Clarithromycin» and «Warfarin»

• Interactions Clarithromycin with Warfarin

  • Dangerous interactions
    • ⓘ Increases the effectiveness of indirect anticoagulants (suppressing intestinal microflora, reduces the synthesis of vitamin K and the prothrombin index), reduces the effectiveness of drugs, during the metabolism of which paraaminobenzoic acid is formed, ethinyl estradiol - the risk of 'breakthrough' bleeding.
    • ⓘ Exogenous factors: potentially possible interaction of warfarin and drugs of the following classes and groups: 5-lipoxygenase inhibitors, adrenostimulants, drugs of central action to reduce alcohol abuse, analgesics, inhaled anesthetics, antiandrogens, antiarrhythmic drugs, antibiotics¹ (oral aminoglycosides, parenteral cephalosporins, macrolides, IV high-dose penicillins, macrolides, tetracyclines), quinolone antibacterial drugs, long-acting sulfonamides, anticoagulants, anticonvulsants¹, antidepressants¹, intravaginal and systemic antifungal drugs¹, antimalarial drugs, antitumor drugs¹, antiparasitic and antimicrobial drugs¹, platelet aggregation inhibitors, antiteroid drugs¹, beta-blockers, cholelitolytic drugs, antidiabetic drugs, oral diuretics¹, drugs that regulate the acidity of gastric juice and anti-ulcer drugs¹, prokinetics, drugs for the treatment of gout, hemorheological drugs, drugs for the treatment of ulcerative colitis, hepatotoxic drugs, hyperglycemic drugs, emergency medications for hypertension, hypnotic drugs¹, leukotriene receptor antagonists, lipid-lowering drugs (fibrates, HMG-CoA reductase inhibitors, bile acid sequestrants)¹, MAO inhibitors, long-acting narcotic drugs, drugs of natural origin, NSAIDs (non-selective COX-2 inhibitors), psychostimulants, pyrazolones, salicylates, SSRIs, adrenocorticosteroids, anabolic steroids (derivatives of 17-alkyltestosterone), thrombolytics, thyroid agents, anti-tuberculosis drugs, uricosuric drugs, vaccines, vitamins¹.
  • Negative interactions
    • ⓘ Clarithromycin increases the concentration in the blood (enhances the effects) of drugs metabolized in the liver with the participation of cytochrome P450 enzymes: warfarin and other indirect anticoagulants (there are separate post-marketing reports that, in combination with oral anticoagulants, clarithromycin can potentiate their effect, in case of combined use, it is necessary to carefully monitor PV), carbamazepine, theophylline, astemizole, cisapride, triazolam, midazolam, cyclosporine, digoxin, phenytoin, ergot alkaloids, etc.; (when used simultaneously, it is recommended to measure their concentration in the blood).
    • ⓘ When taking warfarin and clarithromycin together, bleeding may occur, a marked increase in INR and prothrombin time.
    • ⓘ In the case of combined use with warfarin and other indirect anticoagulants, it is necessary to monitor INR and prothrombin time.
    • ⓘ However, the literature describes cases of an increase in the international normalized ratio (INR) in patients receiving maintenance therapy with acenocumarol or warfarin, who are prescribed a course of treatment with amoxicillin.
    • ⓘ In addition, it may be necessary to adjust the dose of anticoagulants for oral administration.
    • ⓘ Lansoprazole slows down the elimination of drugs metabolized in the liver by microsomal oxidation (including diazepam, ibuprofen, indomethacin, clarithromycin, prednisolone, propranolol, terfenadine, warfarin, phenytoin).
    • ⓘ However, there have been reports of increased INR and prothrombin time in patients who were simultaneously taking proton pump inhibitors and warfarin.
    • ⓘ With the simultaneous use of lansoprazole and warfarin, it may be necessary to monitor INR and prothrombin time at the beginning and at the end of therapy, as well as during irregular use of lansoprazole.
    • ⓘ Inhibitors of CYP2C9, CYP1A2 and/or CYP3A4 can potentially enhance the effect (increase INR) of warfarin by increasing its exposure.
    • ⓘ Inducers CYP2C9, CYP1A2 and/or CYP3A4 can potentially reduce the effect (decrease INR) of warfarin by reducing its exposure.
  • No interactions
    • ⓘ With simultaneous use of lansoprazole at a dose of 60 mg and warfarin, no changes in the pharmacokinetics of warfarin or INR were observed.
  • Unclear interactions
    • ⓘ The metabolism of the following drugs/classes is carried out by the same CYP3A isoenzyme as the metabolism of clarithromycin, for example, alprazolam, carbamazepine, cilostazol, cyclosporine, disopyramide, methylprednisolone, midazolam, omeprazole, indirect anticoagulants (e.g., warfarin), atypical antipsychotics (e.g., quetiapine), quinidine, rifabutin, sildenafil, tacrolimus, triazolam and a vinblastine.
    • ⓘ Indirect anticoagulants.
    • ⓘ Warfarin.
    • ⓘ CYP450 isoenzymes involved in warfarin metabolism include CYP2C9, CYP2C19, CYP2C8, CYP2C18, CYP1A2 and CYP3A4.
    • ⓘ The more active S-enantiomer of warfarin (60% of the total anticoagulation response) is metabolized with the participation of CYP2C9, while the R-enantiomer is metabolized by CYP1A2 and CYP3A4.

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