What drugs does Biaxin (clindamycin) interact with?

Biaxin Drug Interactions

Critical Clarification

The question contains an error: Biaxin is the brand name for clarithromycin, NOT clindamycin. These are two distinct antibiotics with different interaction profiles. I will address clarithromycin (Biaxin) interactions based on the question's intent.

Major Drug Interactions with Clarithromycin

CYP3A4-Mediated Interactions

Clarithromycin is a potent CYP3A4 inhibitor, leading to numerous clinically significant drug interactions. 1

• Contraindicated combinations include terfenadine, astemizole, pimozide, and cisapride due to risk of QT prolongation and life-threatening arrhythmias 2

• Cardiovascular agents requiring caution include:

  • Antiarrhythmic agents (increased drug levels) 2
  • Calcium-channel blocking agents (enhanced hypotensive effects) 2

Drugs Requiring Dose Adjustment or Monitoring

• Anticoagulants: Oral anticoagulants like warfarin require close INR monitoring due to enhanced anticoagulant effect 2, 3

• Statins: 3-hydroxy-3-methylglutaryl-coenzyme A reductase inhibitors (statins) have increased risk of rhabdomyolysis 2

• Immunosuppressants: Cyclosporine levels increase significantly, requiring dose adjustment 2

• Benzodiazepines: Enhanced sedation and prolonged effects 2

• Ergot alkaloids: Risk of ergot toxicity 2

• Other antibiotics: Avoid concurrent use with clindamycin/lincomycin due to antagonistic effects 2

Additional Interactions

• Carbamazepine: Increased carbamazepine levels with risk of toxicity 2

• Theophylline: Enhanced theophylline levels requiring monitoring 2

• Sildenafil: Increased sildenafil exposure 2

• Azole antifungals: Bidirectional interaction affecting both drug levels 2

• Chloramphenicol: Potential antagonism 2

Clinical Management Recommendations

Review all concurrent medications before prescribing clarithromycin, particularly in patients taking drugs with narrow therapeutic indices. 2

• Separate administration of clarithromycin from interacting drugs when possible
• Monitor for signs of drug toxicity when interactions cannot be avoided
• Consider alternative antibiotics in patients on multiple interacting medications
• Be particularly vigilant for QT prolongation in patients with cardiac risk factors 2