Compatibility «Clarithromycin» and «Dexamethasone»

• Interactions Clarithromycin with Dexamethasone

  • 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.
    • ⓘ If necessary, co-administration with dexamethasone (a moderate inducer of CYP3A4) should be closely monitored for signs of increased side effects of ifosfamide (metabolized to active metabolites involving CYP3A4) (for example, neurotoxicity, nephrotoxicity).
    • ⓘ The simultaneous use of cariprazine with CYP3A4 inducers, such as dexamethasone, has not been evaluated and is not recommended, since their effect on active drugs and metabolites is unknown.
    • ⓘ With the combined use of crizotinib (a moderate CYP3A4 inhibitor) and dexamethasone (a CYP3A4 substrate), the risk of side effects associated with the use of dexamethasone may increase.
    • ⓘ With the simultaneous use of nilotinib (a CYP3A4 inhibitor) and dexamethasone (a CYP3A4 substrate), metabolism may decrease and the risk of side effects associated with GCS may increase.
    • ⓘ The combined use of ulipristal (CYP3A4 substrate) with dexamethasone, which is an inducer of CYP3A4, should be avoided.
  • 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.
    • ⓘ Simultaneous use of dexamethasone (a moderate CYP3A4 inducer) and abemaciclib (a CYP3A4 substrate) should be avoided due to reduced exposure to abemaciclib and its active metabolites, which may lead to a decrease in efficacy.
    • ⓘ Avanafil is primarily metabolized by CYP3A4, and the simultaneous use of CYP3A4 inducers such as dexamethasone may reduce its plasma levels.
    • ⓘ Concomitant use of axitinib (CYP3A4 substrate) and dexamethasone (CYP3A4 inducer) should be avoided due to the risk of reducing the effectiveness of axitinib.
    • ⓘ Caution should be exercised when using dexamethasone (CYP3A4 inducer) with amlodipine at the same time due to a possible increase in hepatic metabolism of amlodipine (CYP3A4 substrate).
    • ⓘ When used concomitantly with apalutamide (a strong CYP3A4 inducer), the effectiveness of dexamethasone (a CYP3A4 substrate) may decrease, and the possibility of increasing the dose of dexamethasone should be considered, if clinically appropriate.
    • ⓘ Since aripiprazole is metabolized by CYP3A4, the simultaneous use of CYP3A4 inducers such as dexamethasone may lead to a decrease in plasma concentrations of aripiprazole.
    • ⓘ Simultaneous use of dexamethasone (substrate and inducer of CYP3A4) with atazanavir (substrate, as well as a strong inhibitor of CYP3A4) should be avoided.
    • ⓘ The possibility of using other GCS, such as beclomethasone and prednisone, the concentration of which is less affected by strong CYP3A4 inhibitors, especially with prolonged use, should be considered.
    • ⓘ Concomitant administration of dexamethasone (CYP3A4 inducer) with bedaquiline should be avoided, which may lead to a decrease in the systemic effect of bedaquiline (AUC) and possibly its therapeutic effect.
    • ⓘ Drugs that are inducers of CYP3A4, such as dexamethasone, reduce the concentration of bicalutamide in plasma.
    • ⓘ Dose adjustment of systemic dexamethasone (CYP3A4 substrate) may be required if bosentan (CYP3A4 inducer) is prescribed or discontinued during therapy.
    • ⓘ The combined use of dexamethasone (inducer and substrate CYP3A4, substrate P-gp) and boceprevir (inhibitor and substrate CYP3A4, substrate P-gp) is not recommended, etc.; dexamethasone concentration may increase and the concentration of boceprevir in blood plasma may decrease.
    • ⓘ Caution should be exercised when using bromocriptine (CYP3A4 substrate) and dexamethasone (CYP3A4 inducer) simultaneously due to a possible decrease in the concentration of bromocriptine in blood plasma and loss of its effectiveness.
    • ⓘ Induction of the CYP3A4 isoenzyme by dexamethasone may lead to a decrease in the concentration of budesonide in plasma and a decrease in its clinical effect.
    • ⓘ Simultaneous use of venetoclax (CYP3A4 substrate) and dexamethasone (moderate CYP3A4 inducer), etc., should be avoided; it is possible to reduce the concentration and effectiveness of venetoclax.
    • ⓘ Use caution when using vinblastine (a CYP3A4 substrate) with a CYP3A4 inducer such as dexamethasone at the same time.
    • ⓘ Simultaneous use of dexamethasone (CYP3A4 inducer) and vincristine (CYP3A4 substrate) should be avoided due to a possible increase in vincristine metabolism and a decrease in its effectiveness.
    • ⓘ When dexamethasone (a CYP3A4 substrate) and voriconazole (a strong CYP3A4 inhibitor) are used together, it is necessary to monitor the development of adverse reactions associated with dexamethasone.
    • ⓘ Dexamethasone (a moderate CYP3A4 inducer) can significantly reduce the concentration of guanfacine (CYP3A4 substrate) in blood plasma.
    • ⓘ The combined use of dapsone (a CYP3A4 substrate) and dexamethasone (a moderate CYP3A4 inducer) can reduce the concentration of dapsone in plasma and increase the formation of dapsone hydroxylamine (a metabolite associated with hemolysis).
    • ⓘ Dexamethasone is a substrate and inducer of CYP3A4, and darunavir is a substrate, as well as a strong inhibitor of this isoenzyme.
    • ⓘ The possibility of using GCS such as beclomethasone and prednisone, the concentration of which is less affected by strong CYP3A4 inhibitors, especially with prolonged use, should be considered.
    • ⓘ If simultaneous use of dexamethasone (a moderate inducer of CYP3A4) is necessary, it is necessary to monitor the decrease in the effectiveness of dexlansoprazole (CY2C19 and CYP3A4 substrate).
    • ⓘ Simultaneous use of deflazacort (CYP3A4 substrate) and dexamethasone (moderate CYP3A4 inducer) should be avoided, which can significantly reduce the concentration of the active metabolite of deflazacort, which will lead to loss of effectiveness.
    • ⓘ The elimination of donepezil can be increased with the simultaneous use of inducers of the liver isoenzymes CYP2D6 and CYP3A4, such as dexamethasone.
    • ⓘ The simultaneous use of doravirin (a CYP3A4 substrate) and dexamethasone (a moderate CYP3A4 inducer) may lead to a decrease in the effect of doravirin and loss of virological control.
    • ⓘ Simultaneous use of dronedarone and CYP3A4 inducers such as dexamethasone should be avoided, this may lead to a decrease in plasma concentrations and a subsequent decrease in the effectiveness of dronedarone therapy; plasma concentrations of dexamethasone may also be increased.
    • ⓘ Zafirlukast inhibits CYP3A4 isoenzymes and should be used with caution in patients receiving drugs metabolized by CYP3A4, such as GCS.
    • ⓘ CYP3A4 is the main isoenzyme responsible for the metabolism of zolpidem, and there is evidence of a significant decrease in the systemic effects and pharmacodynamic effects of zolpidem with the simultaneous use of rifampicin, a strong inducer of CYP3A4.
    • ⓘ When used concomitantly, CYP3A4 inducers such as dexamethasone can reduce the systemic effects of zonisamide (a CYP3A4 substrate) by increasing its metabolism.
    • ⓘ Simultaneous use of ivabradine (CYP3A4 substrate) and dexamethasone (CYP3A4 inducer) should be avoided.
    • ⓘ When used concomitantly with rifamycin (CYP3A4 inducer), dose adjustment of dexamethasone (CYP3A4 substrate) may be required due to the possibility of reducing its effects.
    • ⓘ Ixabepilon is a CYP3A4 substrate, and concomitant use with dexamethasone, which is an inducer of CYP3A4, may lead to a decrease in ixabepilon concentration to subtherapeutic.
    • ⓘ Dexamethasone, which is an inducer of CYP3A4, can increase the metabolism of imatinib and reduce its concentration in the blood and clinical effects.
    • ⓘ Concomitant use with other drugs that are metabolized by CYP3A4 (for example, indinavir) may increase their clearance, which will lead to a decrease in plasma concentrations.
    • ⓘ If necessary, the combined use of itraconazole (a strong inhibitor and substrate of CYP3A4) and dexamethasone (a moderate inducer and substrate of CYP3A4) should be monitored for side effects associated with the use of GCS (decreased metabolism) and changes in the reaction to itraconazole (increased clearance).
    • ⓘ The simultaneous use of dexamethasone and clarithromycin may reduce the concentration of clarithromycin in the blood serum due to the induction of the CYP3A4 isoenzyme.
    • ⓘ The intended therapeutic effect of clarithromycin may be reduced.
    • ⓘ Alternatives to clarithromycin should be considered in patients receiving CYP3A4 inducers.
    • ⓘ In addition, clarithromycin inhibits CYP3A4, which may lead to an increase in the concentration of dexamethasone in blood plasma and require a reduction in the dosage of GCS.
    • ⓘ Concomitant use of clindamycin (CYP3A4 substrate) and dexamethasone (CYP3A4 inducer) may increase clearance and lead to loss of clindamycin efficacy.
    • ⓘ Caution is recommended when using dexamethasone (CYP3A4 inducer) and clozapine (CYP3A4 substrate) simultaneously.
    • ⓘ Patients receiving clozapine in combination with a mild to moderate CYP3A4 inducer should be monitored for loss of therapy effectiveness.
    • ⓘ The simultaneous use of lansoprazole (a substrate of CYP2C19 and CYP3A4) and dexamethasone (a moderate inhibitor of CYP3A4) may lead to a decrease in the concentration of lansoprazole in blood plasma and its effectiveness.
    • ⓘ Concomitant use of lapatinib (CYP3A4 substrate) with dexamethasone (CYP3A4 inducer) should be avoided due to a decrease in the concentration of lapatinib in plasma.
    • ⓘ Simultaneous systemic use of lidocaine (CYP3A4 and CYP1A2 substrate) and dexamethasone (CYP3A4 inducer) may reduce the concentration of lidocaine in blood plasma.
    • ⓘ With the simultaneous use of dexamethasone and the combination of lopinavir + ritonavir, it is possible to reduce the level of lopinavir in blood plasma and its clinical efficacy; ritonavir is a CYP3A4 inhibitor, therefore, careful monitoring of therapeutic and side effects is required when dexamethasone (CYP3A4 substrate) and ritonavir are used simultaneously.
    • ⓘ With the combined use of lurazidone, metabolized mainly with the participation of CYP3A4, and dexamethasone (a moderate inducer of CYP3A4), it is possible to reduce the concentration of lurazidone in blood plasma and its effectiveness.
    • ⓘ Caution should be exercised if it is necessary to use maraviroc (CYP3A4 substrate) with dexamethasone (CYP3A4 inducer) together because of the possible reduction in the effects of maraviroc and a decrease in its effectiveness.
    • ⓘ Dexamethasone is an inducer of CYP3A4 and can increase the metabolism of mefloquine, and reduce the concentration of mefloquine in blood plasma when used simultaneously.
    • ⓘ Mitotan, which is a strong inducer of CYP3A4, may lead to a decrease in the concentration of dexamethasone in blood plasma with simultaneous use, it may be necessary to adjust the dose of dexamethasone.
    • ⓘ Concomitant use of olaparib (CYP3A4 substrate) with dexamethasone (moderate CYP3A4 inducer) should be avoided due to the likelihood of a decrease in the effectiveness of olaparib.
    • ⓘ The simultaneous use of omeprazole (a substrate of CYP2C19 and CYP3A4) and dexamethasone (a moderate inducer of CYP3A4) may lead to a decrease in the concentration of omeprazole in blood plasma and its effectiveness.
    • ⓘ Concomitant use of pazopanib (CYP3A4 inhibitor, CYP3A4 substrate and P-gp) should be avoided in patients who require long-term use of a CYP3A4 inducer such as dexamethasone, which may lead to a change in the concentration of pazopanib and/or dexamethasone.
    • ⓘ When used concomitantly with dexamethasone (a moderate CYP3A4 inducer), perampanel (a CYP3A4 substrate) should be started with a higher initial dose of 4 mg 1 time per day before bedtime due to a potential decrease in its concentration in blood plasma.
    • ⓘ Caution should be exercised and the therapeutic response monitored when using CYP3A4 inducers, such as dexamethasone, with amlodipine (CYP3A4 substrate), etc.; an increase in hepatic metabolism of amlodipine is possible.
    • ⓘ Posaconazole is a strong inhibitor of CYP3A4, an isoenzyme partially responsible for the metabolism of dexamethasone.
    • ⓘ The combined use of primidone (CYP3A4 inducer) may lead to a decrease in the effectiveness of dexamethasone (CYP3A4 substrate).
    • ⓘ If necessary, simultaneous use with ribociclib (a strong CYP3A4 inhibitor) may increase the number of adverse reactions associated with dexamethasone (CYP3A4 substrate).
    • ⓘ The simultaneous use of rivaroxaban (CYP3A4 substrate) and dexamethasone (CYP3A4 inducer) may lead to a decrease in the effect and effectiveness of rivaroxaban.
    • ⓘ Careful monitoring of therapeutic and side effects is required with the simultaneous use of dexamethasone (CYP3A4 substrate) and ritonavir (CYP3A4 inhibitor).
    • ⓘ With the simultaneous use of rifamycins (CYP3A4 inducers) and dexamethasone (CYP3A4 substrate), the effectiveness of dexamethasone may decrease, and dose adjustment may be required.
    • ⓘ Caution should be exercised when using dexamethasone (CYP3A4 inducer) and roflumilast (CYP3A4 substrate) at the same time; this may lead to a decrease in the systemic effects of roflumilast and its active metabolite.
    • ⓘ When used with drugs that are inducers of CYP3A4, such as dexamethasone, dose adjustment is not required, but patients should be closely monitored and the dose of ruxolitinib should be titrated, depending on safety and efficacy.
    • ⓘ Simultaneous use of simeprevir and systemic dexamethasone should be avoided; induction of CYP3A4 with dexamethasone may reduce plasma concentrations of simeprevir, which will lead to ineffective treatment.
    • ⓘ Concomitant use of sorafenib (CYP3A4 substrate) with dexamethasone (CYP3A4 inducer) should be avoided due to a possible decrease in the concentration of sorafenib in blood plasma.
    • ⓘ If possible, the simultaneous use of dexamethasone (a moderate CYP3A4 inducer) and sunitinib (a CYP3A4 substrate) should be avoided due to the reduced effect of sunitinib, which may reduce its effectiveness.
    • ⓘ Studies have shown that simultaneous administration of CYP3A4 enzyme inducers, such as dexamethasone, reduces plasma levels of tadalafil.
    • ⓘ Dexamethasone is an inducer and substrate of the hepatic isoenzyme CYP3A4, telaprevir is an inhibitor and substrate of this isoenzyme.
    • ⓘ Concomitant use of ticagrelor (a CYP3A4 substrate) with dexamethasone (a moderate CYP3A4 inducer) may lead to a decrease in the concentration and effectiveness of ticagrelor.
    • ⓘ Simultaneous use of dexamethasone (CYP3A4 inducer) with toremifene (CYP3A4 substrate) should be avoided due to a possible decrease in the concentration of toremifene in blood plasma, which may lead to a decrease in its effectiveness.
    • ⓘ Dexamethasone is an inducer of CYP3A4, and the effect of tofacitinib is reduced when used concomitantly with strong inducers of CYP3A4.
    • ⓘ The combined use of phenobarbital (CYP3A4 inducer) may lead to a decrease in the effect of dexamethasone (CYP3A4 substrate).
    • ⓘ With the simultaneous use of ceritinib (a strong CYP3A4 inhibitor), due to a decrease in the metabolism of GCS, adverse reactions associated with their use should be monitored; Cushing's syndrome may develop and adrenal function suppression with prolonged use.
    • ⓘ The possibility of using GCS such as beclomethasone and prednisone, the concentration of which is less affected by strong CYP3A4 inhibitors, should be considered.
    • ⓘ If simultaneous use of dexamethasone (a moderate CYP3A4 inducer) is necessary, it is necessary to monitor the decrease in the effectiveness of esomeprazole (CY2C19 and CYP3A4 substrate).
    • ⓘ If necessary, the combined use of dexamethasone (a CYP3A4 substrate) and enzalutamide (a strong CYP3A4 inducer) should be monitored for a decrease in the effectiveness of dexamethasone and consider increasing the dose of dexamethasone, if clinically appropriate.
    • ⓘ Caution should be exercised when using dexamethasone and erythromycin (a CYP3A4 inhibitor), etc.; This may lead to increased plasma concentrations of GCS, such as dexamethasone.
    • ⓘ If possible, the simultaneous use of erlotinib (CYP3A4 substrate) and dexamethasone (moderate CYP3A4 inducer) should be avoided due to the risk of a decrease in plasma concentrations and the effectiveness of erlotinib.
    • ⓘ Due to the induction of CYP3A4 by dexamethasone, it is possible to reduce the clinical effectiveness of estrogens.
    • ⓘ Dexamethasone, which is an inducer of CYP3A4, can increase clearance and reduce the clinical efficacy of etoposide (a CYP3A4 substrate).
    • ⓘ Dexamethasone may induce CYP3A4 activity and increase etravirine metabolism; there may be a decrease in antiviral efficacy.
  • No interactions
    • ⓘ Simultaneous administration of CYP3A4 enzyme inducers, such as dexamethasone, can be expected to reduce the level of vardenafil in blood plasma.
    • ⓘ It can be expected that the simultaneous use of sildenafil with inducers of the CYP3A4 enzyme, such as dexamethasone, will reduce the plasma concentrations of sildenafil.
  • Positive interactions
    • ⓘ It is recommended to choose concomitant drugs with minimal or zero potential for CYP3A4 induction.
    • ⓘ The dose of daclatasvir, a CYP3A4 substrate, should be increased to 90 mg orally once a day when used in combination with moderate CYP3A4 inducers such as dexamethasone.
    • ⓘ It is recommended to closely monitor the decrease in the effectiveness of zolpidem while prescribing moderate CYP3A4 inducers, such as dexamethasone.
    • ⓘ Although the concentration of the active metabolite of 14-OH-clarithromycin increases, this metabolite has unequal antimicrobial activity compared to clarithromycin.
  • Unclear interactions
    • ⓘ The simultaneous use of brentuximab vedotin and dexamethasone (CYP3A4 inducer) may reduce the effect of monomethylauristatin E (CYP3A4 substrate), the active metabolite of brentuximab vedotin, and, consequently, the effectiveness of brentuximab.
    • ⓘ Dexamethasone, which is an inducer of CYP3A4, can increase the metabolic rate of buspirone.
    • ⓘ Vardenafil is metabolized by CYP3A4.
    • ⓘ Vemurafenib is a CYP3A4 substrate/inducer and a P-gp substrate/inhibitor.
    • ⓘ Dexamethasone is a CYP3A4 substrate/inducer and a P-gp substrate.
    • ⓘ Gefitinib is largely metabolized by CYP3A4, and dexamethasone is an inducer of CYP3A4.
    • ⓘ Dexamethasone and dabrafenib are substrates and moderate inducers of CYP3A4.
    • ⓘ Dexamethasone is a moderate inducer of CYP3A4.
    • ⓘ Cariprazine and its active metabolites are intensively metabolized by CYP3A4.
    • ⓘ Clarithromycin.
    • ⓘ The simultaneous use of codeine with dexamethasone may reduce codeine levels due to the induction of CYP3A4 by dexamethasone.
    • ⓘ Codeine is mainly metabolized by CYP2D6 to morphine and CYP3A4 to norcodeine, which has no analgesic properties.
    • ⓘ Loperamide is metabolized by the hepatic isoenzyme CYP3A4, dexamethasone is an inducer of this isoenzyme.
    • ⓘ Mefloquine is metabolized by CYP3A4.
    • ⓘ Ruxolitinib is a CYP3A4 substrate.
    • ⓘ Sildenafil is metabolized mainly by CYP3A4.
    • ⓘ Dexamethasone is an inducer of CYP3A4.
    • ⓘ Sirolimus is intensively metabolized by CYP3A4 in the intestine and liver.
    • ⓘ Tadalafil is metabolized mainly by CYP3A4.
    • ⓘ Dexamethasone is a substrate of CYP3A4 and P-gp, and telithromycin is a strong inhibitor of CYP3A4 and a potential inhibitor of P-gp.
    • ⓘ In addition, dexamethasone is an inducer, and telithromycin is a CYP3A4 substrate.
    • ⓘ Temsirolimus is a substrate, and dexamethasone is an inducer of CYP3A4.
    • ⓘ Dexamethasone (a moderate CYP3A4 inducer) may increase the excretion of quinidine (a CYP3A4 substrate) by the liver and reduce its effectiveness.
    • ⓘ Cisapride is metabolized by the cytochrome P450 system, in particular by the CYP3A4 isoenzyme.
    • ⓘ CYP3A4 inducers such as dexamethasone may increase the clearance of cisapride.
    • ⓘ Escitalopram is metabolized by CYP2C19 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

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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