Klacid Forte 500mg Abbott medicine for respiratory infections (14 tablets)

Contrain to use Clarithromycin with ticagrelor or ranolazine.

Be cautious when using

Use any antibiotic therapy, such as Clarithromycin, to treat H. pylori infections can produce anti -drug strains.

Do not prescribe Clarithromycin for pregnant women before careful consideration of benefits and risks, especially in the first 3 months of pregnancy.

Like other antibiotics, the use of long -term clarithromycin can cause fungal proliferation and non -sensitive bacteria. If superinfection occurs, appropriate treatment should be conducted.

Be careful when used for patients with severe renal impairment.

There have been reports on liver dysfunction, including liver enzymes, liver cell inflammation or cholestatic hepatitis, with or without jaundice when using clarithromycin. Liver dysfunction may be serious and often recovered. In some cases, there has been a report of death from liver failure often associated with serious diseases available and/or medications used simultaneously. Stop using clarithromycin if signs and symptoms of hepatitis, such as anorexia, jaundice, dark urine itchy, or abdominal pain.The fake colitis has been reported to most antibacterial drugs, including macrolids, and mild to life -threatening condition. Diarrhea is associated with Clostridium Difficile (CDAD) reported when used with most antibiotics including clarithromycin, and the degree of mild diarrhea to death.

Antibiotic treatment changes the normal bacteria of the intestine, which can lead to overexoration of C. Difficile. CDAD must be concerned in all patients with diarrhea after antibiotics. Careful medical records are necessary because there is a report on the appearance of CDAD for 2 months after antibiotic use.

Clarithromycin is excreted mainly through the liver, so be careful when using this antibiotic in patients with liver function impairment. Also be cautious when used for patients with kidney failure to severe to severe.

colchicine

There have been reports after the drug to the market for colchicine poisoning when using clarithromycin and colchicine, especially in the elderly, some occur in patients with renal impairment. Died in some cases. Contrain to use Colchicine and Clarithromycin simultaneously.

Be careful when using Clarithromycin with triazolobenzodiazepine drugs, such as triazolam and midazolam intramuscularly.

Be careful when using Clarithromycin simultaneously with other drugs that affect other hearing, especially aminoglycoside. Need to monitor hearing function and vestibular during and after treatment.

Due to the risk of extension of QT, Clarithromycin should be used cautiously in patients with coronary artery disease, severe heart failure, lack of magnesium, slow heart rate (

pneumonia

Due to the increasing streptococcus pneumoniae's macrolid drug resistance, the implementation of antibiotics is important when prescribing Clarithromycin for patients with pneumonia with community. Clarithromycin should be used in combination with other appropriate antibiotics in the treatment of pneumonia.

Skin and soft tissue infections from light to medium

Most of the skin infections are usually caused by Staphylococcus aureus and Streptococcus pyogenes, both bacteria can be resistant to macrolide drugs. Therefore, antibiotics are very important. In the absence of beta-lactam antibiotics (for example, allergies), other antibiotics, such as clindamycin, may be the first choice. Currently, macrolide drugs are only considered for the treatment of skin and soft tissue infections, such as bacterial infections caused by coryneebacterium minutissimum, acne, skin infections causing high -grade fever and cases that cannot be used penicillin.

In the case of acute and severe hypersensitivity reactions, such as Stevens-Johnson syndrome, anaphylactic shock, poisoned epidermal necrosis and dress, immediately stop using clarithromycin and urgently treat appropriate treatment.

Be cautious when using Clarithromycin along with drugs irritating the enzyme system CYP3A4.

Should pay attention to the diagonal resistance between Clarithromycin and other macrolid drugs, as well as with Lincomycin and Clindamycin.

HMG-CoA Reductase inhibitors (Statin drugs)

Contraindicated use Clarithromycin with lovastatin or simvastatin. Be careful when prescribing Clarithromycin along with other statins. There have been reports on Ly Co Van in patients using Clarithromycin simultaneously with statin drugs. Patients should be monitored on signs and symptoms of muscle diseases.

In case of being forced to use clarithromycin and statin medications, the lowest dosage recommendations are registered by statin. Consider using statin drugs regardless of CYP3A metabolism (such as fluvastatin).

Oral hypoglycemic medications/lnsulin

Simultaneous use Clarithromycin and oral hypoglycemic drugs or insulin may significantly reduce blood sugar. Need strict control of blood sugar.

Oral anticoagulants

Concomitance Clarithromycin and warfarin are at risk of serious bleeding, increasing the Inr (International Normalized Ratio) and prothrombin time. Regular tests of Inr and prothrombin must be checked when the patient takes and clarithromycin and anticoagulants.

The ability to drive and operate machinery

There has been no report on the impact of the drug while driving and operating machinery.

It is recommended that patients with the risk of dizziness, confusion, and disorientation may occur when using the drug.

pregnancy and lactation

Clarithromycin's safety during pregnancy has not been verified. Therefore, the drug should not be used during pregnancy unless the benefits are more than the risk.

Clarithromycin's safety during breastfeeding has not been set. Clarithromycin is determined in breast milk.

Drug interaction

cisapride, pimozide, astemizole and terfenadine

Increased Cisapride concentration has been reported in patients with simultaneous use of cisapride and clarithromycin. This can cause extension of QT and arrhythmias including ventricular tachycardia, ventricular vibration and torsion. Similar manifestations were seen when using simultaneously pimozide and clarithromycin.

Macrolide disrupts the metabolism of terfenadin, E increases the concentration of terfenadine, sometimes leading to arrhythmia such as extending the QT distance, ventricular tachycardia, ventricular vibration and torsion (see contraindicated). In a study of 14 healthy volunteers, simultaneously using clarithromycin and terfenadine increased by 2-3 times the concentration in serum metabolic metabolites of terfenadine and extended the QT range but did not detect any clinical manifestations. Similar manifestations are seen when using simultaneously Astemizole and other macrolids.

Alkaloid fungus

Market reports show that the use of Clarithromycin at the same time with ergotamine or dihydroergotamine is related to the toxicity of the fungus of the fungus typical by vasoconstriction, ischemia at the limbs and other tissues including the central nervous system. Contraindicated use at the same time Clarithromycin with mushroom alkaloids.

HMG-CoA Reductase inhibitors (Statin drugs)

Do not simultaneously use clarithromycin with lovastatin or simvastatin because these statins are metabolized largely by CYP3A4, increasing plasma medication concentration when used with clarithromycin, leading to an increase in muscle disease risk, including muscle prize. There have been reports on the muscular awards in patients using clarithromycin along with these statins. If necessary, Clarithromycin is needed, lovastatin or simvastatin must be stopped during this treatment.

Be careful when prescribing Clarithromycin with statin medications. In cases where clarithromycin must be used and statin drugs, the lowest dosage recommendations are registered by statin. Consider using statin drugs regardless of the metabolism of CYP3A (such as fluvastatin). Patients should be monitored on signs and symptoms of muscle diseases.

The impact of other drugs on Clarithromycin

The drugs irritating the CYP3A enzyme system (for example, Rifampicin, Phenytoin, Carbamazepine, Phenobarbital, St John’s Wort) can increase the metabolism of Clarithromycin. This can cause low clarithromycin levels below the treatment threshold, reducing the effectiveness of the drug's treatment. Moreover, it may be necessary to monitor the plasma concentration of drugs that irritate the CYP3A system, which can be increased by Clarithromycin inhibit the CYP3A system.

Use Clarithromycin and Rifabutin at the same time increase rifabutin levels and reduce the levels of serum clarithromycin, along with increased risk of grape vein inflammation.

The following drugs are known or suspected to affect Clarithromycin's circulatory concentration; Adjust the clarithromycin dose or choose the alternative treatment should be considered.

Efavirenz, Nevirapine, Rifampicin, Rifabutin and Rifapentine

Cytochrome P450 metabolic drugs such as Efavirenz, Nevirapine, Rifampicin, Rifabutin and Rifapentine may increase the metabolism of clarithromycin, thus reducing the concentration of clarithromycin in plasma. Meanwhile, the concentration of 14-oh-clarithromycin increases, which also has antibacterial activity. Due to the antibacterial activity of Clarithromycin and 14-OH-Clarithromycin different for different bacteria, the effectiveness of treatment may be affected if used at the same time Clarithromycin with enzyme induction substances.

Eravirine

Clarithromycin's concentration is reduced by Etravirin, however, the concentration of active metabolites, 14-oh-clarithromycin increases. Because metabolites have 14-oh-clarithromycin activity that reduces the activity of mycobacterium avium complex (Mac) complex, the common activity for pathogens may be changed. Therefore, it is necessary to consider replacing clarithromycin with other drugs when treating Mac in patients with Etravirine.

fluconazole

Use Fluconazole 200 mg at the same time and Clarithromycin 500 mg twice a day for 21 healthy volunteers to increase the minimum concentration (cmin) in the stable state of Clarithromycin to 33% and the area under the curve (AUC) to 18%. The concentration in the stable state of metabolites is active 14-oh-clarithromycin is not affected when used simultaneously with fluconazole. No dose adjustment of clarithromycin.

ritonavir

A pharmacokinetic study proves that simultaneous use of ritonavir 200 mg every 8 hours and Clarithromycin 500 mg every 12 hours inhibit the metabolism of Clarithromycin. Clarithromycin's CMAX increased by 31%, CMIN increased by 182% and AUC increased by 77% when used with ritonavir. Found the complete inhibition of 14-oh-clarithromycin.

Because Clarithromycin has a large treatment range, it is not necessary to reduce the dose in patients with normal renal function. However, for patients with renal impairment, the dose adjustment should be as follows: For patients with creatinine clearance from 30 - 60 ml/min, reduce clarithromycin dose by 50%. For patients with creatinine clearance

Consider adjusting the dose in patients with renal impairment when using Ritonavir in combination with enzyme inhibitors including Atazanavir and Saquinavir.

The effect of clarithromycin on other drugs

anti -arrhyths

There have been reports after bringing the drug to the market to occur when using Clarithromycin at the same time with Quinidine or Disopyramide. Electrolyte test should be checked for about QT length during use at the same time clarithromycin with these drugs. Need to monitor the serum concentration of these drugs while taking clarithromycin.

There have been after -sales reports on hypoglycemia when using clarithromycin with disopyramide. Therefore, it is necessary to monitor blood sugar when using clarithromycin simultaneously with disopyramide.

Oral hypoglycemic drugs/insulin

Clarithromycin inhibits CYP3A and may be related to or causes hypoglycemia when used simultaneously with some hypoglycemic drugs such as Nateganide and Repaglinide. Need strict control of blood sugar.

interactions via CYP3A4

Simultaneously used Clarithromycin, known as a CYP3A4 inhibitor, with a major metabolic drug through CYP3A4 may be related to the increase in the concentration of the drug, which may increase or prolong both the treatment and adverse effects of the same drug.

Be cautious when using Clarithromycin in patients treated with drugs known as the substrate of the CYP3A4 enzyme, especially if the CYP3A4 substrate has a narrow safety (eg carbamazepine) and the substrate is mainly metabolized by this enzyme. Adjusting the dose can be considered and when possible, the serum concentration of the drugs metabolized mainly by CYP3A4 should be closely checked in patients using Clarithromycin simultaneously.

omeprazole

Use Clarithromycin (500 mg every 8 hours) along with omeprazole (40 mg/day) on healthy adults. Plasma concentrations in the stable state of Omeprazole increased (CMAX increased by 30%, ACU 0-24 increased by 89%and the sale time increased by 34%) when used at the same time as Clarithromycin. The average 24 -hour gastric pH is 5.2 when using omeprazole alone and 5.7 when sharing Omeprazole with clarithromycin.

Sildenafil, Tadalafil and Vardenafil

Each phosphodiesterase enzyme inhibitor is metabolized, at least in part, because CYP3A4, and CYP3A4 can be inhibited when used simultaneously Clarithromycin.

Use these drugs at the same time with Clarithromycin will be able to increase the exposure of phosphodiesterase inhibitors. The dose of these drugs should be reduced when used simultaneously with clarithromycin.

Theophyllin, carbamezapine

The results of clinical studies show that, although increasing at a modest level, statistically significance (P ≤ 0.05) concentration of theophylline or carbamazepine during the circulation when they share one of these drugs with clarithromycin.

Tolterodine

The main metabolic path of Tolterodine is through 2D6 ISOform of Cytochrome P450 (CYP2D6). However, in people who do not have CYP2D6, the identified transformation line is through CYP3A4. In these people, the inhibition of CYP3A4 will significantly increase the concentration of serum tolterodine. The decrease of the tolterodine dose may be necessary when there are CYP3A4 inhibitors as clarithromycin.

triazolobenzodiazepine (for example: Alprazolam, Midazolam, Triazolam)

When using Midazolam at the same time with Clarithromycin (500 mg, 2 times/day), Midazolam's AUC increased by 2.7 times when used injecting and increased 7 times when used orally. Therefore, avoid using clarithromycin with oral midazolam at the same time. If using midazolam injected at the same time as Clarithromycin, you should closely monitor patients to be able to adjust the dose. The same note for other benzodiazepine transformed through CYP3A4, including triazolam and alprazolam.

For benzodiazepine, the elimination does not depend on CYP3A4 (Temazepam, Nitrazepam, Lorazepam), important important interactions are almost no occurrence when used with Clarithromycin. There have been reports after bringing the drug to the market for drug interactions and the effects on the central nervous system (for example, drowsiness and confusion) when using Clarithromycin at the same time with Triazolam. Should monitor the effect on the central nervous system in patients taking drugs.

Other drug interactions

aminoglycoside

Be careful when using Clarithromycin simultaneously with other drugs that affect other hearing, especially aminoglycoside. (See warning and caution).

colchicine

Colchicine is a substrate for both CYP3A4 and P-Glycoproteln (PGP). Clarithromycin and other macrolides inhibit CYP3A4 and PGP. When using Clarithromycin at the same time as Colchicine, the inhibition of CYP3A4 and/or PGP due to Clarithromycin can lead to increased exposure to colchicine, which should be tested for patients on clinical symptoms due to colchicine poisoning.

Should reduce the dose of colchicine when used simultaneously with clarithromycin in patients with normal renal and liver function. Contrain to the simultaneous use of clarithromycin and colchicine in patients with renal failure or liver failure (see caution).

digoxin

Digoxin is a substrate for P-Glycoprotein transportation (PGP). Clarithromycin inhibits PGP. When shared with clarithromycin and digoxin, PGP inhibitors by clarithromycin may increase the exposure of digoxin. There has been a report on the increase in serum Digoxin concentration in patients using Digoxin and Clarithromycin at the same time. Some patients have clinical signs of Digoxin poisoning, including death -causing arrhythmia. Should closely monitor serum digoxin concentrations in patients using clarithromycin and digoxin at the same time.

zidovudine

Take Clarithromycin at the same time quickly release and zidovudine in adults infected with HIV -infected people can lead to a decrease in zidovudine levels in a stable state. Because clarithromycin affects zidovudine's absorption at the same time, it is possible to avoid this interaction by using clarithromycin and zidovudine at time apart. This interaction does not occur in HIV -infected children using chaos clarithromycin with zidovudine or dideoxylnosine. Similar drug interactive studies with clarithromycin tablets are adjusted with zidovudine that have not been done.

phenytoin and valproate

There have been spontaneous or published reports on interaction of CYP3A4 inhibitors, including clarithromycin with drugs that are not metabolized by CYP3A (eg phenytoin and valproate). The serum concentration of these drugs should be determined when used with Clarithromycin. There have been reports on increased plasma concentrations of the above drugs.

Two -way drug interaction

Atazanavir

both Clarithromycin and Atazanavir are the substrate and inhibitors of CYP3A4, and there is evidence of a two -way drug interaction. Use Clarithromycin at the same time (500 mg x 2 times/day) with Atazanavir (400 mg once a day) increasing the exposure to clarithromycin twice and reducing 70% of exposure to 14-oh-clarithromycin, an increase of 28% AUC of Atazanavir.

Because Clarithromycin has a wide range of treatment, the decrease in clarithromycin is not necessary in patients with normal renal function. In patients with average renal impairment (the clearing of Creatinin 30 to 60 ml/min), the dose of clarithromycin should be reduced by 50%.

For patients with creatinine clearance less than 30 ml/min, the dose clarithromycin should be reduced by 75% and should use a reasonable form of medicine. Clarithromycin should not be used at the same time ≥1000 mg/day with protease inhibitors.

Calcium blockers

Be cautious when using Clarithromycin simultaneously with calcium blockers metabolized through CYP3A4 (such as Verapamil, Amlodipine, Diltiazem) due to the risk of hypotension. Clarithromycin's plasma concentrations and calcium blockers have an increase in drug interaction. Observed hypotension, slow arrhythmia and lactic acid infection in patients using Clarithromycin and Verapamil.

iTraconazole

both Clarithromycin and Itraconazole are the substrates and CYP3A4 inhibitors, resulting in a two -way drug interaction. Clarithromycin may increase the plasma concentration of otraconazole, while iTraconazole may increase the plasma concentration of clarithromycin. Patients who are using Clarithromycin and Itraconazole should be closely monitored by these signs or symptoms due to this prolonged or prolonged pharmacological effect.

saquinavir

both Clarithromycin and Saquinavir are the substrate and inhibitors of CYP3A4, and there has been evidence of two -way interaction. Use a combination of clarithromycin (500 mg x 2 times/day) and Saquinavir (soft gelatin capsule, 1200 mg x 3 times/day) for 12 healthy volunteers to increase AUC in a stable state to 177% and CMAX to 187% compared to saquinavir. Clarithromycin's AUC and CMAX values ​​are about 40% higher than using clarithromycin.

No need to adjust the dose when using these two drugs at the same time in a certain period of dose/form of research. Observations from studies on drug interactions using soft gelatin capsules may not be the same as when using hard gelatin capsules of Saquinavir. Observations from drug interactive studies performed with Saquinavir may not be the same as the effects visible when treated with Saquinavir/Ritonavir. When using Saquinavir and Ritonavir, it is recommended to note the hidden effect of ritonavir on clarithromycin.