Clarithromycin

FDA label

Read the full label on DailyMed ↗

Renal Severe (CrCl <30 mL/min): reduce dose 50%. With concomitant atazanavir or ritonavir-containing regimen: moderate (CrCl 30-60) reduce 50%, severe (CrCl <30) reduce 75%.

Hepatic No adjustment needed (hepatic impairment with normal renal function)

Instructions

• Take with food
• Swallow whole; do not chew, break, or crush

Contraindications

• Concomitant cisapride or pimozide (QT prolongation, arrhythmia)
• History of cholestatic jaundice/hepatic dysfunction with prior clarithromycin
• Colchicine in patients with renal or hepatic impairment
• Lomitapide, lovastatin, or simvastatin
• Ergot alkaloids (ergotamine, dihydroergotamine)
• Lurasidone

Cautions

• Severe acute hypersensitivity (anaphylaxis, SJS, TEN, DRESS, AGEP)
• QT prolongation and torsade de pointes
• Hepatotoxicity
• Serious reactions from CYP3A4 interactions (colchicine, statins, calcium channel blockers, etc.)
• Increased all-cause mortality ≥1 year after treatment in patients with coronary artery disease
• C. difficile-associated diarrhea
• Embryo-fetal toxicity (avoid in pregnancy unless no alternative)
• Exacerbation of myasthenia gravis

Adverse reactions

• Abdominal pain
• Diarrhea
• Nausea
• Vomiting
• Dysgeusia

Pregnancy Not recommended in pregnancy except when no alternative therapy is appropriate; animal studies show malformations (cardiovascular anomalies, cleft palate).

Lactation Present in human milk (<2% of maternal weight-adjusted dose); breastfed-infant effects comparable to amoxicillin.