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Drug Interactions between amoxicillin / clarithromycin / vonoprazan and exenatide

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

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Interactions between your drugs

Moderate

clarithromycin exenatide

Applies to: amoxicillin / clarithromycin / vonoprazan and exenatide

MONITOR: Concomitant use of insulin and other antidiabetic agents with clarithromycin may cause significant hypoglycemia. There have been rare reports of hypoglycemia in patients treated with clarithromycin, some of whom were taking oral hypoglycemic agents or insulin. The exact mechanism of interaction has not been established. With certain hypoglycemic drugs such as nateglinide, pioglitazone, repaglinide and rosiglitazone, inhibition of the CYP450 3A4 isoenzyme by clarithromycin may be involved.

MANAGEMENT: Caution is advised if clarithromycin is prescribed to patients receiving antidiabetic agents. Patients should be advised to regularly monitor their blood sugar and counseled on how to recognize and treat hypoglycemia, which may include symptoms such as headache, dizziness, drowsiness, nervousness, confusion, tremor, hunger, weakness, perspiration, palpitation, and tachycardia.

References (8)
  1. (2002) "Product Information. Biaxin (clarithromycin)." Abbott Pharmaceutical
  2. Niemi M, Neuvonen PJ, Kivisto KT (2001) "The cytochrome P4503A4 inhibitor clarithromycin increases the plasma concentrations and effects of repaglinide." Clin Pharmacol Ther, 70, p. 58-65
  3. Bussing R, Gende A (2002) "Severe hypoglycemia from clarithromycin-sulfonylurea drug interaction." Diabetes Care, 25, p. 1659-61
  4. Leiba A, Leibowitz A, Grossman E (2004) "An unusual case of hypoglycemia in a diabetic patient." Ann Emerg Med, 44, p. 427-8
  5. Cerner Multum, Inc. "UK Summary of Product Characteristics."
  6. Khamaisi M, Leitersdorf E (2008) "Severe hypoglycemia from clarithromycin-repaglinide drug interaction." Pharmacotherapy, 28, p. 682-4
  7. Schelleman H, Bilker WB, Brensinger CM, Wan F, Hennessy S (2010) "Anti-infectives and the risk of severe hypoglycemia in users of glipizide or glyburide." Clin Pharmacol Ther, 88, p. 214-22
  8. Otsuka SH (2013) "Severe hypoglycemia from helicobacter pylori triple-drug therapy and insulin detemir drug interaction." Pharmacotherapy, 33, e45-9
Minor

amoxicillin clarithromycin

Applies to: amoxicillin / clarithromycin / vonoprazan and amoxicillin / clarithromycin / vonoprazan

Although some in vitro data indicate synergism between macrolide antibiotics and penicillins, other in vitro data indicate antagonism. When these drugs are given together, neither has predictable therapeutic efficacy. Data are available for erythromycin, although theoretically this interaction could occur with any macrolide. Except for monitoring of the effectiveness of antibiotic therapy, no special precautions appear to be necessary.

References (3)
  1. Strom J (1961) "Penicillin and erythromycin singly and in combination in scarlatina therapy and the interference between them." Antibiot Chemother, 11, p. 694-7
  2. Cohn JR, Jungkind DL, Baker JS (1980) "In vitro antagonism by erythromycin of the bactericidal action of antimicrobial agents against common respiratory pathogens." Antimicrob Agents Chemother, 18, p. 872-6
  3. Penn RL, Ward TT, Steigbigel RT (1982) "Effects of erythromycin in combination with penicillin, ampicillin, or gentamicin on the growth of listeria monocytogenes." Antimicrob Agents Chemother, 22, p. 289-94

Drug and food interactions

Moderate

exenatide food

Applies to: exenatide

ADJUST DOSING INTERVAL: Exenatide slows gastric emptying and may reduce the extent and rate of absorption of concomitantly administered oral medications. When acetaminophen 1000 mg was administered simultaneously with exenatide 10 mcg and also one hour, 2 hours, and 4 hours after exenatide injection, acetaminophen systemic exposure (AUC) was decreased by 21%, 23%, 24%, and 14%, respectively; peak plasma concentration (Cmax) was decreased by 37%, 56%, 54%, and 41%, respectively; and time to peak plasma concentration (Tmax) was increased from 0.6 hours in the control period to 0.9 hours, 4.2 hours, 3.3 hours, and 1.6 hours, respectively. These values were not significantly changed when acetaminophen was given one hour before exenatide injection.

MANAGEMENT: Concomitantly administered oral medications that are dependent on threshold concentrations for efficacy (e.g., antibiotics, contraceptives) or that require rapid gastrointestinal absorption (e.g., hypnotics, pain medications) should be administered at least 1 hour before exenatide. If such medications are to be administered with food, patients should be advised to take them with a meal or snack when exenatide is not administered.

References (1)
  1. (2005) "Product Information. Byetta (exenatide)." Amylin Pharmaceuticals Inc
Minor

clarithromycin food

Applies to: amoxicillin / clarithromycin / vonoprazan

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

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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