May decrease incidence of cryptosporidiosis in HIV-infected adults. 105 111 204 Anti-infectives may suppress the infection, but none has been found to reliably eradicate Cryptosporidium. 105 106 444 445 CDC, NIH, IDSA, and others state that the most appropriate treatment for cryptosporidiosis in HIV-infected individuals is the use of potent antiretroviral agents to restore immune function and symptomatic treatment of diarrhea. Manufacturer's labeling: 500 mg twice daily use with other antimycobacterial drugs, eg, ethambutol or rifampin. Continue therapy if clinical response is observed; may discontinue when patient is considered at low risk of disseminated infection.
When 250 mg doses of Clarithromycin as an oral suspension were administered to fasting healthy adult subjects, peak plasma concentrations were attained around 3 hours after dosing. Alfentanil: Macrolide Antibiotics may increase the serum concentration of Alfentanil. Management: For patients receiving an interacting macrolide antibiotic, caution should be used in administering alfentanil; monitor for increased anesthetic and respiratory depressant effects. Consider using lower doses of alfentanil or an alternative anesthetic. In AIDS patients and other immunocompromised patients treated with the higher doses of clarithromycin over long periods of time for mycobacterial infections, it was often difficult to distinguish adverse reactions possibly associated with clarithromycin administration from underlying signs of HIV disease or intercurrent illness.
In COPD patients, there was a significant association between the use of clarithromycin and death from heart-related problems. This association was not seen in pneumonia patients, according to a journal news release. Testicular atrophy occurred in rats at doses 7 times, in dogs at doses 3 times, and in monkeys at doses 8 times greater than the maximum human daily dose on a body surface area basis. Radotinib: CYP3A4 Inhibitors Strong may increase the serum concentration of Radotinib. Malfertheiner P. Compliance, adverse events and antibiotic resistance in Helicobacter pylori treatment. Scand J Gastroenterol Suppl.
Lansoprazole is very similar to dexlansoprazole. Do not use medications containing dexlansoprazole while using lansoprazole. Rarely, after taking this drug, people have gotten out of bed and driven vehicles while not fully awake "-driving". Clarithromycin Tablets, USP and Clarithromycin for Oral Suspension, USP are indicated for the treatment of mild to moderate infections caused by susceptible isolates due to Staphylococcus aureus, or Streptococcus pyogenes. Twelfth Edition. CLSI document M02-A12, Clinical and Laboratory Standards Institute, 950 West Valley Road, Suite 2500, Wayne, Pennsylvania 19087, USA, 2015.
Renal impairment decreases clearance of clarithromycin and 14-hydroxyclarithromycin. ATCC is a registered trademark of the American Type Culture Collection. This quality control range is applicable only to S. pneumoniae ATCC 49619 tested by a microdilution procedure using cation adjusted Mueller Hinton broth with 2-5% lysed horse blood. Chien SM, Pichotta P, Siepman N et al. Treatment of community acquired pneumonia: a randomized, controlled trial comparing clarithromycin and erythromycin. Proceedings of ICAAC Chicago 1991. Abstract No. 872. Other medications can affect the removal of from your body, which may affect how suvorexant works. Augmentin and Floxin two other antibiotics so when I couldn't sleep with Clarithromycin I knew immediately what was going on. The PA who prescribed it though did not believe that an antibiotic could cause insomnia. So there you are: I am still taking it now on day 6 of 10. Regarding other side effects, I have tinnitus anyway so not worried really about the ringing; leg cramps at night are much worse than normal -- all the way up the leg, not just the knee and down; hyped up during the day as well as at night. It's kind of like taking an amphetamine, I think. Sorry for everyone going through this. Wilcox MH. Treatment of Clostridium difficile infection. J Antimicrob Chemother. It may also be used to prevent certain bacterial infections. Erythromycin is known as a macrolide antibiotic. It works by stopping the growth of bacteria. North Chicago, IL; 2004 Feb. This medication may also cause muscle problems myopathy.
Infants and children may be more sensitive to the effects of this drug, especially the effects on the heartbeat. This medication has been prescribed for your current condition only. Do not use it later for another infection unless told to do so by your doctor. A different medication may be necessary in those cases. Dizziness or confusion may occur while you take clarithromycin. Use clarithromycin with caution. Imatinib: CYP3A4 Inhibitors Strong may increase the serum concentration of Imatinib. Bortezomib: CYP3A4 Inhibitors Strong may increase the serum concentration of Bortezomib. Vinflunine: May enhance the QTc-prolonging effect of Moderate Risk QTc-Prolonging Agents. A-56268; TE-031 erythromycin, roxithromycin, and clindamycin. Antimicrob Agents Chemother. In the event of severe acute hypersensitivity reactions, such as anaphylaxis, Stevens-Johnson Syndrome, toxic epidermal necrolysis, drug rash with eosinophilia and systemic symptoms DRESS and Henoch-Schonlein purpura, discontinue clarithromycin therapy immediately and institute appropriate treatment. Torronen, R. Bilberries reduce low-grade inflammation in individuals with features of metabolic syndrome. Trabectedin: CYP3A4 Inhibitors Strong may increase the serum concentration of Trabectedin. Ayanian JZ, Fuchs CS, Stone RM. Lovastatin and rhabdomyolysis. Ann Intern Med. In the event of severe acute hypersensitivity reactions, such as anaphylaxis, Stevens-Johnson Syndrome, toxic epidermal necrolysis, drug rash with eosinophilia and systemic symptoms DRESS and Henoch-Schonlein purpura, discontinue Clarithromycin therapy immediately and institute appropriate treatment. Paricalcitol: CYP3A4 Inhibitors Strong may increase the serum concentration of Paricalcitol. ranolazine
In a smaller number of patients, microbiologic determinations were made at the pre-treatment visit. This drug should be used in combination with other antimycobacterial agents that have shown in vitro activity against MAC or clinical benefit in MAC treatment. Long-term or repeated use of clarithromycin may cause a second infection. Tell your doctor if signs of a second infection occur. Your medicine may need to be changed to treat this. Conivaptan: May increase the serum concentration of CYP3A4 Substrates. Approximately 99% of the drug is bound to plasma proteins. Susceptibility testing is recommended in patients who fail therapy; if resistance to this drug is established, a non-clarithromycin-containing regimen is recommended. The recommended adult dosage is 500 mg Clarithromycin Tablets, USP given every 8 hours and 40 mg omeprazole given once every morning for 14 days. Pimozide: Macrolide Antibiotics may enhance the QTc-prolonging effect of Pimozide. Macrolide Antibiotics may decrease the metabolism of Pimozide. This mechanism may not apply to azithromycin. If this combination is used, monitor patients more closely for evidence of pravastatin toxicity. Corticosteroids Orally Inhaled: CYP3A4 Inhibitors Strong may increase the serum concentration of Corticosteroids Orally Inhaled. Management: Orally inhaled fluticasone propionate with a strong CYP3A4 inhibitor is not recommended. Exceptions: Beclomethasone Oral Inhalation; Triamcinolone Systemic. Erythromycin may cause a condition that affects the rhythm QT prolongation. This medication has been prescribed for your current condition only. Do not use it later for another infection unless your doctor directs you to do so. A different medication may be necessary in that case. Pranlukast: CYP3A4 Inhibitors Strong may increase the serum concentration of Pranlukast. Jablonowski H, Fatkenheuer G, Youle M et al. Ancillary benefits of Mycobacterium avium-intracellulare complex prophylaxis with clarithromycin in HIV-infected patients. Drugs. Avoid missing doses and complete the entire course of therapy. It may harm an unborn baby. Discuss the use of reliable forms of with your doctor. If you become or think you may be pregnant, tell your doctor right away. epogen how to purchase europe epogen
AIDS patients have been treated with Clarithromycin suspension for mycobacterial infections. Coumadin is prescription medicine used to treat blood clots and to lower the chance of blood clots forming in your body. Blood clots can cause a stroke, heart attack, or other serious conditions if they form in the legs or lungs. Hung IFN, Wu VCC, Cheng BSF et al. Fatal interaction between clarithromycin and colchicine in patients with renal insufficiency: a retrospective study. Clin Infect Dis. Digoxin: Digoxin is a substrate for P-glycoprotein Pgp and Clarithromycin is known to inhibit Pgp. When Clarithromycin and digoxin are co-administered, inhibition of Pgp by Clarithromycin may lead to increased exposure of digoxin. Elevated digoxin serum concentrations in patients receiving Clarithromycin and digoxin concomitantly have been reported in postmarketing surveillance. Some patients have shown clinical signs consistent with digoxin toxicity, including potentially fatal arrhythmias. Monitoring of serum digoxin concentrations should be considered, especially for patients with digoxin concentrations in the upper therapeutic range. Gelber RH, Siu P, Tsang M et al. Activities of various macrolide antibiotics against Mycobacterium leprae infection in mice. Antimicrob Agents Chemother. You and your healthcare provider should decide if you will take Coumadin and breastfeed. Check your baby for bruising or bleeding if you take Coumadin and breastfeed. Erythromycin was previously recommended by the American Heart Association for prophylaxis prior to dental, oral and upper respiratory tract procedures in at-risk, penicillin-allergic patients. It is no longer recommended because of the high incidence of gastrointestinal adverse effects and complicated pharmacokinetics of the various formulations. However, patients who have successfully received erythromycin for prophylaxis in the past may continue with this regimen if desired. Currently, clindamycin, first-generation cephalosporins in patients who have not had an IgE-mediated anaphylactic reaction to penicillin azithromycin or clarithromycin are drugs of choice for prophylaxis in penicillin-allergic patients undergoing oral, dental, respiratory tract or esophageal procedures. Simultaneous administration of clarithromycin tablets and didanosine to 12 HIV-infected adult patients resulted in no statistically significant change in didanosine pharmacokinetics. Labenz J, Börsch G. Response to Savarino et al. Am J Gastroenterol. Colchicine: Life-threatening and fatal drug interactions have been reported in patients treated with clarithromycin and colchicine. Clarithromycin is a strong CYP3A4 inhibitor and this interaction may occur while using both drugs at their recommended doses. If co-administration of clarithromycin and colchicine is necessary in patients with normal renal and hepatic function, reduce the dose of colchicine. Monitor patients for clinical symptoms of colchicine toxicity. Tamsulosin: CYP3A4 Inhibitors Strong may increase the serum concentration of Tamsulosin. Patients with disseminated MAC disease should continue chronic maintenance therapy secondary prophylaxis unless immune reconstitution occurs due to ART.
Peterson WL. Helicobacter pylori and peptic ulcer disease. N Engl J Med. Johnson M, Mattson L, Bopp B et al. The in vitro protein binding of 14-hydroxy clarithromycin in human plasma. Proceedings of ICAAC Chicago 1991. Abstract. Clostridium difficile associated diarrhea CDAD has been reported with use of nearly all antibacterial agents, including Clarithromycin, and may range in severity from mild diarrhea to fatal colitis. Treatment with antibacterial agents alters the normal flora of the colon leading to overgrowth of C. difficile. Delamanid: CYP3A4 Inhibitors Strong may increase the serum concentration of Delamanid. Management: Increase electrocardiogram ECG monitoring frequency if delamanid is combined with strong CYP3A4 inhibitors because the risk for QTc interval prolongation may be increased. Continue frequent ECG assessments throughout the full delamanid treatment period. Picci, M. Studies on Vaccinium myrtillus anthocyanosides. I. Vasoprotective and antiinflammatory activity. Arzneimittelforschung. Of the H. influenzae isolated pre-treatment, 3% were resistant to Clarithromycin and 10% were resistant to the control agent. F in a well-closed container. Do not refrigerate the reconstituted Clarithromycin for Oral Suspension, USP. Immediate-release 250 mg tablets: Store at controlled room temperature 15C to 30C 59F to 86F in a well-closed container; protect from light. Drugs, dietary changes, and other factors affect INR levels achieved with Coumadin therapy. buy cilostazol at cvs cilostazol
This may make you sleepy during the day. Tell your doctor if you have daytime drowsiness. Your dose may need to be adjusted. Intended Use and Disclaimer: Should not be printed and given to patients. This information is intended to serve as a concise initial reference for healthcare professionals to use when discussing medications with a patient. You must ultimately rely on your own discretion, experience and judgment in diagnosing, treating and advising patients. Zidovudine: Simultaneous oral administration of Clarithromycin immediate-release tablets and zidovudine to HIV-infected adult patients may result in decreased steady-state zidovudine concentrations. Clarithromycin only works against bacteria; it does not treat viral infections eg, the common cold. Kinoshita, J. H. Diabetic cataracts and flavonoids. Do not take this medication with alcohol, or if you have had alcohol that day, especially in the evening before bed. Australia Pty Ltd. November 2, 2002. Vardenafil may cause a condition that affects the rhythm QT prolongation. Clarithromycin Extended-Release Tablets is indicated only for acute maxillary sinusitis, acute bacterial exacerbation of chronic bronchitis, and community-acquired pneumonia in adults. The efficacy and safety of Clarithromycin Extended-Release Tablets in treating other infections for which Clarithromycin Tablets, USP and Clarithromycin for Oral Suspension, USP are approved have not been established. However, if premature discontinuations due to Mycobacterium avium complex MAC or death are excluded, approximately equal percentages of patients on each arm 54. Morimoto S, Nagate T, Sugita K et al. Chemical modification of erythromycins. III. In vitro and in vivo antibacterial activities of new semisynthetic 6- O-methylerythromycins A, TE-031 clarithromycin and TE-032. J Antibiot Tokyo. Talley NJ, Zinsmeister AR, Weaver A et al. Gastric adenocarcinoma and Helicobacter pylori infection. J Natl Cancer Inst. On call ENT I spoke with about side effects said he felt RX was too high a dosage and for too many days; pharmacist was not alarmed at 2 week dosage. ENT said stop immediately and contact Dr next business day. Experienced what I now believe were hallucinations, rapid heart beat, weird dreams not even sure if I was asleep muscle weakness. All worse in evening after taking second dose of the day. Each night seem to last for weeks waiting for time to pass. As to effectiveness, on day 5 sinuses started draining, could breathe better, started with pressure headaches. Dr's goal to clear infection in two weeks so CT scan can be done to finalize treatment plan-two full weeks on this medicine would have put me fully into the Purple Haze I was already in. I cannot believe people take drugs intentionally to cause what I and others have reported as side effects. Tell your healthcare provider if you take any of these medicines. Ask your healthcare provider if you are not sure if your medicine is one listed above. CYP3A4 activity levels have also been linked to diet and environmental factors, such as duration of exposure to xenobiotic substances. vendita online daflon originale
Clarithromycinhas been associated with prolongation of the QT interval and infrequent cases of arrhythmia. Cases of torsades de pointes have been spontaneously reported during postmarketing surveillance in patients receiving clarithromycin. Fatalities have been reported. Telaprevir: Clarithromycin may increase the serum concentration of Telaprevir. Telaprevir may increase the serum concentration of Clarithromycin. Especially in elderly patients, there have been reports of colchicine toxicity with concomitant use of Clarithromycin and colchicine, some of which occurred in patients with renal insufficiency. The opinions expressed in WebMD User-generated content areas like communities, reviews, ratings, or blogs are solely those of the User, who may or may not have medical or scientific training. These opinions do not represent the opinions of WebMD. User-generated content areas are not reviewed by a WebMD physician or any member of the WebMD editorial staff for accuracy, balance, objectivity, or any other reason except for compliance with our Terms and Conditions. Conditions of Use and Important Information: This information is meant to supplement, not replace advice from your doctor or healthcare provider and is not meant to cover all possible uses, precautions, interactions or adverse effects. This information may not fit your specific health circumstances. Never delay or disregard seeking professional medical advice from your doctor or other qualified health care provider because of something you have read on WebMD. You should always speak with your doctor or health care professional before you start, stop, or change any prescribed part of your health care plan or treatment and to determine what course of therapy is right for you.
Electronic Code of Federal Regulations. Title 21. Part 182 -- Substances Generally Recognized As Safe. Older adults may be more sensitive to the side effects of this drug, especially confusion, unsteadiness, excessive drowsiness. A-56268 on Toxoplasma gondii. Antimicrob Agents Chemother. This drug is used with other to help control infection. It helps to decrease the amount of HIV in your body so your can work better. This lowers your chance of getting HIV complications such as new infections, and improves your quality of life. belongs to a class of drugs known as nucleoside reverse transcriptase inhibitors-NRTIs. GuanFACINE: CYP3A4 Inhibitors Strong may increase the serum concentration of GuanFACINE. Management: Reduce the guanfacine dose by 50% when initiating this combination. Fraschini F, Scaglione F, Pintucci JP et al. Clarithromycin and its 14-OH-metabolite. Pharmacokinetics and tissues distribution in humans. Proceedings of ICAAC Chicago 1991. Abstract No. 512. Serum concentrations of these medications should also be monitored. There have been spontaneous or published reports of CYP3A based interactions of clarithromycin with disopyramide and quinidine. There have been postmarketing reports of hypoglycemia with the concomitant administration of clarithromycin and disopyramide. Therefore, blood glucose levels should be monitored during concomitant administration of clarithromycin and disopyramide. cordarone canada online
This helps to relieve symptoms of such as difficulty in beginning the flow of urine, weak stream, and the need to urinate frequently or urgently including during the middle of the night. Colantuoni, A. Effect of Vaccinium myrtillus anthocyanosides on ischaemia reperfusion injury in hamster cheek pouch microcirculation. Imidafenacin: CYP3A4 Inhibitors Strong may increase the serum concentration of Imidafenacin. Store in the original package at room temperature away from light and moisture. not store in the bathroom. Keep all away from children and pets. Gooch WM, Adelglass J, Kelsey DK et al. Loracarbef versus clarithromcyin in children with acute otitis media with effusion. Clin Ther. Prediabetes. Some research suggest that eating a diet high in whole grains, fatty fish, and bilberries three times daily for 12 weeks reduces blood sugar in people with prediabetes. However, it is not clear if bilberry or other parts of this diet cause the reduction in blood sugar. ekit.info deltasone
Infants and children receiving vitamin K-supplemented nutrition, including infant formulas, may be resistant to warfarin therapy, while human milk-fed infants may be sensitive to warfarin therapy. ABCB1 Inhibitors may increase the serum concentration of Prucalopride. Since this drug makes you drowsy, not drive, use machinery, or do any activity that requires alertness until you are sure you can perform such activities safely. Avoid beverages. Treating infections caused by certain bacteria. It may also be used to prevent a certain infection in persons with advanced HIV infection. This enzyme is involved in the metabolism of approximately half the drugs that are used today, including acetaminophen, codeine, ciclosporin cyclosporin diazepam, and erythromycin. The enzyme also metabolizes some steroids and carcinogens. Most drugs undergo deactivation by CYP3A4, either directly or by facilitated from the body. Also, many substances are by CYP3A4 to form their active compounds, and many protoxins being into their toxic forms for examples - see table below. Clarithromycin should not be used in pregnant women except in clinical circumstances where no alternative therapy is appropriate. If Clarithromycin is used during pregnancy, or if pregnancy occurs while the patient is taking this drug, the patient should be apprised of the potential hazard to the fetus. In a steady-state study in which healthy elderly subjects 65 years to 81 years of age were given 500 mg of clarithromycin every 12 hours, the maximum serum concentrations and area under the curves of clarithromycin and 14-OH clarithromycin were increased compared to those achieved in healthy young adults. These changes in pharmacokinetics parallel known age-related decreases in renal function. In clinical trials, elderly patients did not have an increased incidence of adverse reactions when compared to younger patients. Consider dosage adjustment in elderly patients with severe renal impairment. Further dose reductions may be needed in patients with impaired renal function. Consider alternative antimicrobial for any non-MAC infection. Fusidic Acid Systemic: May increase the serum concentration of CYP3A4 Substrates. Halofantrine: CYP3A4 Inhibitors Strong may increase the serum concentration of Halofantrine. Second Edition. CLSI document M24-A2, Clinical and Laboratory Standards Institute, 950 West Valley Road, Suite 2500, Wayne, Pennsylvania 19087, USA, 2011. Take Coumadin exactly as prescribed. Your healthcare provider will adjust your dose from time to time depending on your response to Coumadin. Tell your doctor if your condition persists after 7 to 10 days, or if it worsens.
Inducers of CYP3A enzymes, such as efavirenz, nevirapine, rifampicin, rifabutin, and rifapentine will increase the metabolism of Clarithromycin, thus decreasing plasma concentrations of Clarithromycin, while increasing those of 14-OH-Clarithromycin. Since the microbiological activities of Clarithromycin and 14-OH-Clarithromycin are different for different bacteria, the intended therapeutic effect could be impaired during concomitant administration of Clarithromycin and enzyme inducers. Alternative antibacterial treatment should be considered when treating patients receiving inducers of CYP3A. There have been spontaneous or published reports of CYP3A based interactions of Clarithromycin with rifabutin see in the table above. Coumadin is contraindicated in any unsupervised patient with senility. Observe caution with administration of Coumadin to elderly patients in any situation or with any physical condition where added risk of hemorrhage is present. Adequate and well-controlled studies with Coumadin have not been conducted in any pediatric population, and the optimum dosing, safety, and efficacy in pediatric patients is unknown. Pediatric use of Coumadin is based on adult data and recommendations, and available limited pediatric data from observational studies and patient registries. Pediatric patients administered Coumadin should avoid any activity or sport that may result in traumatic injury. Clarithromycin has been associated with prolongation of the QT interval and infrequent cases of arrhythmia. Cases of torsades de pointes have been spontaneously reported during postmarketing surveillance in patients receiving Clarithromycin. Fatalities have been reported. Shake the bottle well before each dose. Treatment with Coumadin may be considered after the platelet count has normalized. Paar D, Terjung B, Sauerbruch T. Life-threatening interaction between clarithromycin and disopyramide. Lancet. The combination of Clarithromycin and omeprazole was effective in eradicating H. pylori see Table 21. H. pylori eradication was defined as no positive test culture or histology at 4 weeks following the end of treatment, and two negative tests were required to be considered eradicated. In the per-protocol analysis, the following patients were excluded: dropouts, patients with major protocol violations, patients with missing H. pylori tests post-treatment, and patients that were not assessed for H. pylori eradication at 4 weeks after the end of treatment because they were found to have an unhealed ulcer at the end of treatment. Organisms resistant to erythromycin generally resistant to clarithromycin. With any of these dosing regimens, the steady-state concentration of this metabolite is generally attained within 3 days to 4 days. Rifabutin: Concomitant administration of rifabutin and Clarithromycin resulted in an increase in rifabutin, and decrease in Clarithromycin serum levels together with an increased risk of uveitis see in the table below. This may interfere with certain laboratory tests urine tests possibly causing false test results. Make sure laboratory personnel and all your doctors know you use this drug. P4503A activity on the acute disposition and effects of oral transmucosal fentanyl citrate. Hypersensitivity reactions: Severe acute reactions have been reported, including anaphylaxis, Stevens-Johnson syndrome SJS toxic epidermal necrolysis TEN drug rash with eosinophilia and systemic symptoms DRESS and Henoch-Schönlein purpura IgA vasculitis; discontinue therapy and initiate treatment immediately for severe acute hypersensitivity reactions. Dronedarone: CYP3A4 Inhibitors Strong may increase the serum concentration of Dronedarone. Rowland M, Drumm B. Helicobacter pylori infection and peptic ulcer disease in children. Curr Opin Pediatr. podofilox for usa
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For patients with an unprovoked DVT or PE, treatment with warfarin is recommended for at least 3 months. After 3 months of therapy, evaluate the risk-benefit ratio of long-term treatment for the individual patient. Talley NJ. The role of Helicobacter pylori in nonulcer dyspepsia. Clarithromycin dose should be reduced by 75%. Take this by as directed by your doctor, usually before a meal. Hepatic impairment reduces formation of the active metabolite; however, an increase in renal clearance of the parent drug obviates the need for a dosage reduction unless renal impairment also is present. innopran
Bhardwaj RK, Glaeser H, Becquemont L, Klotz U, Gupta SK, Fromm MF August 2002. "Piperine, a major constituent of black pepper, inhibits human P-glycoprotein and CYP3A4". The Journal of Pharmacology and Experimental Therapeutics. Importance of informing clinician of existing or contemplated concomitant therapy, including prescription and OTC drugs, as well as any concomitant illnesses. Morain C, Gilvarry J. Eradication of Helicobacter pylori in patients with non-ulcer dyspepsia. Scand J Gastroenterol Suppl. Zidovudine is not a cure for HIV infection.
Temsirolimus. Levels of sirolimus, the active metabolite, may be increased, likely due to inhibition of CYP-mediated metabolism. The cytochrome P450 proteins are that catalyze many reactions involved in and synthesis of cholesterol, steroids, and other lipids components. CYP3A inhibitors such as clarithromycin. And to tell their physician if they fall often as this may increase their risk for complications.
Exercise caution when prescribing clarithromycin with atorvastatin or pravastatin. In situations where the concomitant use of clarithromycin with atorvastatin or pravastatin cannot be avoided, atorvastatin dose should not exceed 20 mg daily and pravastatin dose should not exceed 40 mg daily. Includes death, nonfatal reinfarction, and thromboembolic cerebral stroke. Recently CYP3A4 has also been identified in the brain, however its role in the is still unknown. Omura S, Tsuzuki K, Sunazuka T et al. Macrolides with gastrointestinal motor stimulating activity. J Med Chem. Extended release tablets should be taken with food.