Drug interactions
Buprenorphine + Clarithromycin
Severity: Major
Buprenorphine and Clarithromycin: major interaction.
Last updated Sources: US FDA label
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 inhibits CYP3A4 and may raise buprenorphine levels, increasing sedation and respiratory depression. Both drugs also affect QT, adding to arrhythmia risk.
What this interaction means in plain words
Buprenorphine 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.
Buprenorphine belongs to Musculoskeletal; Clarithromycin belongs to Anti Bacterial.
Why it happens
CYP3A4 inhibition of buprenorphine metabolism plus additive QT prolongation.
What to do
Prefer a non-interacting antibiotic such as azithromycin or another class. If used together, monitor for sedation, reduce the buprenorphine dose as needed and check the ECG.
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 Buprenorphine
- Alvimopan + Buprenorphine Contraindicated
- Buprenorphine + Calcium / magnesium / potassium / sodium oxybates Contraindicated
- Buprenorphine + Olanzapine / samidorphan Contraindicated
- Buprenorphine + Phenelzine Contraindicated
- Buprenorphine + Pimozide Contraindicated
- Buprenorphine + Thioridazine Contraindicated
Other interactions of Clarithromycin
- Astemizole + Clarithromycin Contraindicated
- Avanafil + Clarithromycin Contraindicated
- Cisapride + Clarithromycin Contraindicated
- Clarithromycin + Colchicine Contraindicated
- Clarithromycin + Conivaptan Contraindicated
- Clarithromycin + Dihydroergotamine Contraindicated
Frequently asked questions
Can I take Buprenorphine with Clarithromycin?
MediHelp rates the interaction as major. Buprenorphine 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 inhibits CYP3A4 and may raise buprenorphine levels, increasing sedation and respiratory depression. Both drugs also affect QT, adding to arrhythmia risk.
How serious is the interaction between Buprenorphine 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 a non-interacting antibiotic such as azithromycin or another class. If used together, monitor for sedation, reduce the buprenorphine dose as needed and check the ECG.
What other medicines interact with Buprenorphine?
MediHelp also lists interactions of Buprenorphine with, for example, Alvimopan, Calcium / magnesium / potassium / sodium oxybates, Olanzapine / samidorphan. The full list is on the Buprenorphine page.
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