Drug interactions
Clarithromycin + Fluticasone-salmeterol
Severity: Major
Clarithromycin and Fluticasone-salmeterol: major interaction.
Last updated Sources: Health Canada product monograph
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 is a strong CYP3A4 inhibitor and raises systemic exposure to both salmeterol and fluticasone. Higher salmeterol levels can cause tachycardia, tremor, hypokalemia and QTc prolongation, and greater fluticasone exposure can cause systemic corticosteroid effects including adrenal suppression. Clarithromycin itself also prolongs the QT interval.
What this interaction means in plain words
Clarithromycin and Fluticasone-salmeterol 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; Fluticasone-salmeterol belongs to Respiratory.
Why it happens
Inhibition of CYP3A4-mediated metabolism of salmeterol and fluticasone, plus additive QT prolongation.
What to do
Avoid the combination where possible, using an alternative antibiotic such as azithromycin with ECG consideration or a non-CYP3A4-inhibiting option. If unavoidable, monitor heart rate, ECG, potassium and signs of corticosteroid excess.
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 Fluticasone-salmeterol
- Darunavir + Fluticasone-salmeterol Contraindicated
- Elvitegravir / cobicistat / emtricitabine / tenofovir df + Fluticasone-salmeterol Contraindicated
- Fluticasone-salmeterol + Fosamprenavir Contraindicated
- Fluticasone-salmeterol + Indinavir Contraindicated
- Fluticasone-salmeterol + Lopinavir Contraindicated
- Fluticasone-salmeterol + Nelfinavir 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 Fluticasone-salmeterol?
MediHelp rates the interaction as major. Clarithromycin and Fluticasone-salmeterol 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 is a strong CYP3A4 inhibitor and raises systemic exposure to both salmeterol and fluticasone. Higher salmeterol levels can cause tachycardia, tremor, hypokalemia and QTc prolongation, and greater fluticasone exposure can cause systemic corticosteroid effects including adrenal suppression. Clarithromycin itself also prolongs the QT interval.
How serious is the interaction between Clarithromycin and Fluticasone-salmeterol?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Avoid the combination where possible, using an alternative antibiotic such as azithromycin with ECG consideration or a non-CYP3A4-inhibiting option. If unavoidable, monitor heart rate, ECG, potassium and signs of corticosteroid excess.
What other medicines interact with Fluticasone-salmeterol?
MediHelp also lists interactions of Fluticasone-salmeterol with, for example, Darunavir, Elvitegravir / cobicistat / emtricitabine / tenofovir df, Fosamprenavir. The full list is on the Fluticasone-salmeterol page.
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