Drug interactions
Clarithromycin + Sirolimus
Severity: Major
Clarithromycin and Sirolimus: 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 sirolimus blood concentrations, which can cause toxicity such as myelosuppression, hyperlipidemia, impaired wound healing and nephrotoxicity.
What this interaction means in plain words
Clarithromycin and Sirolimus 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; Sirolimus belongs to Miscellaneous.
Why it happens
Inhibition of CYP3A4 and P-glycoprotein reduces sirolimus clearance.
What to do
Prefer azithromycin or another non-interacting antibiotic. If clarithromycin is necessary, reduce the sirolimus dose and monitor trough levels and renal function closely during and after therapy.
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 Sirolimus
- Adenovirus types 4 and 7 live + Sirolimus Contraindicated
- Bcg vaccine live + Sirolimus Contraindicated
- Influenza virus vaccine quadrivalent intranasal + Sirolimus Contraindicated
- Ketoconazole + Sirolimus Contraindicated
- Levoketoconazole + Sirolimus Contraindicated
- Measles mumps and rubella vaccine live + Sirolimus Contraindicated
Frequently asked questions
Can I take Clarithromycin with Sirolimus?
MediHelp rates the interaction as major. Clarithromycin and Sirolimus 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 sirolimus blood concentrations, which can cause toxicity such as myelosuppression, hyperlipidemia, impaired wound healing and nephrotoxicity.
How serious is the interaction between Clarithromycin and Sirolimus?
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 azithromycin or another non-interacting antibiotic. If clarithromycin is necessary, reduce the sirolimus dose and monitor trough levels and renal function closely during and after therapy.
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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