Clarithromycin

Renal impairment

eGFR (mL/min/1.73m²)	PO Dose	IV Dose
30-50	Dose as in normal renal function	Dose as in normal renal function
10-29	250-500mg BD	250-500mg BD
Less than 10	250-500mg BD	250-500mg BD
HDF/High Flux	Dose as in eGFR less than 10ml/min/1.73m². Unknown dialysability.	Dose as in eGFR less than 10ml/min/1.73m². Unknown dialysability.
HD/PD	Dose as in eGFR less than 10ml/min/1.73m². Not dialysed.	Dose as in eGFR less than 10ml/min/1.73m². Not dialysed.

Hepatic impairment

Clarithromycin is contraindicated in patients with severe hepatic failure in combination with renal impairment.
In patients with severe hepatic impairment, use with caution. Hepatic dysfunction including jaundice has been reported – monitor LFT’s.

Pregnancy

Use only if potential benefit outweighs risks. Erythromycin is the macrolide of choice in pregnancy.

Breastfeeding

Discuss with pharmacy.

Avoid simvastatin in patients on clarithromycin. Potentially hazardous interactions with other drugs. Contact pharmacist for advice.
FDA is advising caution before prescribing clarithromycin to patients with heart disease because of a potential increased risk of heart problems or death that can occur years later.
MHRA Drug Safety Update (February 2022). Hydroxychloroquine, chloroquine: increased risk of cardiovascular events when used with macrolide antibiotics; reminder of psychiatric reactions
- Consider the benefits and risks before prescribing systemic azithromycin or other systemic macrolide antibiotics (erythromycin or clarithromycin) to patients being treated with hydroxychloroquine or chloroquine. An observational study has shown that co-administration of azithromycin with hydroxychloroquine in patients with rheumatoid arthritis is associated with an increased risk of cardiovascular events (including angina or chest pain and heart failure) and cardiovascular mortality.
- If there is a clinical need to prescribe systemic macrolide antibiotics with hydroxychloroquine or chloroquine, use caution in patients with risk factors for cardiac events and follow advice in the product information for each medicine.
- Be vigilant for psychiatric reactions, especially in the first month of treatment; events have been reported in patients with no prior history of psychiatric disorders.
- Report suspected adverse drug reactions on a Yellow Card.
- Advise patients and carers to:
  - seek urgent medical help if you have any signs of problems with your heart (for example, palpitations, fainting, chest pain, or unexplained breathlessness)
  - speak to their doctor as soon as possible if you or your family members or caregivers notice any new or worsening mental health symptoms

Summary of Product Characteristics (SPC) for Clarithromycin 500mg powder for solution for infusion. Accessed via www.medicines.org.uk 26/03/18. Last updated 13/03/18
Summary of Product Characteristics (SPC) for Clarithromycin 500mg film tablets. Accessed via www.medicines.org.uk 26/03/18. Last updated 26/03/18
The Renal Drug Database. Ciprofloxacin. Accessed via renaldrugdatabase.com 26/03/18. Last updated 19/12/17
Drugs in Pregnancy and Lactation. Briggs G et al. 6^th Edition.
FDA alert clarithromycin (Biaxin): Drug Safety Communication – Potential Increased Risk of Heart Problems or Death in Patients with Heart Disease. 22/2/18. Accessed www.fda.gob/safety/medwatch/safetyinformation 08/04/2018

General Information

Renal and hepatic impairment

Pregnancy and breastfeeding

Additional information

References

Editorial Information