Drug interactions
Clarithromycin + Midazolam
Severity: Major
Clarithromycin and Midazolam: 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 raises midazolam exposure, particularly after oral dosing, prolonging and deepening sedation. Excessive sedation and respiratory depression can occur.
What this interaction means in plain words
Clarithromycin and Midazolam 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; Midazolam belongs to Central Nervous System.
Why it happens
Clarithromycin inhibits intestinal and hepatic CYP3A4, reducing midazolam first-pass and systemic clearance.
What to do
Avoid oral midazolam with clarithromycin; if unavoidable, use a reduced dose with respiratory and sedation monitoring. Prefer a non-CYP3A4 benzodiazepine such as lorazepam or an alternative antibiotic like azithromycin.
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 Midazolam
- Atazanavir + Midazolam Contraindicated
- Cobicistat + Midazolam Contraindicated
- Darunavir + Midazolam Contraindicated
- Elvitegravir / cobicistat / emtricitabine / tenofovir df + Midazolam Contraindicated
- Fosamprenavir + Midazolam Contraindicated
- Indinavir + Midazolam Contraindicated
Frequently asked questions
Can I take Clarithromycin with Midazolam?
MediHelp rates the interaction as major. Clarithromycin and Midazolam 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 raises midazolam exposure, particularly after oral dosing, prolonging and deepening sedation. Excessive sedation and respiratory depression can occur.
How serious is the interaction between Clarithromycin and Midazolam?
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 oral midazolam with clarithromycin; if unavoidable, use a reduced dose with respiratory and sedation monitoring. Prefer a non-CYP3A4 benzodiazepine such as lorazepam or an alternative antibiotic like azithromycin.
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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