Clarithromycin (Clarosip / Klaricid / Klaricid XL)

Clarithromycin (Clarosip / Klaricid / Klaricid XL) is an approved antibiotic for use in combination with other drugs for the treatment of Mycobacterium avium intracellulare (MAI).1 In the United States it is also approved as MAI prophylaxis.2 It is also approved for treating respiratory tract infections and mild-to-moderate skin and soft tissue infections.

The recommended dose for treating people with MAI is 500mg twice daily on an empty stomach. Doses higher than this have been associated with worse survival in several clinical trials.

Clarithromycin is also being tested alone and in combination with other drugs for the treatment of toxoplasmosis.3

Its side-effects include diarrhoea, nausea, abnormal taste, dyspepsia, abdominal pain, and headache.

Clarithromycin should not be taken at the same time as the anti-histamine drugs astemizole or terfenadine due to heart irregularities. Taking clarithromycin decreases levels of AZT (zidovudine, Retrovir) in the blood.4 Due to complex interactions, clarithromycin should be avoided by patients taking the protease inhibitors atazanavir (Reyataz), efavirenz (Sustiva) or nevirapine (Viramune).5 6 7 A reduced dose should be used by patients taking ritonavir-boosted lopinavir (Kaletra), while patients taking ritonavir (Norvir) or tipranavir (Aptivus) should use clarithromycin with caution.8 9

References

  1. Chaisson RE et al. Clarithromycin therapy for bacteremic Mycobacterium avium complex disease. Ann Intern Med 121: 905-911, 1994
  2. Benson CA et al. Clarithromycin or rifabutin alone or in combination for primary prophylaxis of Mycobacterium avium complex disease in patients with AIDS: a randomized, double-blind, placebo-controlled trial. The AIDS Clinical Trials Group 196 / Terry Beirn Community Programs for Clinical Research on AIDS 009 Protocol Team. J Infect Dis 181: 1289-1297, 2000
  3. Derouin F et al. Determination of the inhibitory effect on toxoplasma growth in the serum of AIDS patients during acute therapy for toxoplasmic encephalitis. J Acquir Immune Defic Syndr Hum Retrovirol 19: 50-54, 1998
  4. Polis MA et al. Clarithromycin lowers plasma zidovudine levels in persons with human immunodeficiency virus infection. Antimicrob Agents Chemother 41: 1709-1714, 1997
  5. Mummaneni V et al. Steady state pharmacokinetic study of atazanavir with clarithromycin in healthy subjects. 42nd Interscience Conference on Antimicrobial Agents and Chemotherapy, San Diego, abstract H-1717, 2002
  6. Benedek IH et al. Pharmacokinetic interaction studies in healthy volunteers with efavirenz and the macrolide antibiotics, azithromycin and clarithromycin. Fifth Conference on Retroviruses and Opportunistic Infections, Chicago, abstract 347, 1998
  7. Robinson P et al. Effect of the reverse transcriptase inhibitor, nevirapine, on the steady-state pharmacokinetics of clarithromycin in HIV-positive patients. Sixth Conference on Retroviruses and Opportunistic Infections, Chicago, abstract 374, 1999
  8. Ouellet D et al. Pharmacokinetic interaction between ritonavir and clarithromycin. Clin Pharmacol Ther 64: 355-362, 1998
  9. van Heeswijk R et al. The effect of tipranavir / ritonavir 500 / 200mg on the pharmacokinetics of clarithromycin in healthy volunteers. 44th Interscience Conference on Antimicrobial Agents and Chemotherapy, Washington, abstract A-457, 2004

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This content was checked for accuracy at the time it was written. It may have been superseded by more recent developments. NAM recommends checking whether this is the most current information when making decisions that may affect your health.

NAM’s information is intended to support, rather than replace, consultation with a healthcare professional. Talk to your doctor or another member of your healthcare team for advice tailored to your situation.