From the Guidelines
Clarithromycin is contraindicated in patients with a history of QT prolongation or ventricular cardiac arrhythmias, severe liver disease, and those taking certain medications that can interact dangerously with clarithromycin, including ergot alkaloids, pimozide, lovastatin, simvastatin, ticagrelor, and colchicine in patients with renal or hepatic impairment. The use of clarithromycin is also contraindicated in patients with known hypersensitivity to macrolide antibiotics 1. Additionally, concurrent use with cisapride, astemizole, or terfenadine is contraindicated due to the risk of cardiac arrhythmias 1.
Some key points to consider when prescribing clarithromycin include:
- History of hypersensitivity to macrolide antibiotics
- History of QT prolongation or ventricular cardiac arrhythmias
- Severe liver disease
- Concomitant use of certain medications, such as ergot alkaloids, pimozide, lovastatin, simvastatin, ticagrelor, and colchicine in patients with renal or hepatic impairment
- Pregnancy, particularly for the treatment of Mycobacterium avium complex (MAC) infection, as it has shown embryonic and fetal harm in animal studies 1
- Myasthenia gravis, as patients may experience worsening symptoms with clarithromycin
- Coronary artery disease, renal impairment, and those taking other medications metabolized by CYP3A4 enzyme system, as clarithromycin can inhibit this enzyme system and potentially cause dangerous elevations in blood levels of certain medications 1.
It is essential to undertake a full clinical and drug history to cover these aspects and potential drug interactions 1.
From the FDA Drug Label
- CONTRAINDICATIONS 4.1 Hypersensitivity Clarithromycin is contraindicated in patients with a known hypersensitivity to clarithromycin, erythromycin, or any of the macrolide antibacterial drugs [see Warnings and Precautions (5.1)]. 4.2 Cisapride and Pimozide Concomitant administration of clarithromycin with cisapride and pimozide is contraindicated [see Drug Interactions (7)] 4.3 Cholestatic Jaundice/Hepatic Dysfunction Clarithromycin is contraindicated in patients with a history of cholestatic jaundice or hepatic dysfunction associated with prior use of clarithromycin. 4.4 Colchicine Concomitant administration of clarithromycin and colchicine is contraindicated in patients with renal or hepatic impairment. 4.5 Lomitapide, Lovastatin, and Simvastatin Concomitant administration of clarithromycin with lomitapide is contraindicated due to potential for markedly increased transaminases [see Warnings and Precautions (5.4) and Drug Interactions (7)]. 4.6 Ergot Alkaloids Concomitant administration of clarithromycin and ergotamine or dihydroergotamine is contraindicated [see Drug Interactions (7)]. 4.7 Lurasidone Concomitant administration of clarithromycin and lurasidone is contraindicated since it may result in an increase in lurasidone exposure and the potential for serious adverse reactions [see Drug Interactions (7)].
The contraindications for clarithromycin are:
- Hypersensitivity to clarithromycin, erythromycin, or any macrolide antibacterial drug
- Concomitant administration with cisapride and pimozide
- History of cholestatic jaundice or hepatic dysfunction associated with prior use of clarithromycin
- Concomitant administration with colchicine in patients with renal or hepatic impairment
- Concomitant administration with lomitapide, lovastatin, or simvastatin
- Concomitant administration with ergot alkaloids (ergotamine or dihydroergotamine)
- Concomitant administration with lurasidone 2
From the Research
Contraindications for Clarithromycin
The following are some of the contraindications for clarithromycin:
- Hypersensitivity to clarithromycin or any other macrolide antibiotic 3, 4
- Concomitant use with certain medications, such as astemizole, cisapride, pimozide, midazolam, and triazolam, due to the risk of QT prolongation and cardiac arrhythmias 3, 5
- Severe renal impairment (creatinine clearance < 1.8 L/h) without proper dosage adjustment 3
- Concomitant use with potent inhibitors of CYP3A, such as ritonavir, due to increased risk of toxicity 3
- History of ventricular tachycardia or other severe cardiac arrhythmias 6
- Hypokalemia, as it may potentiate the risk of QT prolongation and cardiac arrhythmias 5
Special Precautions
In addition to the contraindications, special precautions should be taken when using clarithromycin in certain patient populations, including:
- Patients with renal impairment, as dosage adjustments may be necessary 3, 4
- Patients with hepatic impairment, although no dosage adjustments are typically required 4
- Elderly patients, as they may be more susceptible to the adverse effects of clarithromycin 4
- Patients taking other medications that may interact with clarithromycin, such as theophylline, carbamazepine, and warfarin 3, 7