Dry mouth, panic attacks, and nightmares have also been reported, albeit less frequently. In patients with long QT syndrome , cardiac disease, or patients taking other QT-prolonging medications, this can increase risk for life-threatening arrhythmias.

Rarely, it can cause ototoxicity , delirium and mania. 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[ edit ] Clarithromycin has been observed to have a dangerous interaction with colchicine as the result of inhibition of CYP3A4 metabolism and P-glycoprotein transport.

Clostridium difficile-associated diarrhoea CDAD has been reported with use of nearly all antibacterial agents including clarithromycin, and may range in severity from mild diarrhoea to fatal colitis. Treatment with antibacterial agents alters the normal flora of the colon, which may lead to overgrowth of C. CDAD must be considered in all patients who present with diarrhoea following antibiotic use. Careful medical history is necessary since CDAD has been reported to occur over two months after the administration of antibacterial agents.

Therefore, discontinuation of clarithromycin therapy should be considered regardless of the indication. Microbial testing should be performed and adequate treatment initiated. Drugs inhibiting peristalsis should be avoided. There have been post-marketing reports of colchicine toxicity with concomitant use of clarithromycin and colchicine, especially in older people, some of which occurred in patients with renal insufficiency.

Deaths have been reported in some such patients see section 4. Concomitant administration of clarithromycin and colchicine is contraindicated see section 4. Caution is advised regarding concomitant administration of clarithromycin and triazolobenzodiazepines, such as triazolam, and intravenous or oromucosal midazolam see section 4. Cardiovascular event Prolonged cardiac repolarisation and QT interval, imparting a risk of developing cardiac arrhythmia and torsades de pointes, have been seen in treatment with macrolides including clarithromycin see section 4.

Clarithromycin must not be given to patients with hypokalaemia see section 4. Epidemiological studies investigating the risk of adverse cardiovascular outcomes with macrolides have shown variable results. Some observational studies have identified a rare short-term risk of arrhythmia, myocardial infarction and cardiovascular mortality associated with macrolides including clarithromycin.

Consideration of these findings should be balanced with treatment benefits when prescribing clarithromycin. In view of the emerging resistance of Streptococcus pneumonia to macrolides, it is important that sensitivity testing be performed when prescribing clarithromycin for community-acquired pneumonia.

In hospital-acquired pneumonia, clarithromycin should be used in combination with additional appropriate antibiotics. Skin and soft tissue infections of mild to moderate severity: These infections are most often caused by Staphylococcus aureus and Streptococcus pyogenes, both of which may be resistant to macrolides. Therefore, it is important that sensitivity testing be performed. In cases where beta—lactam antibiotics cannot be used e. Currently, macrolides are only considered to play a role in some skin and soft tissue infections, such as those caused by Corynebacterium minutissimum, acne vulgaris, and erysipelas and in situations where penicillin treatment cannot be used.

In the event of severe acute hypersensitivity reactions, such as anaphylaxis, severe cutaneous adverse reactions SCAR e. Clarithromycin should be used with caution when administered concurrently with medications that induce the cytochrome CYP3A4 enzyme see section 4.

Concomitant use of clarithromycin with lovastatin or simvastatin is contraindicated see section 4. Caution should be exercised when prescribing clarithromycin with other statins. Rhabdomyolysis has been reported in patients taking clarithromycin and statins. Patients should be monitored for signs and symptoms of myopathy. In situations where the concomitant use of clarithromycin with statins cannot be avoided, it is recommended to prescribe the lowest registered dose of the statin.

Use of a statin that is not dependent on CYP3A metabolism e. Careful monitoring of glucose is recommended see section 4. There is a risk of serious haemorrhage and significant elevations in International Normalized Ratio INR and prothrombin time when clarithromycin is co-administered with warfarin see section 4. INR and prothrombin times should be frequently monitored while patients are receiving clarithromycin and oral anticoagulants concurrently. Long-term use may, as with other antibiotics, result in colonization with increased numbers of non-susceptible bacteria and fungi.

If superinfections occur, appropriate therapy should be instituted. Attention should also be paid to the possibility of cross resistance between clarithromycin and other macrolide drugs, as well as lincomycin and clindamycin.

Cisapride, pimozide, astemizole and terfenadine Elevated cisapride levels have been reported in patients receiving clarithromycin and cisapride concomitantly.

This may result in QT prolongation and cardiac arrhythmias including ventricular tachycardia, ventricular fibrillation and torsades de pointes.

Similar effects have been observed in patients taking clarithromycin and pimozide concomitantly see section 4. Macrolides have been reported to alter the metabolism of terfenadine resulting in increased levels of terfenadine which has occasionally been associated with cardiac arrhythmias such as QT prolongation, ventricular tachycardia, ventricular fibrillation and torsades de pointes see section 4. In one study in 14 healthy volunteers, the concomitant administration of clarithromycin and terfenadine resulted in a 2 to 3 fold increase in the serum level of the acid metabolite of terfenadine and in prolongation of the QT interval which did not lead to any clinically detectable effect.

Similar effects have been observed with concomitant administration of astemizole and other macrolides. Concomitant administration of oral midazolam and clarithromycin is contraindicated. The recommended dose is 7. For children less than 9 kg, the dose must be determined by the doctor. If you think that the effect of the medicine is too strong or too weak, consult your doctor. If you have any further questions on the use of this product, ask your doctor or pharmacist.

If a doctor prescribes another medicine , tell you are taking alprazolam. Check with your doctor regularly developments of disorder that motivates the use of clarithromycin. Maybe there is some reason that prevented you properly receive the indicated doses and induce your doctor to erroneous conclusions about treatment. Do not restart treatment with clarithromycin at your own risk without first talking to your doctor, nor encourage its use by another person, even if have the same symptoms you have.

Nor is it advisable to interrupt or reduce the dose without considering the opinion of your doctor. If you feel unwell during treatment with clarithromycin, immediately consult your doctor. If you use more medicine than you should If you have taken more medicine than you should, it is expected the appearance of digestive disorders. Consult your doctor or pharmacist immediately or go to the nearest hospital carrying with you the medicine package, since the doctors will try to quickly remove clarithromycin not yet absorbed by your body.

If you forget to take clarithromycin Do not take a double dose to compensate for a forgotten dose. Take the prescribed dose as soon as possible and continue taking it every day at the same hour. The frequency of side effects is classified into: Can not be established the true incidence from the available data Adverse effects that may occur more frequently at least 1 in patients are related to the digestive system, such as nausea, diarrhea, and vomiting.

Other adverse reactions include headaches, altered taste, hearing loss usually reversible upon discontinuation , ringing in the ears and mild rash. Uncommon side effects include decreased white blood cells or platelets in the blood, liver disorders which are usually reversible , abnormal liver tests, allergic reactions that can range from itching to, in rare cases, severe allergies, transient adverse CNS effects dizziness, anxiety, insomnia, nightmares, confusion, hallucinations and convulsions, although it has not established a causal relationship , impaired smell, usually accompanied by altered taste, gum inflammation, superficial inflammation of the tongue, tongue discoloration and staining of teeth this coloration typically disappears with a dental cleaning by a professional , pancreatitis, abdominal pain, upset stomach or indigestion.

Rarely at least 1 in It also has been described the appearance of disorientation, psychosis or depersonalization though not established a causal relationship. Rarely It has been described the occurrence of abnormal electrocardiogram or heart rhythm disorders. Also can occurs dizziness, mouth infection by fungi or liver damage in rare cases can be fatal since are associated with other important disease and simultaneous use of other drugs.

There has been isolated cases frequency can not be determined from the available data interstitial nephritis kidney disorder caused by inflammation of this organ. There have been reports of colchicine toxicity when taken with clarithromycin some of which had a fatal outcome, particularly in elderly patients with kidney problems. If you notice any side effects not listed in this website or in the leaflet accompanying the container, ask your doctor or pharmacist.

The bacteria could also become less sensitive to this or other medicines. This could make the infection harder to treat in the future. Mild diarrhea is common with antibiotic use. However, a more serious and sometimes fatal form of diarrhea pseudomembranous colitis may rarely occur.

This may develop while you use the antibiotic or within several months after you stop using it. Contact your doctor right away if stomach pain or cramps, severe diarrhea, or bloody stools occur. Do not treat diarrhea without first checking with your doctor. Severe and sometimes fatal liver problems have been reported with Clarithromycin Ranbaxy. This has usually been reversible when the medicine is stopped.

Discuss any questions or concerns with your doctor. Tell your doctor right away if you experience symptoms of liver problems eg, yellowing of the skin or eyes; dark urine; pale stools; severe or persistent nausea, loss of appetite, or stomach pain; unusual tiredness.

It can cause very bad health problems that may not go away and sometimes death. Get medical help right away if you have signs like red, swollen, blistered, or peeling skin with or without fever ; red or irritated eyes; or sores in your mouth, throat, nose, or eyes.

Tell your doctor or dentist that you take Clarithromycin Ranbaxy before you receive any medical or dental care, emergency care, or surgery.

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