Standard release tab & oral susp: May be taken with or without food.
XL & MR tab: Should be taken with food. Swallow whole, do not chew/crush.
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Hypersensitivity to clarithromycin or any macrolide antibiotics. History of cholestatic jaundice/hepatic dysfunction associated with previous clarithromycin use; hypokalaemia, history of QT prolongation (congenital or documented acquired), ventricular cardiac arrhythmia including torsades de pointes; severe hepatic failure in combination with renal impairment. Concomitant use with ergot alkaloids (e.g. ergotamine, dihydroergotamine), oral midazolam, astemizole, cisapride, domperidone, pimozide, terfenadine, ticagrelor, ranolazine, lovastatin, simvastatin, colchicine, lomitapide. Modified-release tab: Significant renal impairment (CrCl <30 mL/min).
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Patient with coronary artery disease, severe cardiac insufficiency, clinically relevant bradycardia or conduction disturbances; electrolyte disturbances (e.g. hypomagnesaemia), myasthenia gravis. Patient taking other drugs known to prolong QT interval (e.g. class IA or III antiarrhythmic, antipsychotic agents, antidepressants, fluoroquinolones). Patient with renal impairment concurrently taking atazanavir or ritonavir-containing regimens. Hepatic and moderate to severe renal impairment. Children. Pregnancy and lactation. Monitoring Parameters Perform culture and susceptibility tests; consult local institutional recommendations before treatment initiation due to antibiotic resistance risks. Monitor BUN and serum creatinine; CBC with differential.
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Significant: Hepatic dysfunction (e.g. increased liver enzymes, hepatocellular and/or cholestatic hepatitis with or without jaundice); exacerbation or new onset of myasthenia gravis.
Gastrointestinal disorders: Abdominal pain, diarrhoea, nausea, vomiting, dysgeusia, dyspepsia.
General disorders and administration site conditions: Inj site reactions (e.g. phlebitis, pain, inflammation).
Infections and infestations: Candidiasis.
Investigations: Prolonged prothrombin time, increased BUN.
Nervous system disorders: Headache.
Psychiatric disorders: Insomnia.
Skin and subcutaneous tissue disorders: Rash, hyperhidrosis.
Vascular disorders: Vasodilation (IV).
Potentially Fatal: Hepatic failure, pseudomembranous colitis or C. difficile-associated diarrhoea (CDAD); QT prolongation, arrhythmias including torsades de pointes; anaphylaxis, severe cutaneous adverse reactions (e.g. acute generalised exanthematous pustulosis, Stevens-Johnson syndrome, toxic epidermal necrolysis, drug rash with eosinophilia and systemic symptoms, Henoch-Schonlein purpura or IgA vasculitis).
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May result in significant hypoglycaemia with oral hypoglycaemics (e.g. sulfonylureas, repaglinide, nateglinide) and insulin. Increased risk of haemorrhage and elevated INR and prothrombin time with warfarin. May induce metabolism and decrease efficacy with CYP3A inducers (e.g. rifampicin, phenytoin, carbamazepine, phenobarbital). May reduce the plasma levels with strong CYP450 inducers (e.g. efavirenz, nevirapine, rifabutin, rifapentine). Decreased exposure with etravirine. Increased plasma concentration and exposure with fluconazole. May elevate the serum concentrations of digoxin and CYP450 substrates (e.g. alprazolam, carbamazepine, cilostazol, ciclosporin, methylprednisolone, omeprazole, quetiapine, sildenafil, sirolimus, tacrolimus, vinblastine, theophylline, valproate, tolterodine). May increase the risk of torsades de pointes with quinidine or disopyramide. May decrease the plasma concentrations of zidovudine. Ritonavir significantly inhibits the metabolism of clarithromycin. Concomitant use with atazanavir, itraconazole, saquinavir, or certain Ca channel blockers (e.g. verapamil, amlodipine, diltiazem) may result in bi-directional drug interactions. Increased or prolongation of sedation with triazolam.
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J01FA09 - clarithromycin ; Belongs to the class of macrolides. Used in the systemic treatment of infections.
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