Drug Interactions between amoxicillin / clarithromycin / vonoprazan and mirabegron

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.

Coadministration with inhibitors of CYP450 3A4 may increase the plasma concentrations of mirabegron, which has been shown in vitro to be a substrate of the isoenzyme. However, in vivo results indicate that CYP450 3A4 may play a limited role in the overall elimination. In a study consisting of 23 healthy male and female subjects, mirabegron peak plasma concentration (Cmax) increased by 45% and systemic exposure (AUC) increased by 80% when a single 100 mg dose of mirabegron was administered following multiple dosing of ketoconazole 400 mg daily for 9 days. No dosage adjustment is recommended when mirabegron is administered in combination with ketoconazole and probably other CYP450 3A4 inhibitors.

Coadministration with inhibitors of CYP450 3A4 may increase the plasma concentrations of mirabegron, which has been shown in vitro to be a substrate of the isoenzyme. However, in vivo results indicate that CYP450 3A4 may play a limited role in the overall elimination. In a study consisting of 23 healthy male and female subjects, mirabegron peak plasma concentration (Cmax) increased by 45% and systemic exposure (AUC) increased by 80% when a single 100 mg dose of mirabegron was administered following multiple dosing of ketoconazole 400 mg daily for 9 days. No dosage adjustment is recommended when mirabegron is administered in combination with ketoconazole and probably other CYP450 3A4 inhibitors.