Skip to main content

Drug Interactions between clarithromycin and etravirine

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

Edit list (add/remove drugs)

Interactions between your drugs

Moderate

clarithromycin etravirine

Applies to: clarithromycin and etravirine

GENERALLY AVOID: Coadministration with etravirine may decrease the plasma concentrations of clarithromycin and increase concentrations of the active metabolite, 14-hydroxy-clarithromycin. The mechanism is etravirine induction of CYP450 3A4, the isoenzyme that metabolizes clarithromycin to 14-hydroxy-clarithromycin. In 15 study subjects administered clarithromycin 500 mg twice a day with etravirine, clarithromycin peak plasma concentration (Cmax), systemic exposure (AUC) and trough plasma concentration (Cmin) decreased by 34%, 39% and 53%, respectively, while Cmax, AUC and Cmin of 14-hydroxy-clarithromycin increased by 33%, 21% and 5%, respectively. Etravirine Cmax, AUC, and Cmin also increased by over 40% each due to inhibition of its CYP450 3A4 metabolism by clarithromycin.

MANAGEMENT: Because 14-hydroxy-clarithromycin has demonstrated reduced activity relative to the parent drug against Mycobacterium avium complex (MAC), overall activity against this pathogen may be altered during coadministration of clarithromycin with etravirine. Therefore, alternatives to clarithromycin (e.g., azithromycin) should be considered for the treatment of MAC in patients receiving etravirine.

References (1)
  1. (2008) "Product Information. Intelence (etravirine)." Ortho Biotech Inc

Drug and food interactions

Moderate

etravirine food

Applies to: etravirine

ADJUST DOSING INTERVAL: Coadministration with food increases the oral bioavailability of etravirine. The mechanism is unknown. Compared to administration following a meal, the systemic exposure (AUC) to etravirine was decreased by about 50% when the drug was administered under fasting conditions. The types of meal studied (ranging from 345 kilocalories containing 17 grams fat to 1160 kilocalories containing 70 grams fat) did not appear to make a difference with respect to impact on etravirine bioavailability.

MANAGEMENT: Etravirine should always be administered following a meal.

References (1)
  1. (2008) "Product Information. Intelence (etravirine)." Ortho Biotech Inc
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)
  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

Report options

Loading...
QR code containing a link to this page

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.

Medical Disclaimer