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Drug Interactions between Biaxin XL and Selfemra

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

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Interactions between your drugs

Moderate

clarithromycin FLUoxetine

Applies to: Biaxin XL (clarithromycin) and Selfemra (fluoxetine)

GENERALLY AVOID: The use of some macrolide antibiotics has been associated with increased blood levels of some selective serotonin reuptake inhibitors (SSRIs), resulting in excessive serotonergic effects or serotonin syndrome. The mechanism is inhibition of the CYP450 3A4 isoenzyme, which metabolizes SSRIs.

MANAGEMENT: In cases where both drugs are necessary, one could consider using a macrolide antibiotic that does not inhibit CYP450 3A4, such as azithromycin or dirithromycin.

References

  1. Timothy P, Sketris IS, Mackenzie SL, Hewlett TJ (1995) "Delirium probably induced by clarithromycin in a patient receiving fluoxetine." Ann Pharmacother, 29, p. 486-8
  2. Tracy TS, Cupp MJ (1996) "Delirium probably induced by clarithromycin in a patient receiving fluoxetine - comment." Ann Pharmacother, 30, p. 1199-200
  3. Pollak PT, Slayter KL (1996) "Delirium probably induced by clarithromycin in a patient receiving fluoxetine - reply." Ann Pharmacother, 30, p. 1200
  4. Lee DO, Lee CD (1999) "Serotonin syndrome in a child associated with erythromycin and sertraline." Pharmacotherapy, 19, p. 894-6
  5. Martin TG (1996) "Serotonin syndrome." Ann Emerg Med, 28, p. 520-6
View all 5 references

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Drug and food interactions

Moderate

FLUoxetine food

Applies to: Selfemra (fluoxetine)

GENERALLY AVOID: Alcohol may potentiate some of the pharmacologic effects of CNS-active agents. Use in combination may result in additive central nervous system depression and/or impairment of judgment, thinking, and psychomotor skills.

MANAGEMENT: Patients receiving CNS-active agents should be warned of this interaction and advised to avoid or limit consumption of alcohol. Ambulatory patients should be counseled to avoid hazardous activities requiring complete mental alertness and motor coordination until they know how these agents affect them, and to notify their physician if they experience excessive or prolonged CNS effects that interfere with their normal activities.

References

  1. Warrington SJ, Ankier SI, Turner P (1986) "Evaluation of possible interactions between ethanol and trazodone or amitriptyline." Neuropsychobiology, 15, p. 31-7
  2. Gilman AG, eds., Nies AS, Rall TW, Taylor P (1990) "Goodman and Gilman's the Pharmacological Basis of Therapeutics." New York, NY: Pergamon Press Inc.
  3. (2012) "Product Information. Fycompa (perampanel)." Eisai Inc
  4. (2015) "Product Information. Rexulti (brexpiprazole)." Otsuka American Pharmaceuticals Inc
View all 4 references

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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. 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

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

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