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Drug Interactions between clarithromycin and semaglutide

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

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Interactions between your drugs

Moderate

clarithromycin semaglutide

Applies to: clarithromycin and semaglutide

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

Drug and food interactions

Moderate

semaglutide food

Applies to: semaglutide

ADJUST DOSING INTERVAL: Taking oral semaglutide with food, beverage, or other oral medications may alter semaglutide absorption and exposure. In a controlled study with healthy volunteers, limited or no measurable semaglutide exposure was observed in subjects that were fed 30 minutes prior to taking oral semaglutide, while all subjects that fasted overnight and 30 minutes after the oral semaglutide dose had measurable semaglutide exposure. Area under the curve (AUC) and semaglutide peak plasma concentration (Cmax) were approximately 40% greater in subjects that fasted compared to those who did not. AUC and Cmax were also increased with a post-dose fasting period greater than 30 minutes.

MANAGEMENT: It is recommended that oral semaglutide be taken 30 minutes before the first food, beverage, or other oral medications of the day with no more than 4 ounces of plain water to ensure its efficacy. Fasting longer than 30 minutes after the oral semaglutide dose may lead to increased gastrointestinal side effects including nausea, vomiting, or diarrhea.

References (4)
  1. (2024) "Product Information. Rybelsus (semaglutide)." Novo Nordisk Pharmaceuticals Inc
  2. (2024) "Product Information. Rybelsus (semaglutide)." Novo Nordisk Canada Inc
  3. (2024) "Product Information. Rybelsus (semaglutide)." Novo Nordisk Ltd
  4. Baekdal TA, Breitschaft A, Donsmark M, Maarbjerg SJ, Sondergaard FL, Borregaard J (2021) "Effect of various dosing conditions on the pharmacokinetics of oral semaglutide, a human glucagon-like peptide-1 analogue in a tablet formulation" Diabetes Ther, 12, p. 1915-27
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.

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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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