Drug interactions
Clarithromycin + Cyclosporin
Severity: Major
Clarithromycin and Cyclosporin: 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 markedly increases cyclosporine concentrations and has led to nephrotoxicity and neurotoxicity. Clarithromycin itself may also accumulate in renal impairment.
What this interaction means in plain words
Clarithromycin and Cyclosporin 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 belongs to Anti Bacterial; Cyclosporin belongs to Miscellaneous.
Why it happens
Inhibition of CYP3A4 and P-glycoprotein by clarithromycin reduces cyclosporine clearance.
What to do
Prefer an alternative antibiotic such as azithromycin. If clarithromycin is needed, reduce the cyclosporine dose and monitor trough levels and creatinine closely.
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 Cyclosporin
- Adenovirus types 4 and 7 live + Cyclosporin Contraindicated
- Aliskiren + Cyclosporin Contraindicated
- Bcg vaccine live + Cyclosporin Contraindicated
- Bosentan + Cyclosporin Contraindicated
- Cidofovir + Cyclosporin Contraindicated
- Cyclosporin + Dengue vaccine 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 Clarithromycin with Cyclosporin?
MediHelp rates the interaction as major. Clarithromycin and Cyclosporin 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 markedly increases cyclosporine concentrations and has led to nephrotoxicity and neurotoxicity. Clarithromycin itself may also accumulate in renal impairment.
How serious is the interaction between Clarithromycin and Cyclosporin?
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 an alternative antibiotic such as azithromycin. If clarithromycin is needed, reduce the cyclosporine dose and monitor trough levels and creatinine closely.
What other medicines interact with Cyclosporin?
MediHelp also lists interactions of Cyclosporin with, for example, Adenovirus types 4 and 7 live, Aliskiren, Bcg vaccine live. The full list is on the Cyclosporin page.
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