Clarithromycin

Pronunciation

Generic Name: clarithromycin (kla RITH roe MYE sin)
Brand Names: Biaxin, Biaxin XL, Biaxin XL-Pak

What is clarithromycin?

Clarithromycin is a macrolide antibiotic. It fights bacteria in your body.

Clarithromycin is used to treat many different types of bacterial infections affecting the skin and respiratory system. It is also used together with other medicines to treat stomach ulcers caused by Helicobacter pylori.

Clarithromycin may also be used for purposes not listed in this medication guide.

Important information

You should not use this medication if you are allergic to clarithromycin, or to similar medicines such as azithromycin (Zithromax), erythromycin (E.E.S., EryPed, Ery-Tab, Erythrocin, Pediazole), or telithromycin (Ketek).

You should not use this medication if you have a life-threatening heart rhythm disorder, a history of Long QT syndrome, if you have ever had jaundice or liver problems caused by taking clarithromycin, or if you have liver or kidney disease and are also taking colchicine (Colcrys).

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Do not use clarithromycin if you are also using any of the drugs listed below. They can interact with clarithromycin and cause serious or life-threatening side effects:

  • cisapride (Propulsid);

  • pimozide (Orap);

  • lovastatin (Mevacor, Altoprev, Advicor) or simvastatin (Zocor, Simcor, Vytorin); or

  • ergot medicine such as ergotamine (Ergomar, Ergostat, Cafergot, Ercaf, Wigraine), or dihydroergotamine (D.H.E. 45, Migranal Nasal Spray).

Take this medicine for the full prescribed length of time. Your symptoms may improve before the infection is completely cleared. Skipping doses may also increase your risk of further infection that is resistant to antibiotics. Clarithromycin will not treat a viral infection such as the common cold or flu.

Before taking this medicine

You should not use this medication if you are allergic to clarithromycin or to similar medicines such as azithromycin (Zithromax), erythromycin (E.E.S., EryPed, Ery-Tab, Erythrocin, Pediazole), or telithromycin (Ketek).

You should not use this medication if you have a life-threatening heart rhythm disorder, a history of Long QT syndrome, if you have ever had jaundice or liver problems caused by taking clarithromycin, or if you have liver or kidney disease and are also taking colchicine (Colcrys).

Do not use clarithromycin if you are also using any of the drugs listed below. They can interact with clarithromycin and cause serious or life-threatening side effects:

  • cisapride (Propulsid);

  • pimozide (Orap);

  • lovastatin (Mevacor, Altoprev, Advicor) or simvastatin (Zocor, Simcor, Vytorin); or

  • ergot medicine such as ergotamine (Ergomar, Ergostat, Cafergot, Ercaf, Wigraine), or dihydroergotamine (D.H.E. 45, Migranal Nasal Spray).

To make sure you can safely take clarithromycin, tell your doctor if you have any of these other conditions:

  • liver disease;

  • kidney disease;

  • myasthenia gravis;

  • porphyria;

  • an electrolyte imbalance (such as low levels of potassium or magnesium in your blood);

  • a family history of Long QT syndrome; or

  • if you take any of these heart rhythm medications -- amiodarone (Cordarone, Pacerone), disopyramide (Norpace), dofetilide (Tikosyn), flecainide (Tambocor), dronedarone (Multaq), ibutilide (Corvert), mexiletine (Mexitil), procainamide (Procan, Pronestyl), propafenone, (Rythmol), quinidine (Quin-G), or sotalol (Betapace).

FDA pregnancy category C. It is not known whether clarithromycin will harm an unborn baby. Before you take clarithromycin, tell your doctor if you are pregnant or plan to become pregnant while using this medication.

See also: Pregnancy and breastfeeding warnings (in more detail)

It is not known whether clarithromycin passes into breast milk or if it could harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby.

Do not give clarithromycin to a child younger than 6 months of age.

Older adults may be more likely to have side effects on heart rhythm, including a life-threatening fast heart rate.

How should I take clarithromycin?

Take clarithromycin exactly as prescribed by your doctor. Do not take in larger or smaller amounts or for longer than recommended. Follow the directions on your prescription label.

You may take clarithromycin tablets and oral suspension (liquid) with or without food.

Clarithromycin extended-release tablets (Biaxin XL) should be taken with food.

Do not crush, chew, or break an extended-release clarithromycin tablet. Swallow it whole. Breaking the pill may cause too much of the drug to be released at one time.

Shake the oral suspension (liquid) well just before you measure a dose. Measure the liquid with a special dose-measuring spoon or medicine cup, not with a regular table spoon. If you do not have a dose-measuring device, ask your pharmacist for one.

Take this medicine for the full prescribed length of time. Your symptoms may improve before the infection is completely cleared. Skipping doses may also increase your risk of further infection that is resistant to antibiotics. Clarithromycin will not treat a viral infection such as the common cold or flu.

Store at room temperature away from moisture and heat. Do not keep the oral liquid in a refrigerator.

What happens if I miss a dose?

Take the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not take extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.

Overdose symptoms may include severe stomach pain, nausea, vomiting, or diarrhea.

What should I avoid?

Antibiotic medicines can cause diarrhea, which may be a sign of a new infection. If you have diarrhea that is watery or bloody, stop taking clarithromycin and call your doctor. Do not use anti-diarrhea medicine unless your doctor tells you to.

Clarithromycin side effects

Get emergency medical help if you have any of these signs of an allergic reaction to clarithromycin: hives; difficult breathing; swelling of your face, lips, tongue, or throat.

Call your doctor at once if you have a serious side effect such as:

  • headache with chest pain and severe dizziness, fast or pounding heartbeats, shortness of breath, fainting;

  • diarrhea that is watery or bloody;

  • fever, swollen glands, body aches, flu symptoms, new or worsening cough;

  • skin rash, easy bruising or bleeding, severe tingling, numbness, pain, muscle weakness;

  • confusion, vomiting, swelling, rapid weight gain, urinating less than usual or not at all;

  • problems with your hearing; or

  • severe skin reaction -- fever, sore throat, swelling in your face or tongue, burning in your eyes, skin pain, followed by a red or purple skin rash that spreads (especially in the face or upper body) and causes blistering and peeling.

Clarithromycin may also cause severe liver symptoms. Stop taking clarithromycin and call your doctor at once if you have any of these liver symptoms:

  • low fever, itching;

  • nausea, upper stomach pain, loss of appetite;

  • dark urine, clay colored stools; or

  • jaundice (yellowing of the skin or eyes).

Less serious clarithromycin side effects may include:

  • upset stomach, vomiting, diarrhea;

  • unusual or unpleasant taste in your mouth;

  • tooth discoloration;

  • headache;

  • mild itching or rash; or

  • vaginal itching or discharge.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

See also: Side effects (in more detail)

Clarithromycin Dosing Information

Usual Adult Dose of Clarithromycin for Tonsillitis/Pharyngitis:

Due to Streptococcus pyogenes:
Immediate release: 250 mg orally every 12 hours for 10 days

Usual Adult Dose for Sinusitis:

Acute maxillary sinusitis due to Haemophilus influenzae, Moraxella catarrhalis, or S pneumoniae:
Immediate release: 500 mg orally every 12 hours for 14 days
Extended release tablets: 1000 mg orally every 24 hours for 14 days

Usual Adult Dose of Clarithromycin for Bronchitis:

Acute exacerbation of chronic bronchitis:
Immediate release:
Due to H influenzae: 500 mg orally every 12 hours for 7 to 14 days
Due to H parainfluenzae: 500 mg orally every 12 hours for 7 days
Due to M catarrhalis or S pneumoniae: 250 mg orally every 12 hours for 7 to 14 days

Extended release tablets:
Due to H influenzae, H parainfluenzae, M catarrhalis, or S pneumoniae: 1000 mg orally every 24 hours for 7 days

Usual Adult Dose for Pneumonia:

Community-acquired pneumonia:
Immediate release:
Due to H influenzae: 250 mg orally every 12 hours for 7 days
Due to S pneumoniae or Chlamydophila pneumoniae: 250 mg orally every 12 hours for 7 to 14 days

Extended release tablets:
Due to H influenzae, H parainfluenzae, M catarrhalis, S pneumoniae, or C pneumoniae: 1000 mg orally every 24 hours for 7 days

Usual Adult Dose of Clarithromycin for Mycoplasma Pneumonia:

Community-acquired pneumonia due to Mycoplasma pneumoniae:
Immediate release: 250 mg orally every 12 hours for 7 to 14 days
Extended release tablets: 1000 mg orally every 24 hours for 7 days

Usual Adult Dose for Skin and Structure Infection:

Uncomplicated infections due to Staphylococcus aureus or S pyogenes:
Immediate release: 250 mg orally every 12 hours for 7 to 14 days

Usual Adult Dose for Helicobacter pylori Infection:

H pylori eradication to reduce the risk of duodenal ulcer recurrence:
Immediate release:
Triple therapy:
Clarithromycin plus lansoprazole and amoxicillin: Clarithromycin 500 mg orally every 12 hours for 10 to 14 days
Clarithromycin plus omeprazole and amoxicillin: Clarithromycin 500 mg orally every 12 hours for 10 days

Dual therapy:
Clarithromycin plus omeprazole: Clarithromycin 500 mg orally every 8 hours for 14 days
Clarithromycin plus ranitidine bismuth citrate: Clarithromycin 500 mg orally every 8 to 12 hours for 14 days

Usual Adult Dose of Clarithromycin for Mycobacterium avium-intracellulare -- Prophylaxis:

Immediate release:
Prevention of disseminated Mycobacterium avium complex (MAC) disease in patients with advanced HIV infection: 500 mg orally twice a day

Centers for Disease Control and Prevention (CDC), National Institutes of Health (NIH), and Infectious Diseases Society of America (IDSA) recommendations for HIV-infected patients:
Primary prevention of disseminated MAC disease: 500 mg orally twice a day

Chronic maintenance therapy (secondary prophylaxis) for disseminated MAC disease: 500 mg orally twice a day plus ethambutol, with or without rifabutin

Secondary prophylaxis is usually continued for life; however, discontinuation may be considered in patients with sustained immune recovery in response to antiretroviral therapy.

Usual Adult Dose for Mycobacterium avium-intracellulare -- Treatment:

Immediate release:
Treatment of disseminated mycobacterial infections due to MAC: 500 mg orally twice a day

Clarithromycin should be used in combination with other antimycobacterial agents that have shown in vitro activity against MAC or clinical benefit in MAC treatment.

Clarithromycin therapy should continue for life if clinical mycobacterial improvements are observed.

CDC, NIH, and IDSA recommendations:
Treatment of disseminated MAC infections in HIV-infected patients: 500 mg orally twice a day plus ethambutol, with or without rifabutin

Combination therapy with at least 2 drugs is recommended. Chronic suppressive therapy (secondary prophylaxis) is recommended after initial therapy.

Usual Adult Dose for Bacterial Endocarditis Prophylaxis:

(Not approved by FDA)

American Heart Association (AHA) recommendations for patients allergic to penicillins:
Immediate release: 500 mg orally as a single dose 30 to 60 minutes before the procedure

Usual Adult Dose of Clarithromycin for Legionella Pneumonia:

(Not approved by FDA)

Legionnaires' disease:
Immediate release: 500 mg orally every 12 hours
Duration: 10 days for mild to moderate infections in immunocompetent patients; 3 weeks may be necessary to prevent relapse, especially in patients with more severe infections or with underlying comorbidity or immunodeficiency

Usual Adult Dose for Pertussis Prophylaxis:

(Not approved by FDA)

CDC recommendations for treatment and postexposure prophylaxis:
Immediate release: 500 mg orally every 12 hours for 7 days

Usual Adult Dose for Pertussis:

(Not approved by FDA)

CDC recommendations for treatment and postexposure prophylaxis:
Immediate release: 500 mg orally every 12 hours for 7 days

Usual Pediatric Dose of Clarithromycin for Tonsillitis/Pharyngitis:

Due to S pyogenes:
Immediate release: 7.5 mg/kg orally every 12 hours for 10 days

Usual Pediatric Dose for Sinusitis:

Acute maxillary sinusitis due to H influenzae, M catarrhalis, or S pneumoniae:
Immediate release: 7.5 mg/kg orally every 12 hours for 10 days

Usual Pediatric Dose for Pneumonia:

Community-acquired pneumonia due to M pneumoniae, S pneumoniae, or C pneumoniae:
Immediate release: 7.5 mg/kg orally every 12 hours for 10 days

Usual Pediatric Dose for Otitis Media:

Acute infections due to H influenzae, M catarrhalis, or S pneumoniae:
Immediate release: 7.5 mg/kg orally every 12 hours for 10 days

Usual Pediatric Dose for Skin and Structure Infection:

Uncomplicated infections due to S aureus or S pyogenes:
Immediate release: 7.5 mg/kg orally every 12 hours for 10 days

Abscesses usually require surgical drainage.

Usual Pediatric Dose for Mycobacterium avium-intracellulare -- Prophylaxis:

Immediate release:
Prevention of disseminated MAC disease in patients with advanced HIV infection:
20 months or older: 7.5 mg/kg (maximum: 500 mg/dose) orally twice a day

CDC, NIH, IDSA, and American Academy of Pediatrics (AAP) recommendations for HIV-exposed and HIV-infected infants and children:
Primary prevention of MAC infections: 7.5 mg/kg (maximum: 500 mg/dose) orally twice a day

Secondary prevention of MAC infections: 7.5 mg/kg (maximum: 500 mg/dose) orally twice a day plus ethambutol, with or without rifabutin

CDC, NIH, and IDSA recommendations for HIV-infected adolescents:
Primary prevention of disseminated MAC disease: 500 mg orally twice a day

Chronic maintenance therapy (secondary prophylaxis) for disseminated MAC disease: 500 mg orally twice a day plus ethambutol, with or without rifabutin

Secondary prophylaxis is usually continued for life; however, discontinuation may be considered in patients with sustained immune recovery in response to antiretroviral therapy.

Usual Pediatric Dose for Mycobacterium avium-intracellulare -- Treatment:

Immediate release:
Treatment of disseminated mycobacterial infections due to MAC:
20 months or older: 7.5 mg/kg (maximum: 500 mg/dose) orally twice a day

Clarithromycin should be used in combination with other antimycobacterial agents that have shown in vitro activity against MAC or clinical benefit in MAC treatment.

Clarithromycin therapy should continue for life if clinical mycobacterial improvements are observed.

CDC, NIH, IDSA, and AAP recommendations for HIV-exposed and HIV-infected infants and children:
Treatment of MAC infections: 7.5 to 15 mg/kg (maximum: 500 mg/dose) orally twice a day plus ethambutol, with or without rifabutin

CDC, NIH, and IDSA recommendations for HIV-infected adolescents:
Treatment of disseminated MAC infections: 500 mg orally twice a day plus ethambutol, with or without rifabutin

Combination therapy with at least 2 drugs is recommended. Chronic suppressive therapy (secondary prophylaxis) is recommended after initial therapy.

Usual Pediatric Dose for Pertussis Prophylaxis:

(Not approved by FDA)

CDC recommendations for treatment and postexposure prophylaxis:
Immediate release:
1 to 5 months: 7.5 mg/kg orally every 12 hours for 7 days
6 months or older: 7.5 mg/kg (maximum: 500 mg/dose) orally every 12 hours for 7 days

Usual Pediatric Dose for Pertussis:

(Not approved by FDA)

CDC recommendations for treatment and postexposure prophylaxis:
Immediate release:
1 to 5 months: 7.5 mg/kg orally every 12 hours for 7 days
6 months or older: 7.5 mg/kg (maximum: 500 mg/dose) orally every 12 hours for 7 days

Usual Pediatric Dose for Bacterial Endocarditis Prophylaxis:

(Not approved by FDA)

AHA recommendations for children allergic to penicillins:
Immediate release: 15 mg/kg (maximum: 500 mg) orally as a single dose 30 to 60 minutes before procedure

What other drugs will affect clarithromycin?

Tell your doctor about all other medicines you use, especially:

  • a blood thinner such as warfarin (Coumadin, Jantoven);

  • colchicine (Colcrys);

  • itraconazole (Sporanox);

  • omeprazole (Prilosec);

  • ranitidine bismuth citrate (Tritec);

  • sildenafil (Viagra), tadalafil (Adcirca, Cialis), or vardenafil (Levitra);

  • theophylline (Elixophyllin, Theo-24, Theochron, Uniphyl);

  • tolterodine (Detrol);

  • any other antibiotic, especially rifabutin (Mycobutin), rifapentine (Priftin), or rifampin (Rifater, Rifadin, Rifamate);

  • cholesterol-lowering medicines such as atorvastatin (Lipitor, Caduet), pravastatin (Pravachol), and others;

  • drugs that weaken your immune system, such as cyclosporine (Neoral, Sandimmune, Gengraf), tacrolimus (Prograf), or steroids;

  • heart medication such as amlodipine (Norvasc, Caduet, Exforge, Lotrel, Tekamlo, Tribenzor, Twynsta, Amturnide), digoxin (digitalis, Lanoxicaps, Lanoxin), diltiazem (Cartia, Cardizem), verapamil (Calan, Covera, Isoptin, Verelan), and others;

  • HIV medicines such as atazanavir (Reyataz), efavirenz (Sustiva, Atripla), nevirapine (Viramune), ritonavir (Norvir, Kaletra), saquinavir (Invirase), or zidovudine (Retrovir);

  • insulin or oral diabetes medication;

  • a sedative such as alprazolam (Xanax), midazolam (Versed), or triazolam (Halcion); or

  • seizure medications such as carbamazepine (Carbatrol, Equetro, Tegretol), phenytoin (Dilantin), and valproic acid (Depakote, Depakene).

This list is not complete and there are many other drugs that can interact with clarithromycin. Tell your doctor about all medications you use. This includes prescription, over-the-counter, vitamin, and herbal products. Do not start a new medication without telling your doctor. Keep a list of all your medicines and show it to any healthcare provider who treats you.

Where can I get more information?

  • Your pharmacist can provide more information about clarithromycin.
  • Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use clarithromycin only for the indication prescribed.
  • Disclaimer: Every effort has been made to ensure that the information provided is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects.

Copyright 1996-2014 Cerner Multum, Inc. Version: 15.01. Revision Date: 2012-09-11, 1:07:36 PM.

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