TRIPASS XR تري باس

 

is predicted to increase the exposure to aliskiren.

Theoretical

▶ Macrolides (clarithromycin, erythromycin) are predicted to

increase the exposure to aliskiren.oStudy

▶ Clarithromycin increases the exposure to almotriptan.n

Study

▶ Clarithromycin is predicted to moderately increase the

exposure to alpha blockers (alfuzosin, tamsulosin). Use with

caution or avoid.oStudy

▶ Clarithromycin is predicted to increase the exposure to alpha

blockers (doxazosin).oStudy

▶ Erythromycin is predicted to increase the exposure to alpha

blockers (tamsulosin).oTheoretical

▶ Clarithromycin moderately increases the exposure to

alprazolam. Avoid.oStudy

▶ Erythromycin is predicted to increase the exposure to

alprazolam.rStudy

▶ Azithromycin is predicted to increase the exposure to

aminophylline.oTheoretical

▶ Clarithromycin is predicted to increase the exposure to

aminophylline. Adjust dose.oTheoretical

▶ Aminophylline is predicted to decrease the exposure to

erythromycin. Adjust dose.rStudy

▶ Clarithromycin very markedly increases the exposure to

antiarrhythmics (dronedarone). Avoid.rStudy → Also see

TABLE 9 p. 1377

▶ Erythromycin is predicted to moderately increase the exposure

to antiarrhythmics (dronedarone). Avoid.rTheoretical →

Also see TABLE 9 p. 1377

▶ Macrolides (clarithromycin, erythromycin) are predicted to

increase the exposure to

Theoretical

antiarrhythmics (lidocaine).o ▶ Clarithromycin is predicted to increase the exposure to

antiarrhythmics

Study

(propafenone). Monitor and adjust dose.r

▶ Erythromycin is predicted to increase the exposure to

antiarrhythmics

o

(propafenone). Monitor and adjust dose.

Study

▶ Clarithromycin is predicted to increase the exposure to

anticholinesterases, centrally acting (galantamine). Monitor and

adjust dose.oStudy

▶ Clarithromycin slightly increases the concentration of

antiepileptics (carbamazepine). Monitor concentration and

adjust dose.rStudy

▶ Erythromycin markedly increases the concentration of

antiepileptics (carbamazepine). Monitor concentration and

adjust dose.rStudy

▶ Clarithromycin is predicted to very slightly increase the

exposure to antiepileptics (perampanel).nStudy

▶ Clarithromycin is predicted to increase the exposure to

antifungals, azoles (isavuconazole). Avoid or monitor side

effects.rStudy

▶ Erythromycin is predicted to increase the exposure to

antifungals, azoles (isavuconazole).oTheoretical

▶ Clarithromycin is predicted to increase the exposure to

antihistamines, non-sedating (mizolastine). Avoid.rStudy

▶ Erythromycin is predicted to increase the exposure to

antihistamines, non-sedating (mizolastine).rTheoretical

▶ Macrolides (clarithromycin, erythromycin) are predicted to

increase the exposure to antihistamines, non-sedating

(rupatadine). Avoid.oStudy

▶ Macrolides (clarithromycin, erythromycin) are predicted to

increase the concentration of

r

antimalarials (piperaquine).

Theoretical

▶ Clarithromycin is predicted to increase the exposure to

apalutamide.nStudy → Also see TABLE 9 p. 1377

▶ Erythromycin is predicted to increase the exposure to

apixaban.oTheoretical

▶ Clarithromycin is predicted to markedly increase the exposure

to aprepitant.oStudy

▶ Erythromycin is predicted to increase the exposure to

aprepitant.oStudy

▶ Clarithromycin is predicted to slightly increase the exposure to

aripiprazole. Adjust aripiprazole dose, p. 395.oStudy

▶ Clarithromycin is predicted to increase the exposure to

axitinib. Avoid or adjust dose.oStudy

▶ Erythromycin

o

is predicted to increase the exposure to axitinib.

Theoretical

▶ Clarithromycin is predicted to increase the exposure to

bedaquiline. Avoid prolonged use.nStudy → Also see TABLE 9

p. 1377

▶ Erythromycin is predicted to increase the exposure to

bedaquiline. Avoid prolonged use.nTheoretical → Also see

TABLE 9 p. 1377

▶ Macrolides are predicted to increase the exposure to beta

blockers, non-selective (nadolol).oStudy

▶ Clarithromycin is predicted to increase the exposure to beta2

agonists (salmeterol). Avoid.rStudy

▶ Macrolides are predicted to increase the exposure to

bictegravir. Use with caution or avoid.oTheoretical

▶ Clarithromycin

o

slightly increases the exposure to bortezomib.

Study

▶ Clarithromycin is predicted to increase the exposure to

bosentan.oTheoretical

▶ Clarithromycin is predicted to markedly increase the exposure

to bosutinib. Avoid or adjust dose.rStudy → Also see

TABLE 9 p. 1377

▶ Erythromycin is predicted to increase the exposure to

bosutinib. Avoid or adjust dose.rTheoretical → Also see

TABLE 9 p. 1377

▶ Clarithromycin is predicted to increase the exposure to

brigatinib. Adjust brigatinib dose, p. 971.rStudy

▶ Clarithromycin is predicted to increase the exposure to

buspirone. Adjust buspirone dose, p. 342.rStudy

▶ Erythromycin is predicted to increase the exposure to

buspirone. Use with caution and adjust dose.oStudy

▶ Clarithromycin

o

slightly increases the exposure to cabozantinib.

Study → Also see TABLE 9 p. 1377

▶ Erythromycin is predicted to increase the exposure to

cabozantinib.oTheoretical → Also see TABLE 9 p. 1377

▶ Erythromycin is predicted to increase the exposure to calcium

channel blockers (amlodipine, felodipine, lacidipine,

lercanidipine, nicardipine, nifedipine, nimodipine). Monitor and

adjust dose.oStudy

▶ Clarithromycin is predicted to increase the exposure to calcium

channel blockers (amlodipine, felodipine, lacidipine, nicardipine,

nifedipine, nimodipine)

Study

. Monitor and adjust dose.o ▶ Erythromycin is predicted to increase the exposure to calcium

channel blockers (diltiazem).rTheoretical

▶ Clarithromycin is predicted to increase the exposure to calcium

channel blockers (diltiazem, verapamil).rStudy

▶ Clarithromycin is predicted to markedly increase the exposure

to calcium channel blockers (lercanidipine). Avoid.rStudy

1484 Macitentan — Macrolides BNF 78

Interactions | Appendix 1

A1

▶ Erythromycin is predicted to increase the exposure to calcium

channel blockers (verapamil).rStudy

▶ Clarithromycin is predicted to increase the exposure to

cannabis extract

Theoretical

. Use with caution and adjust dose.o ▶ Clarithromycin is predicted to moderately increase the

exposure to cariprazine. Avoid.rStudy

▶ Erythromycin is predicted to increase the exposure to

cariprazine. Avoid.rStudy

▶ Clarithromycin is predicted to increase the exposure to

ceritinib. Avoid or adjust ceritinib dose, p. 973.rStudy →

Also see TABLE 9 p. 1377

▶ Macrolides (azithromycin, erythromycin) are predicted to

increase the exposure to ceritinib.oTheoretical → Also

see TABLE 9 p. 1377

▶ Clarithromycin

r

increases the concentration of ciclosporin.

Study

▶ Erythromycin is predicted to increase the concentration of

ciclosporin.rStudy

▶ Clarithromycin is predicted to moderately increase the

exposure to

Study

cilostazol. Adjust cilostazol dose, p. 232.o ▶ Erythromycin slightly increases the exposure to cilostazol.

Adjust cilostazol dose, p. 232.oStudy

▶ Clarithromycin is predicted to moderately increase the

exposure to cinacalcet. Adjust dose.oStudy

▶ Erythromycin potentially increases the risk of toxicity when

given with clozapine.rAnecdotal

▶ Clarithromycin is predicted to markedly increase the exposure

to cobimetinib. Avoid or monitor for toxicity.rStudy

▶ Erythromycin is predicted to increase the exposure to

cobimetinib.rTheoretical

▶ Azithromycin is predicted to increase the exposure to

colchicine

Theoretical

. Avoid or adjust colchicine dose, p. 1120.r

▶ Clarithromycin is predicted to increase the exposure to

colchicine. Avoid potent inhibitors of CYP3A4 or adjust

colchicine dose, p. 1120.rStudy

▶ Erythromycin is predicted to increase the exposure to

colchicine. Adjust colchicine dose with moderate inhibitors of

CYP3A4, p. 1120.rStudy

▶ Clarithromycin is predicted to increase the exposure to

corticosteroids (beclometasone) (risk with beclometasone is

Theoretical

likely to be lower than with other corticosteroids).o ▶ Clarithromycin is predicted to increase the exposure to

corticosteroids (betamethasone, budesonide, ciclesonide,

deflazacort, dexamethasone, fludrocortisone, fluticasone,

hydrocortisone, methylprednisolone, mometasone,

prednisolone, triamcinolone)

r

. Avoid or monitor side effects.

Study

▶ Erythromycin is predicted to increase the exposure to

corticosteroids

o

(methylprednisolone). Monitor and adjust dose.

Study

▶ Macrolides (clarithromycin, erythromycin) increase the

anticoagulant effect of coumarins. Monitor INR and adjust

dose.rAnecdotal

▶ Clarithromycin is predicted to moderately increase the

exposure to crizotinib. Avoid.oStudy → Also see TABLE 9

p. 1377

▶ Macrolides are predicted to increase the exposure to

dabigatran.oTheoretical

▶ Clarithromycin is predicted to increase the exposure to

dabrafenib. Use with caution or avoid.oStudy

▶ Clarithromycin is predicted to markedly to very markedly

increase the exposure to darifenacin. Avoid.rStudy

▶ Erythromycin is predicted to slightly increase the exposure to

darifenacin.oStudy

▶ Clarithromycin is predicted to markedly increase the exposure

to

r

dasatinib. Avoid or adjust dose—consult product literature.

Study → Also see TABLE 9 p. 1377

▶ Erythromycin is predicted to increase the exposure to

dasatinib.rStudy → Also see TABLE 9 p. 1377

▶ Clarithromycin very slightly increases the exposure to

delamanid.rStudy → Also see TABLE 9 p. 1377

▶ Macrolides

Anecdotal

increase the concentration of digoxin.r

▶ Macrolides (clarithromycin, erythromycin) increase the risk of

QT-prolongation when given with

Study

domperidone. Avoid.r

▶ Clarithromycin increases the exposure to dopamine receptor

agonists (bromocriptine).rStudy

▶ Erythromycin is predicted to increase the exposure to

dopamine receptor agonists (bromocriptine).rTheoretical

▶ Macrolides (clarithromycin, erythromycin) are predicted to

increase the concentration of dopamine receptor agonists

(cabergoline). Avoid.rStudy

▶ Clarithromycin is predicted to increase the exposure to

doravirine.nStudy

▶ Clarithromycin is predicted to increase the exposure to

dutasteride

Theoretical

. Monitor side effects and adjust dose.o ▶ Erythromycin is predicted to moderately increase the exposure

to dutasteride.nStudy

▶ Erythromycin slightly increases the exposure to edoxaban.

Adjust edoxaban dose, p. 126.rStudy

▶ Macrolides (azithromycin, clarithromycin) are predicted to

slightly increase the exposure to edoxaban.rTheoretical

▶ Efavirenz

Study → Also see

decreases the exposure to

TABLE 9 p. 1377

clarithromycin.o ▶ Clarithromycin is predicted to markedly increase the exposure

to eletriptan. Avoid.rStudy

▶ Erythromycin moderately increases the exposure to eletriptan.

Avoid.oStudy

▶ Macrolides (clarithromycin, erythromycin) are predicted to

increase the exposure to eliglustat. Avoid or adjust dose—

consult product literature.rStudy

▶ Clarithromycin is predicted to increase the exposure to

encorafenib. Avoid or monitor.rStudy → Also see TABLE 9

p. 1377

▶ Erythromycin is predicted to moderately increase the exposure

to encorafenib.oStudy → Also see TABLE 9 p. 1377

▶ Clarithromycin is predicted to increase the risk of ergotism

when given with ergometrine. Avoid.rTheoretical

▶ Erythromycin is predicted to increase the risk of ergotism

when given with ergometrine.rTheoretical

▶ Clarithromycin is predicted to increase the risk of ergotism

when given with ergotamine. Avoid.rTheoretical

▶ Erythromycin is predicted to increase the risk of ergotism

when given with ergotamine.rTheoretical

▶ Clarithromycin is predicted to slightly increase the exposure to

erlotinib. Use with caution and adjust dose.oStudy

▶ Macrolides (azithromycin, erythromycin) are predicted to

increase the exposure to erlotinib.oTheoretical

▶ Clarithromycin is predicted to increase the exposure to

esketamine. Adjust dose.oStudy

▶ Etravirine decreases the exposure to clarithromycin and

clarithromycin

r

slightly increases the exposure to etravirine.

Study

▶ Clarithromycin is predicted to increase the concentration of

everolimus. Avoid.rStudy

▶ Erythromycin is predicted to increase the concentration of

everolimus. Avoid or adjust dose.oStudy

▶ Clarithromycin is predicted to moderately increase the

exposure to fesoterodine. Adjust fesoterodine dose with potent

inhibitors of CYP3A4; avoid in hepatic and renal impairment,

p. 777.rStudy

▶ Erythromycin is predicted to increase the exposure to

fesoterodine. Adjust fesoterodine dose with moderate

inhibitors of CYP3A4 in hepatic and renal impairment, p. 777.

nStudy

▶ Macrolides are predicted to increase the exposure to

fidaxomicin. Avoid.oStudy

▶ Clarithromycin is predicted to increase the exposure to

fosaprepitant.oTheoretical

▶ Clarithromycin is predicted to increase the exposure to

gefitinib.oStudy

▶ Erythromycin

o

is predicted to increase the exposure to gefitinib.

Theoretical

BNF 78 Macrolides — Macrolides 1485

Interactions | Appendix 1

A1

Macrolides (continued)

▶ Clarithromycin is predicted to moderately to markedly increase

the exposure to grazoprevir. Avoid.rStudy

▶ Clarithromycin is predicted to increase the exposure to

guanfacine. Adjust guanfacine dose, p. 352.oStudy

▶ Erythromycin is predicted to increase the concentration of

guanfacine. Adjust guanfacine dose, p. 352.oTheoretical

▶ H2 receptor antagonists (cimetidine) slightly increase the

exposure to erythromycin.oStudy

▶ HIV-protease inhibitors (atazanavir) are predicted to increase the

exposure to

r

clarithromycin. Adjust dose in renal impairment.

Study

▶ HIV-protease inhibitors (atazanavir, darunavir, fosamprenavir,

lopinavir, ritonavir, tipranavir) are predicted to increase the

exposure to erythromycin.rTheoretical

▶ HIV-protease inhibitors (darunavir, fosamprenavir, lopinavir)

(boosted with ritonavir) are predicted to increase the

exposure to

r

clarithromycin. Adjust dose in renal impairment.

Study

▶ HIV-protease inhibitors (ritonavir) increase the exposure to

clarithromycin. Adjust dose in renal impairment.rStudy

▶ HIV-protease inhibitors (tipranavir boosted with ritonavir)

increase the exposure to clarithromycin and clarithromycin

increases the exposure to HIV-protease inhibitors (tipranavir)

(boosted with ritonavir). Monitor; adjust dose in renal

impairment.rStudy

▶ Clarithromycin increases the exposure to HIV-protease inhibitors

(saquinavir) and HIV-protease inhibitors (saquinavir) increase

the exposure to clarithromycin. Avoid.rStudy → Also see

TABLE 9 p. 1377

▶ Erythromycin is predicted to increase the exposure to HIVprotease inhibitors (saquinavir). Avoid.rTheoretical → Also

see TABLE 9 p. 1377

▶ Clarithromycin is predicted to very markedly increase the

exposure to ibrutinib. Avoid potent inhibitors of CYP3A4 or

adjust ibrutinib dose, p. 983.rStudy

▶ Erythromycin is predicted to increase the exposure to

ibrutinib. Adjust ibrutinib dose with moderate inhibitors of

CYP3A4, p. 983.rStudy

▶ Clarithromycin is predicted to increase the exposure to

imatinib.oStudy

▶ Erythromycin

o

is predicted to increase the exposure to imatinib.

Theoretical

▶ Clarithromycin is predicted to increase the risk of toxicity

when given with irinotecan. Avoid.oStudy

▶ Clarithromycin is predicted to increase the exposure to

ivabradine. Avoid.rStudy

▶ Erythromycin is predicted to increase the exposure to

ivabradine. Avoid.rTheoretical

▶ Clarithromycin is predicted to increase the exposure to

ivacaftor. Adjust ivacaftor p. 293 or lumacaftor with ivacaftor

p. 294 or tezacaftor with ivacaftor p. 295 dose with potent

inhibitors of CYP3A4.rStudy

▶ Erythromycin is predicted to increase the exposure to

ivacaftor. Adjust ivacaftor p. 293 or tezacaftor with ivacaftor

p. 295 dose with moderate inhibitors of CYP3A4.rStudy

▶ Clarithromycin is predicted to increase the exposure to

lapatinib. Avoid.oStudy → Also see TABLE 9 p. 1377

▶ Erythromycin is predicted to increase the exposure to

lapatinib.oStudy → Also see TABLE 9 p. 1377

▶ Macrolides (clarithromycin, erythromycin) are predicted to

increase the concentration of letermovir.oStudy

▶ Clarithromycin

Anecdotal

increases the exposure to linezolid.o ▶ Azithromycin is predicted to increase the exposure to

lomitapide

Theoretical

. Separate administration by 12 hours.o ▶ Clarithromycin is predicted to markedly increase the exposure

to lomitapide. Avoid.rStudy

▶ Erythromycin is predicted to increase the exposure to

lomitapide. Avoid.oTheoretical

▶ Lumacaftor is predicted to decrease the exposure to macrolides

(clarithromycin, erythromycin).oTheoretical

▶ Clarithromycin is predicted to increase the exposure to

lurasidone. Avoid.rStudy

▶ Erythromycin is predicted to increase the exposure to

lurasidone. Adjust lurasidone dose, p. 398.oStudy

▶ Clarithromycin is predicted to increase the exposure to

macitentan.oStudy

▶ Clarithromycin is predicted to markedly increase the exposure

to maraviroc. Adjust dose.rStudy

▶ Clarithromycin is predicted to markedly to very markedly

increase the exposure to

r

midazolam. Avoid or adjust dose.

Study

▶ Erythromycin is predicted to increase the exposure to

midazolam. Monitor side effects and adjust dose.rStudy

▶ Clarithromycin is predicted to very markedly increase the

exposure to

Study

midostaurin. Avoid or monitor for toxicity.r

▶ Erythromycin is predicted to increase the exposure to

midostaurin.oTheoretical

▶ Clarithromycin is predicted to increase the exposure to

mirabegron. Adjust mirabegron dose in hepatic and renal

impairment, p. 781.oStudy

▶ Clarithromycin is predicted to increase the exposure to

mirtazapine.oStudy

▶ Clarithromycin is predicted to increase the exposure to

modafinil.nTheoretical

▶ Clarithromycin increases the risk of neutropenia when given

with monoclonal antibodies (brentuximab vedotin). Monitor and

adjust dose.rTheoretical

▶ Clarithromycin is predicted to increase the exposure to

monoclonal antibodies

Theoretical

(trastuzumab emtansine). Avoid.r

▶ Clarithromycin is predicted to markedly increase the exposure

to naloxegol. Avoid.rStudy

▶ Erythromycin is predicted to increase the exposure to

naloxegol

o

. Adjust naloxegol dose and monitor side effects, p. 65.

Study

▶ Clarithromycin is predicted to increase the exposure to

netupitant.oStudy

▶ Nevirapine

Study

decreases the exposure to clarithromycin.o ▶ Clarithromycin is predicted to moderately increase the

exposure to nilotinib. Avoid.rStudy → Also see TABLE 9

p. 1377

▶ Erythromycin

o

is predicted to increase the exposure to nilotinib.

Theoretical → Also see TABLE 9 p. 1377

▶ Macrolides are predicted to increase the exposure to

nintedanib.oStudy

▶ Clarithromycin is predicted to increase the exposure to

nitisinone. Adjust dose.oTheoretical

▶ Clarithromycin is predicted to increase the exposure to

olaparib. Avoid potent inhibitors of CYP3A4 or adjust olaparib

dose, p. 1005.oStudy

▶ Erythromycin is predicted to increase the exposure to olaparib.

Avoid moderate inhibitors of CYP3A4 or adjust olaparib dose,

p. 1005.oTheoretical

▶ Erythromycin is predicted to increase the exposure to opioids

(alfentanil, buprenorphine, fentanyl, oxycodone). Monitor and

adjust dose.oStudy

▶ Clarithromycin is predicted to increase the exposure to opioids

(alfentanil, buprenorphine, fentanyl, oxycodone, sufentanil).

Monitor and adjust dose.rStudy

▶ Clarithromycin is predicted to increase the concentration of

opioids (methadone).rTheoretical → Also see TABLE 9 p. 1377

▶ Erythromycin is predicted to increase the exposure to opioids

(methadone, sufentanil).oTheoretical → Also see TABLE 9

p. 1377

▶ Clarithromycin is predicted to increase the exposure to

ospemifene

Study

. Avoid in poor CYP2C9 metabolisers.o ▶ Clarithromycin is predicted to increase the exposure to

oxybutynin.nStudy

▶ Erythromycin is predicted to increase the exposure to

oxybutynin.nTheoretical

▶ Clarithromycin is predicted to increase the exposure to

palbociclib. Avoid or adjust palbociclib dose, p. 992.rStudy

▶ Clarithromycin is predicted to increase the exposure to

panobinostat. Adjust panobinostat dose; in hepatic

1486 Macrolides — Macrolides BNF 78

Interactions | Appendix 1

A1

impairment avoid, p. 936.oStudy → Also see TABLE 9

p. 1377

▶ Macrolides (azithromycin, erythromycin) are predicted to

increase the exposure to

Theoretical → Also see TABLE 9

panobinostat

p. 1377

. Adjust dose.o ▶ Clarithromycin is predicted to increase the exposure to

paritaprevir. Avoid.rStudy

▶ Erythromycin is predicted to increase the exposure to

paritaprevir.oTheoretical

▶ Clarithromycin is predicted to increase the exposure to

pazopanib

Study → Also see

. Avoid or adjust

TABLE 9 p. 1377

pazopanib dose, p. 993.o ▶ Erythromycin is predicted to increase the exposure to

pazopanib.oTheoretical → Also see TABLE 9 p. 1377

▶ Erythromycin is predicted to increase the exposure to

phosphodiesterase type-5 inhibitors (avanafil). Adjust avanafil

dose, p. 812.oTheoretical

▶ Clarithromycin is predicted to increase the exposure to

phosphodiesterase type-5 inhibitors

r

(avanafil, vardenafil). Avoid.

Study → Also see TABLE 9 p. 1377

▶ Clarithromycin is predicted to increase the exposure to

phosphodiesterase type-5 inhibitors (sildenafil). Avoid potent

inhibitors of CYP3A4 or adjust

Study → Also see TABLE 9 p. 1377

sildenafil dose, p. 813.r

▶ Erythromycin is predicted to increase the exposure to

phosphodiesterase type-5 inhibitors (sildenafil). Monitor or

adjust sildenafil dose with moderate inhibitors of CYP3A4,

p. 813.oStudy → Also see TABLE 9 p. 1377

▶ Clarithromycin is predicted to increase the exposure to

phosphodiesterase type-5 inhibitors (tadalafil). Use with caution

or avoid.rStudy

▶ Erythromycin is predicted to increase the exposure to

phosphodiesterase type-5 inhibitors (tadalafil).rTheoretical

▶ Erythromycin is predicted to increase the exposure to

phosphodiesterase type-5 inhibitors

r

(vardenafil). Adjust dose.

Theoretical → Also see TABLE 9 p. 1377

▶ Macrolides are predicted to increase the exposure to

pibrentasvir.oTheoretical

▶ Clarithromycin is predicted to increase the exposure to

pimozide. Avoid.rStudy → Also see TABLE 9 p. 1377

▶ Erythromycin is predicted to increase the exposure to

pimozide. Avoid.rTheoretical → Also see TABLE 9 p. 1377

▶ Clarithromycin is predicted to slightly increase the exposure to

ponatinib

Study

. Monitor and adjust ponatinib dose, p. 994.o ▶ Clarithromycin is predicted to moderately increase the

exposure to praziquantel.nStudy

▶ Clarithromycin is predicted to increase the exposure to

quetiapine. Avoid.rStudy

▶ Erythromycin is predicted to increase the exposure to

quetiapine. Avoid.oStudy

▶ Clarithromycin is predicted to increase the exposure to

ranolazine. Avoid.rStudy → Also see TABLE 9 p. 1377

▶ Erythromycin is predicted to increase the exposure to

ranolazine.rStudy → Also see TABLE 9 p. 1377

▶ Clarithromycin is predicted to increase the exposure to

reboxetine. Avoid.oStudy

▶ Clarithromycin is predicted to increase the exposure to

regorafenib. Avoid.oStudy

▶ Clarithromycin is predicted to increase the exposure to

repaglinide.oStudy

▶ Clarithromycin is predicted to increase the exposure to

retinoids

Theoretical

(alitretinoin). Adjust alitretinoin dose, p. 1262.o ▶ Clarithromycin is predicted to increase the exposure to

ribociclib

Study → Also see

. Avoid or adjust

TABLE 9 p. 1377

ribociclib dose, p. 997.o ▶ Erythromycin is predicted to increase the exposure to

ribociclib.oStudy → Also see TABLE 9 p. 1377

▶ Azithromycin increases the risk of neutropenia when given

with rifabutin.rStudy

▶ Clarithromycin increases the risk of uveitis when given with

rifabutin. Adjust dose.rStudy

▶ Erythromycin is predicted to increase the risk of uveitis when

given with rifabutin. Adjust dose.rTheoretical

▶ Rifampicin

r

decreases the concentration of clarithromycin.

Study

▶ Clarithromycin is predicted to increase the exposure to

risperidone. Adjust dose.oStudy → Also see TABLE 9

p. 1377

▶ Clarithromycin is predicted to increase the exposure to

ruxolitinib

Study

. Adjust dose and monitor side effects.o ▶ Erythromycin is predicted to increase the exposure to

ruxolitinib.oTheoretical

▶ Clarithromycin is predicted to increase the exposure to

saxagliptin.oStudy

▶ Erythromycin is predicted to increase the exposure to

saxagliptin.nStudy

▶ Clarithromycin is predicted to increase the concentration of

sirolimus. Avoid.rStudy

▶ Erythromycin increases the concentration of sirolimus.

Monitor and adjust dose.oStudy

▶ Clarithromycin is predicted to increase the exposure to

solifenacin. Adjust solifenacin p. 779 or tamsulosin with

solifenacin

r

p. 786 dose; avoid in hepatic and renal impairment.

Study

▶ Clarithromycin is predicted to moderately increase the

exposure to SSRIs (dapoxetine). Avoid potent inhibitors of

CYP3A4 or adjust dapoxetine dose, p. 821.rStudy

▶ Erythromycin is predicted to increase the exposure to SSRIs

(dapoxetine). Adjust dapoxetine dose with moderate inhibitors

of CYP3A4, p. 821.oTheoretical

▶ Clarithromycin is predicted to increase the exposure to statins

(atorvastatin). Avoid or adjust dose and monitor

rhabdomyolysis.rStudy

▶ Erythromycin is predicted to increase the exposure to statins

(atorvastatin). Monitor and adjust dose.rStudy

▶ Clarithromycin moderately increases the exposure to statins

(pravastatin).rStudy

▶ Erythromycin is predicted to increase the exposure to statins

(pravastatin).rStudy

▶ Clarithromycin is predicted to increase the exposure to statins

(simvastatin). Avoid.rStudy

▶ Erythromycin is predicted to increase the exposure to statins

(simvastatin). Use with caution and adjust simvastatin dose,

p. 205.rStudy

▶ Clarithromycin is predicted to slightly increase the exposure to

sulfonylureas.oTheoretical

▶ Clarithromycin is predicted to slightly increase the exposure to

sunitinib

Study → Also see

. Avoid or adjust

TABLE 9 p. 1377

sunitinib dose, p. 999.o ▶ Erythromycin is predicted to increase the exposure to

sunitinib.oTheoretical → Also see TABLE 9 p. 1377

▶ Clarithromycin is predicted to increase the concentration of

tacrolimus. Monitor and adjust dose.rStudy

▶ Erythromycin is predicted to increase the concentration of

tacrolimus.rStudy

▶ Clarithromycin is predicted to increase the exposure to taxanes

(cabazitaxel). Avoid.rStudy

▶ Erythromycin is predicted to increase the exposure to taxanes

(cabazitaxel).oTheoretical

▶ Clarithromycin is predicted to moderately increase the

exposure to

Study

taxanes (docetaxel). Avoid or adjust dose.r

▶ Clarithromycin is predicted to increase the exposure to taxanes

(paclitaxel).rTheoretical

▶ Clarithromycin is predicted to increase the concentration of

temsirolimus. Avoid.rTheoretical

▶ Erythromycin is predicted to increase the concentration of

temsirolimus.oTheoretical

▶ Clarithromycin is predicted to increase the exposure to

tezacaftor. Adjust tezacaftor with ivacaftor p. 295 dose with

potent inhibitors of CYP3A4.rStudy

▶ Erythromycin is predicted to increase the exposure to

tezacaftor. Adjust tezacaftor with ivacaftor p. 295 dose with

moderate inhibitors of CYP3A4.rStudy

▶ Erythromycin decreases the clearance of theophylline and

theophylline potentially decreases the clearance of

erythromycin. Adjust dose.rStudy

BNF 78 Macrolides — Macrolides 1487

Interactions | Appendix 1

A1

Macrolides (continued)

▶ Macrolides (azithromycin, clarithromycin) are predicted to

increase the exposure to

Anecdotal

theophylline. Adjust dose.o ▶ Azithromycin is predicted to increase the exposure to

ticagrelor. Use with caution or avoid.rStudy

▶ Clarithromycin is predicted to markedly increase the exposure

to ticagrelor. Avoid.rStudy

▶ Clarithromycin is predicted to increase the exposure to

tofacitinib. Adjust tofacitinib dose, p. 1105.oStudy

▶ Erythromycin given with a potent CYP2C19 inhibitor is

predicted to increase the exposure to tofacitinib. Adjust

tofacitinib dose, p. 1105.oStudy

▶ Clarithromycin is predicted to increase the exposure to

tolterodine. Avoid.rStudy → Also see TABLE 9 p. 1377

▶ Erythromycin is predicted to increase the exposure to

tolterodine.nTheoretical → Also see TABLE 9 p. 1377

▶ Clarithromycin is predicted to increase the exposure to

tolvaptan. Manufacturer advises caution or adjust tolvaptan

dose with potent inhibitors of CYP3A4, p. 669.rStudy

▶ Erythromycin is predicted to increase the exposure to

tolvaptan. Manufacturer advises caution or adjust tolvaptan

dose with moderate inhibitors of CYP3A4,

Study

p. 669.o ▶ Macrolides are predicted to increase the exposure to

topotecan.rStudy

▶ Clarithromycin is predicted to increase the exposure to

toremifene.oTheoretical → Also see TABLE 9 p. 1377

▶ Clarithromycin is predicted to increase the exposure to

trabectedin. Avoid or adjust dose.rTheoretical

▶ Macrolides are predicted to increase the concentration of

trametinib.oTheoretical

▶ Clarithromycin is predicted to moderately increase the

exposure to trazodone. Avoid or adjust dose.oStudy

▶ Erythromycin is predicted to increase the exposure to

trazodone.oTheoretical

▶ Clarithromycin is predicted to increase the exposure to

ulipristal. Avoid if used for uterine fibroids.rStudy

▶ Erythromycin is predicted to increase the exposure to

ulipristal. Avoid if used for uterine fibroids.oStudy

▶ Clarithromycin is predicted to increase the exposure to

vemurafenib.rTheoretical → Also see TABLE 9 p. 1377

▶ Macrolides (clarithromycin, erythromycin) are predicted to

increase the exposure to venetoclax. Avoid or adjust dose—

consult product literature.rStudy

▶ Clarithromycin is predicted to increase the exposure to

venlafaxine.oStudy → Also see TABLE 9 p. 1377

▶ Macrolides (clarithromycin, erythromycin) are predicted to

increase the exposure to vinca alkaloids.rTheoretical →

Also see TABLE 9 p. 1377

▶ Clarithromycin is predicted to increase the exposure to vitamin

D substances (paricalcitol).oStudy

▶ Clarithromycin decreases the absorption of zidovudine.

Separate administration by at least 2 hours.oStudy

▶ Clarithromycin is predicted to increase the exposure to

zopiclone. Adjust dose.oTheoretical

▶ Erythromycin is predicted to increase the exposure to

zopiclone. Adjust dose.oStudy

Magnesium

▶ Oral magnesium decreases the absorption of bisphosphonates

(alendronic acid). Alendronic acid should be taken at least

30 minutes before magnesium.oStudy

▶ Oral magnesium is predicted to decrease the absorption of oral

bisphosphonates (ibandronic acid). Avoid magnesium for at least

6 hours before or 1 hour after

Theoretical

ibandronic acid.o ▶ Oral magnesium decreases the absorption of bisphosphonates

(risedronate)

o