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Additional information about the drug Clarithromycin

Clarithromycin, sold under the brand name Biaxin among others, is an antibiotic used to treat various bacterial infections.
Common side effects include nausea, vomiting, headaches, and diarrhea.
Clarithromycin was developed in 1980.
1 Medical uses
1.1 Spectrum of bacterial susceptibility
2 Contraindications
3 Side effects
3.1 Cardiac
3.2 Liver and kidney
3.3 Central nervous system
3.4 Infection
3.5 Pregnancy and breastfeeding
4 Interactions
4.1 Colchicine
4.2 Statins
4.3 Calcium channel blockers
4.4 Carbamazepine
4.5 HIV medications
5 Mechanism of action
6 Pharmacokinetics
7 Metabolism
8 History
9 Society and culture
9.1 Cost
9.2 Available forms
9.3 Brand names
9.4 Manufacturers
10 References
11 External links
Medical uses
Clarithromycin is primarily used to treat a number of bacterial infections including pneumonia, Helicobacter pylori, and as an alternative to penicillin in strep throat. It is effective against upper and lower respiratory tract infections, skin and soft tissue infections and helicobacter pylori infections associated with duodenal ulcers.
Spectrum of bacterial susceptibility
This section needs additional citations for verification. Please help improve this article by adding citations to reliable sources. Unsourced material may be challenged and removed. (February 2018) ( Learn how and when to remove this template message )
Aerobic Gram-positive bacteria
Staphylococcus aureus
Streptococcus pneumoniae
Streptococcus pyogenes
Aerobic Gram-negative bacteria
Haemophilus parainfluenzae 
Haemophilus influenzae
Moraxella catarrhalis
Helicobacter pylori
Mycobacterium avium complex consisting of:
Mycobacterium avium avium
Mycobacterium intracellulare
Other bacteria
Chlamydia pneumoniae
Mycoplasma pneumoniae
Safety and effectiveness of clarithromycin in treating clinical infections due to the following bacteria have not been established in adequate and well-controlled clinical trials:
Aerobic Gram-positive bacteria
Streptococcus agalactiae
Streptococcus (Groups C, F, G)
Viridans group streptococci
Aerobic Gram-negative bacteria
Bordetella pertussis
Legionella pneumophila
Pasteurella multocida
Anaerobic Gram-positive bacteria
Clostridium perfringens
Peptococcus Niger
Propionibacterium acnes
Anaerobic Gram-negative bacteria
Prevotella melaninogenica (formerly Bacteroides melaninogenicus )
Clarithromycin should not be taken by people who are allergic to other macrolides or inactive ingredients in the tablets, including microcrystalline cellulose, croscarmelose sodium, magnesium stearate, and povidone
Clarithromycin should not be used by people with a history of cholestatic jaundice and/or liver dysfunction associated with prior clarithromycin use.
Clarithromycin should not be used in the setting of hypokalaemia (low blood potassium)
Use of clarithromycin with the following medications: cisapride, pimozide, astemizole, terfenadine, ergotamine, ticagrelor, ranolazine or dihydroergotamine is not recommended.
It should not be used with colchicine in people with kidney or liver impairment.
Concomitant use with cholesterol medications such as lovastatin or simvastatin.
Hypersensitivity to clarithromycin or any component of the product, erythromycin, or any macrolide antibiotics.
QT prolongation or ventricular cardiac arrhythmias, including torsade de pointes.
Side effects
The most common side effects are gastrointestinal: diarrhea (3%), nausea (3%), abdominal pain (3%), and vomiting (6%). It also can cause headaches, insomnia, and abnormal liver function tests. Allergic reactions include rashes and anaphylaxis. Less common side effects (<1%) include extreme irritability, hallucinations (auditory and visual), dizziness/motion sickness, and alteration in senses of smell and taste, including a metallic taste. Dry mouth, panic attacks, and nightmares have also been reported, albeit less frequently. Cardiac In February 2018, the FDA issued a Safety Communication warning with respect to an increased risk for heart problems or death with the use of clarithromycin, and has recommended that alternative antibiotics be considered in those with heart disease. Clarithromycin can lead to a prolonged QT interval. In patients with long QT syndrome, cardiac disease, or patients taking other QT-prolonging medications, this can increase risk for life-threatening arrhythmias. In one trial, the use of short-term clarithromycin treatment was correlated with an increased incidence of deaths classified as sudden cardiac deaths in stable coronary heart disease patients not using statins. Liver and kidney Clarithromycin has been known to cause jaundice, cirrhosis, and kidney problems, including renal failure. Central nervous system Common adverse effects of clarithromycin in the central nervous system include dizziness, headaches. Rarely, it can cause ototoxicity, delirium and mania. Infection A risk of oral candidiasis and vaginal candidiasis, due to the elimination of the yeast's natural bacterial competitors by the antibiotic, has also been noted. Pregnancy and breastfeeding Clarithromycin should not be used in pregnant women except in situations where no alternative therapy is appropriate. Interactions Clarithromycin inhibits a liver enzyme, CYP3A4, involved in the metabolism of many other commonly prescribed drugs. Taking clarithromycin with other medications that are metabolized by CYP3A4 may lead to unexpected increases or decreases in drug levels. A few of the common interactions are listed below. Colchicine Clarithromycin has been observed to have a dangerous interaction with colchicine as the result of inhibition of CYP3A4 metabolism and P-glycoprotein transport. Combining these two drugs may lead to fatal colchicine toxicity, particularly in patients with renal insufficiency. Statins Taking clarithromycin concurrently with certain statins (a class of drugs used to reduce blood serum cholesterol levels) increases the risk of side effects, such as muscle aches and muscle break down ( rhabdomyolysis ). Calcium channel blockers Concurrent therapy with calcium channel blocker may increase risk of low blood pressure, kidney failure, and death, compared to pairing calcium channel blockers with azithromycin, a drug similar to clarithromycin but without CYP3A4 inhibition. Carbamazepine Clarithromycin may double the level of carbamazepine in the body by reducing its clearance, which may lead to toxic symptoms of carbamazepine, such as double vision, loss of voluntary body movement, nausea, as well as hyponatremia. HIV medications Depending on the combination of medications, clarithromycin therapy could be contraindicated, require changing doses of some medications, or be acceptable without dose adjustments. Mechanism of action Clarithromycin prevents bacteria from multiplying by acting as a protein synthesis inhibitor. It binds to 23S rRNA, a component of the 50S subunit of the bacterial ribosome, thus inhibiting the translation of peptides. Pharmacokinetics This section needs additional citations for verification. Please help improve this article by adding citations to reliable sources. Unsourced material may be challenged and removed. (February 2018) ( Learn how and when to remove this template message ) Unlike erythromycin, clarithromycin is acid-stable, so can be taken orally without having to be protected from gastric acids. It is readily absorbed, and diffuses into most tissues and phagocytes. Due to the high concentration in phagocytes, clarithromycin is actively transported to the site of infection. During active phagocytosis, large concentrations of clarithromycin are released; its concentration in the tissues can be over 10 times higher than in plasma. Highest concentrations are found in liver, lung tissue, and stool. Metabolism Clarithromycin has a fairly rapid first-pass metabolism in the liver. Its major metabolites include an inactive metabolite, N-desmethylclarithromycin, and an active metabolite, 14-( R )-hydroxyclarithromycin. Compared to clarithromycin, 14-( R )-hydroxyclarithromycin is less potent against mycobacterial tuberculosis and the Mycobacterium avium complex. Clarithromycin (20%-40%) and its active metabolite (10%-15%) are excreted in urine. Of all the drugs in its class, clarithromycin has the best bioavailability at 50%, which makes it amenable to oral administration. Its elimination half-life is about 3 to 4 hours with 250 mg administered every 12 h, but increased to 5 to 7 h with 500 mg administered every 8 to 12 h. With any of these dosing regimens, the steady-state concentration of this metabolite is generally attained within 3 to 4 days. History Clarithromycin was invented by researchers at the Japanese drug company Taisho Pharmaceutical in 1980. The product emerged through efforts to develop a version of the antibiotic erythromycin that did not experience acid instability in the digestive tract, causing side effects, such as nausea and stomachache. Taisho filed for patent protection for the drug around 1980 and subsequently introduced a branded version of its drug, called Clarith, to the Japanese market in 1991. In 1985, Taisho partnered with the American company Abbott Laboratories for the international rights, and Abbott also gained FDA approval for Biaxin in October 1991. The drug went generic in Europe in 2004 and in the US in mid-2005. Society and culture Cost Clarithromycin is available as a generic medication. Available forms In the United States, clarithromycin is available as immediate release tablets, extended release tablets, and granules for oral suspension. Brand names Clarithromycin is available under several brand names in many different countries, for example Biaxin, Bioclar, Crixan, Claritron, Clarihexal, Clacid, Claritt, Clacee, Clarac, Clariwin, Claripen, Clarem, Claridar, Cloff, Fromilid, Infex, Kalixocin, Karicin, Klaricid, Klaridex, Klacid, Klaram, Klabax, MegaKlar, Monoclar, Resclar, Rithmo, Truclar, Vikrol and Zeclar. Manufacturers In the UK the drug product is manufactured in generic form by a number of manufacturers including Somex Pharma, Ranbaxy, Aptil and Sandoz.

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