Drug interactions
Brexpiprazole + Clarithromycin
Severity: Major
Brexpiprazole and Clarithromycin: major interaction.
Last updated Sources: EMA SmPC
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, a strong CYP3A4 inhibitor, substantially increases brexpiprazole exposure, raising the risk of sedation, akathisia, orthostatic hypotension and other dose-related adverse effects. The risk rises further if a CYP2D6 inhibitor is also present.
What this interaction means in plain words
Brexpiprazole 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.
Brexpiprazole belongs to Central Nervous System; Clarithromycin belongs to Anti Bacterial.
Why it happens
Clarithromycin inhibits CYP3A4-mediated metabolism of brexpiprazole, the main clearance route along with CYP2D6.
What to do
Reduce the brexpiprazole dose to half the usual dose during clarithromycin therapy, and to a quarter if a strong or moderate CYP2D6 inhibitor is also used; return to the usual dose after clarithromycin is stopped.
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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References
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 Brexpiprazole
Frequently asked questions
Can I take Brexpiprazole with Clarithromycin?
MediHelp rates the interaction as major. Brexpiprazole 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, a strong CYP3A4 inhibitor, substantially increases brexpiprazole exposure, raising the risk of sedation, akathisia, orthostatic hypotension and other dose-related adverse effects. The risk rises further if a CYP2D6 inhibitor is also present.
How serious is the interaction between Brexpiprazole 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: Reduce the brexpiprazole dose to half the usual dose during clarithromycin therapy, and to a quarter if a strong or moderate CYP2D6 inhibitor is also used; return to the usual dose after clarithromycin is stopped.
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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