Drug interactions
Amitriptyline + Clarithromycin
Severity: Major
Amitriptyline and Clarithromycin: major interaction.
Last updated
For healthcare professionals — reference only. This page is a brief summary, not medical advice and not a substitute for official labeling or clinical judgement. Always verify before prescribing or dispensing.
Summary
Clarithromycin may raise amitriptyline levels and both agents prolong the QT interval. This increases the risk of arrhythmia and tricyclic toxicity including anticholinergic effects and sedation.
What this interaction means in plain words
Amitriptyline and Clarithromycin can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for.
Amitriptyline belongs to Central Nervous System; Clarithromycin belongs to Anti Bacterial.
Why it happens
Additive QT prolongation plus inhibition of CYP3A4-mediated amitriptyline metabolism by clarithromycin.
What to do
Prefer azithromycin or another non-interacting antibiotic. If combined, obtain an ECG and monitor for tricyclic toxicity, adjusting the amitriptyline dose as required.
What to ask your pharmacist
- Does the benefit of taking both outweigh the risk in my case?
- Do I need any blood test, ECG or other check while on both?
- What early warning signs should I watch for, and what should I do if they appear?
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Other interactions of Clarithromycin
- Astemizole + Clarithromycin Contraindicated
- Avanafil + Clarithromycin Contraindicated
- Cisapride + Clarithromycin Contraindicated
- Clarithromycin + Colchicine Contraindicated
- Clarithromycin + Conivaptan Contraindicated
- Clarithromycin + Dihydroergotamine Contraindicated
Other interactions of Amitriptyline
- Amitriptyline + Isocarboxazid Contraindicated
- Amitriptyline + Methylene blue Contraindicated
- Amitriptyline + Phenelzine Contraindicated
- Amitriptyline + Pimozide Contraindicated
- Amitriptyline + Procarbazine Contraindicated
- Amitriptyline + Safinamide Contraindicated
Frequently asked questions
Can I take Amitriptyline with Clarithromycin?
MediHelp rates the interaction as major. Amitriptyline and Clarithromycin can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for. Clarithromycin may raise amitriptyline levels and both agents prolong the QT interval. This increases the risk of arrhythmia and tricyclic toxicity including anticholinergic effects and sedation.
How serious is the interaction between Amitriptyline and Clarithromycin?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Prefer azithromycin or another non-interacting antibiotic. If combined, obtain an ECG and monitor for tricyclic toxicity, adjusting the amitriptyline dose as required.
What other medicines interact with Clarithromycin?
MediHelp also lists interactions of Clarithromycin with, for example, Astemizole, Avanafil, Cisapride. The full list is on the Clarithromycin page.
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