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Drug Interactions between Biaxin XL and ivermectin

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

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Interactions between your drugs

Moderate

clarithromycin ivermectin

Applies to: Biaxin XL (clarithromycin) and ivermectin

MONITOR: Coadministration with inhibitors of CYP450 3A4 may increase the plasma concentrations of ivermectin and the risk of adverse effects. The proposed mechanism, based on in vitro data, is decreased clearance due to inhibition of CYP450 3A4, the primary isoenzyme responsible for the metabolic clearance of ivermectin.

MANAGEMENT: Caution is advised when ivermectin must be used concomitantly with potent CYP450 3A4 inhibitors. Dosage adjustments as well as clinical and laboratory monitoring may be appropriate whenever a potent CYP450 3A4 inhibitor is added to or withdrawn from therapy.

References (2)
  1. Cerner Multum, Inc. "UK Summary of Product Characteristics."
  2. Zeng Z, Andrew NW, Arison BH, Luffer-Atlas D, Wang RW (1998) "Identification of cytochrome P4503A4 as the major enzyme responsible for the metabolism of ivermectin by human liver microsomes." Xenobiotica, 28, p. 313-21

Drug and food interactions

Minor

clarithromycin food

Applies to: Biaxin XL (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)
  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.

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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

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

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