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Drug Interactions between clarithromycin and Eliquis

This report displays the potential drug interactions for the following 2 drugs:

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Interactions between your drugs

Moderate

clarithromycin apixaban

Applies to: clarithromycin and Eliquis (apixaban)

MONITOR: Coadministration with clarithromycin, a combined P-glycoprotein (P-gp) and strong CYP450 3A4 inhibitor, may increase the plasma concentrations of apixaban, which is a substrate of the efflux transporter as well as the isoenzyme. According to the manufacturer, clarithromycin (500 mg twice a day) led to 1.6- and 1.3-fold increases in apixaban AUC and Cmax, respectively. The clinical significance of these changes has not been established. In a retrospective cohort study that used data from the Taiwan National Health Insurance database and included 91,330 patients with nonvalvular atrial fibrillation who received at least 1 non-vitamin K oral anticoagulant (NOAC) prescription for apixaban, dabigatran, or rivaroxaban, the adjusted incidence rate for major bleeding was approximately 40% lower for concurrent use of clarithromycin or erythromycin compared to NOAC use alone.

MANAGEMENT: No dosage adjustment for apixaban is recommended during coadministration with clarithromycin. However, caution is advised and pharmacologic effects of apixaban should be monitored more closely whenever clarithromycin is added to or withdrawn from therapy. Patients should be routinely evaluated for signs and symptoms suggesting blood loss such as a decrease in hemoglobin and/or hematocrit, hypotension, or fetal distress (in pregnant women).

References

  1. (2001) "Product Information. Biaxin (clarithromycin)." Abbott Pharmaceutical
  2. Cerner Multum, Inc. "UK Summary of Product Characteristics."
  3. Cerner Multum, Inc. "Australian Product Information."
  4. (2012) "Product Information. Eliquis (apixaban)." Bristol-Myers Squibb Canada Inc
  5. Cerner Multum, Inc. (2015) "Canadian Product Information."
  6. Chang SH, Chou IJ, Yeh YH, et al. (2017) "Association between use of non–vitamin K oral anticoagulants with and without concurrent medications and risk of major bleeding in nonvalvular atrial fibrillation." JAMA, 318, p. 1250-9
View all 6 references

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Drug and food interactions

Minor

clarithromycin food

Applies to: clarithromycin

Grapefruit juice may delay the gastrointestinal absorption of clarithromycin but does not appear to affect the overall extent of absorption or inhibit the metabolism of clarithromycin. The mechanism of interaction is unknown but may be related to competition for intestinal CYP450 3A4 and/or absorptive sites. In an open-label, randomized, crossover study consisting of 12 healthy subjects, coadministration with grapefruit juice increased the time to reach peak plasma concentration (Tmax) of both clarithromycin and 14-hydroxyclarithromycin (the active metabolite) by 80% and 104%, respectively, compared to water. Other pharmacokinetic parameters were not significantly altered. This interaction is unlikely to be of clinical significance.

References

  1. Cheng KL, Nafziger AN, Peloquin CA, Amsden GW (1998) "Effect of grapefruit juice on clarithromycin pharmacokinetics." Antimicrob Agents Chemother, 42, p. 927-9

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Therapeutic duplication warnings

No warnings were found for your selected drugs.

Therapeutic duplication warnings are only returned when drugs within the same group exceed the recommended therapeutic duplication maximum.

See also

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Drug Interaction Classification

These classifications are only a guideline. The relevance of a particular drug interaction to a specific individual is difficult to determine. Always consult your healthcare provider before starting or stopping any medication.
Major Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.
Moderate Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.
Minor Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.
Unknown No interaction information available.

Further information

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