From the Guidelines
Clarithromycin 500mg can be hard on the stomach, causing gastrointestinal side effects such as nausea, vomiting, and metallic taste, as reported in a study published in the American Journal of Respiratory and Critical Care Medicine 1. The most common toxicities seen with clarithromycin are gastrointestinal, including metallic taste, nausea, and vomiting.
- Gastrointestinal symptoms are dose and serum-level related, and adult patients generally cannot tolerate clarithromycin at more than 1,000 mg/day.
- Some patients, especially elderly patients with low creatinine clearances or low body weight, may require even lower doses (i.e., 250–500 mg/d) because of toxicity.
- Taking clarithromycin with food can help reduce stomach irritation, but it is essential to monitor patients for toxicity, especially when combined with other medications like rifabutin.
- If you experience severe stomach pain, persistent nausea, or vomiting while taking clarithromycin, contact your healthcare provider, as these side effects can be a sign of a more serious issue.
- Completing the full prescribed course is crucial, even if symptoms improve before finishing the medication, to ensure effective treatment and prevent the development of antibiotic-resistant bacteria.
From the FDA Drug Label
Overdosage of clarithromycin can cause gastrointestinal symptoms such as abdominal pain, vomiting, nausea, and diarrhea.
Clarithromycin 500mg can be hard on the stomach, as it may cause gastrointestinal symptoms like abdominal pain, vomiting, nausea, and diarrhea, especially in cases of overdosage 2.
From the Research
Gastrointestinal Effects of Clarithromycin 500mg
- The gastrointestinal effects of clarithromycin 500mg are primarily mild to moderate in nature 3, 4, 5, 6, 7
- Adverse events are mostly gastrointestinal, including diarrhea, abnormal taste, and nausea 3, 4, 5, 6, 7
- The incidence of gastrointestinal adverse events is comparable between clarithromycin 500mg and other macrolides, such as azithromycin 7
- However, the extended-release formulation of clarithromycin 500mg has been shown to have a lower incidence of gastrointestinal adverse events compared to the immediate-release formulation 4, 6
Comparison of Formulations
- The extended-release formulation of clarithromycin 500mg has been shown to be bioequivalent to the immediate-release formulation 4, 6
- The extended-release formulation has a lower peak plasma concentration and a delayed time to reach peak concentration compared to the immediate-release formulation 4
- The incidence of diarrhea is significantly lower with the extended-release formulation compared to the immediate-release formulation 5
Tolerability
- Clarithromycin 500mg is generally well-tolerated, with most adverse events being mild to moderate in nature 3, 4, 5, 6, 7
- The tolerability of clarithromycin 500mg is comparable to other macrolides, such as azithromycin 7
- The extended-release formulation of clarithromycin 500mg has been shown to have an improved gastrointestinal tolerability profile compared to the immediate-release formulation 4, 6