CLARITHROMYCIN

Indications & Dose:

Infections of upper and lower respiratory tract, skin and skin structures; disseminated mycobacterial infections due to Mycoplasma avium and M. intracellular; eradication of Helicobacter pylori associated with active duodenal ulcer disease (in combination with omeprazole and metronidazole

DOSE

Eradication of helicobacter pylori: As combination therapy – ACT 10 i.e. Amoxycillin 500mg BD + Clarithromycin 500mg BD + Omeprazole 20mg OD, all for 10 days.

Adult

Tab/Sachet

Usually 250mg twice daily for 7 days

• Severe infection: PO 500 mg bid for 14 days

XL Tab

Usually one tablet daily with food for 7-14 days

• Severe infection: PO two tablet once daily.

Suspension: Under 1 year; 7.5 mg/kg, 1-2 year;

62.5 mg/kg, 3-6 years; 125 mg, 7-9 years; 187.5

mg, 10-12 years; 250 mg

All twice daily

I.V.Infusion: 1 gm daily by i.v or infusion in two divided doses for 2-5 days

Children: Not recommended in infusion

Contraindications:

Side Effects:

Cautions:

Precautions:

 Renal impairment, children 

Interaction:

Drugs

Alfentanil: Prolonged anesthesia and respiratory depression

Alprazolam: Increased plasma alprazo-lam concentration

Amprenavir: Plasma concentrations of clarithromycin may be increased by amprenavir; plasma concentrations of amprenavir may be increased by clarithromycin

Astemilzole: QT prolongation and life-threatening dysrhythmia

Atorvastatin: Increased plasma atorvastatin concentration with risk of rhabdomyolysis

Bromocriptine: Increased bromocriptine concentration with toxicity 

Buspirone: Increased plasma buspirone concentration

Carbamazepine: Markedly increased plasma carbamazepine concentrations

Cisapride: QT prolongation and dysrhythmia

Clozapine: Increased plasma clozapine concentrations

Colchicine: Potential colchicine toxicity

Cyclosporine: Increased plasma cyclosporine concentrations

Diazepam: Increased plasma concentration of diazepam

Digoxin: Reduced bacterial flora may increase plasma digoxin concentrations

Disopyramide: Increased plasma disopyramid concentrations

Ergotamine: Potential for ergotism

Ethanol: Ethanol reduces plasma clarithromycin concentration

Felodipine: Increased plasma felodipine concentrations

Food: Food may increase or decrease the bioBrands Available with Cost of clarithromycin

Indinavir: Plasma concentrations of clarithromycin may be increased by indinavir; plasma concentrations of indinavir may be increased by clarithromycin

Itraconazole: Increased plasma itraconazole concentration

Lovastatin: Increased plasma lovastatin concentration with risk of rhabdomyolysis

Methylprednisolone: Increased plasma methylprednisolone concentrations

Midazolam: Increased plasma concentration of midazolam

Nelfinavir: Plasma concentrations of clarithromycin may be increased by nelfinavir; plasma concentrations of nelfinavir may be increased by clarithromycin

Penicillin: Decreased activity of penicillin

Quinidine: Increased plasma concentration of quinidine

Ritonavir: Plasma concentrations of clarithromycin may be increased by ritonavir, plasma concentrations of ritonavir may be increased by clarithromycin

Saquinavir: Plasma concentrations of clarithromycin may be increased by saquinavir; plasma concentrations of saquinavir may be increased by clarithromycin

Sildenafil: Increased plasma sildenafil concentration

Simvastatin: Increased plasma simvastatin concentration with risk of rhabdomyolysis

Tacrolimus: Increased plasma tacrolimus concentration

Terfenadine: QT prolongation and life-threatening dysrhythmia

Theophylline: Increased plasma theophylline concentration

Triazolam: Increased plasma triazolam concentration 

Valproic acid: Increased plasma valproic acid concentration

Warfarin: Markedly increased hypoprothrombinemic response to warfarin

Zafirlukast: Reduced plasma zafirlukast concentration probably by reducing bioBrands Available with Cost

Zopiclone: Increased plasma zopiclone concentration 

Warnings:

Adverse Effects:

Lactations:

Pregnancy ; excretion into breast milk unknown; use caution in nursing mothers

Special Precautions:

Counselling:

Side Effects Or Adverse Reactions:

CNS: Headache, psychosis

GI: Abdominal pain, abnormal taste, anorexia, diarrhea, heartburn, hepatotoxicity, nausea, stomatitis, vomiting

GU: Moniliasis; vaginitis

SKIN: Pruritus, rash, urticaria 

Patient And Carer Advice: