Names and pronunciation
(klare-ith′row-my-sin)
Source page 293
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Individual generic drug information
Extracted information for clarithromycin only.
(klare-ith′row-my-sin)
Source page 293
Func. class.: Antiinfective
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Chem. class.: Macrolide
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ACTION: Binds to 50S ribosomal sub- units of susceptible bacteria and sup- presses protein synthesis
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USES: Mild to moderate infections of the upper and lower respiratory tract, uncomplicated skin and skin structure infections caused by Streptococcus pneumoniae, Mycoplasma pneu- moniae, Legionella pneumophila, Moraxella catarrhalis, Neisseria gonor- rhoeae, Corynebacterium diphtheriae, Listeria monocytogenes, Haemophilus influenzae, Streptococcus pyogenes, Staphylococcus aureus, Mycobacte- rium avium complex (MAC); complex infection in AIDS patients; Mycobacte- rium avium intracellulare, Helico- bacter pylori in combination with omeprazole, H. parainfluenzae
Source page 293
Extracted information for clarithromycin only.
CONTRAINDICATIONS: Hyper- sensitivity to this product or macrolide antibiotics, torsades de pointes, QT prolongation Precautions: Pregnancy, breastfeeding, geriatric patients, renal/hepatic disease, heart disease
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SIDE EFFECTS CV: Ventricular dysrhythmias, QT prolon- gation, torsades de pointes GI: Nausea, vomiting, diarrhea, hepa- totoxicity, abdominal pain, anorexia, abnormal taste, CDAD, pancreatitis INTEG: Rash, urticaria, pruritus, Ste- vens-Johnson syndrome, toxic epidermal necrolysis, angioedema MISC: Headache, hearing loss
Source pages 293, 294
INTERACTIONS Increase: levels, toxicity—ALPRAZolam, benzodiazepines, busPIRone, carBAMaz epine, cycloSPORINE, digoxin, disopyra- mide, ergots, felodipine, fluconazole, omeprazole, tacrolimus, theophylline, antidiabetics, midazolam, triazolam Increase: atorvastatin, pravastatin Increase: myopathy, rhabdomyolysis risk—lovastatin, simvastatin; do not use concurrently Increase: action, risk for toxicity—all products metabolized by CYP3A enzyme system Increase: levels of sildenafil, tadalafil, vardenafil Increase: effect of calcium channel blockers Increase: QT prolongation—class IA, III antidysrhythmics, quinidines, procain- amide, dofetilide, sotalol, amiodarone, or other products that prolong QT Increase or decrease action: zidovudine Drug/Food • Do not use with grapefruit juice Drug/Herb Decrease: clarithromycin effect—St. John’s wort Drug/Lab Test Increase: AST, ALT, BUN, creatinine, LDH, total bilirubin, INR, PT
Source page 294
Extracted information for clarithromycin only.
DOSAGE AND ROUTES Acute exacerbation of chronic bronchitis • Adult: PO 250-500 mg q12hr × 7-14 days or 1000 mg/day × 7 days (XL) Pharyngitis/tonsillitis • Adult: PO 250 mg q12hr × 10 days Community-acquired pneumonia • Adult: PO 250 mg q12hr × 7-14 days or 1000 mg/day × 7 days (XL) C Endocarditis prophylaxis • Adult: PO 500 mg 1 hr prior to proce- dure • Child: PO 15 mg/kg 1 hr prior to procedure MAC prophylaxis/treatment • Adult: PO 500 mg bid; will require an additional antiinfective for active infection H. pylori infection • Adult: PO 500 mg with 30 mg lanso- prazole and 1 g amoxicillin together q12hr × 10-14 days or 500 mg with omeprazole 20 mg and 1 g amoxicillin together q12hr × 10 days or 500 mg q8hr and omeprazole 40 mg daily × 14 days, continue omeprazole for 14 more days Acute maxillary sinusitis • Adult: PO 500 mg q12hr × 14 days Acute otitis media • Child: PO 7.5 mg/kg q12hr × 10 days, max 500 mg/dose for MAC Renal dose • Adult/child: PO CCr 30-60 mL/min decrease dose by 50% if using with rito- navir; <30 mL/min, reduce dose by 50%, if used with ritonavir reduce by 75%
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Available forms: Tablets 250, 500 mg; oral suspension 125 mg/5 mL, 250 mg/5 mL; extended-release tablet (XL) 500 mg
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Administer: • Do not break, crush, or chew extended release • Adequate intake of fluids (2 L) during diarrhea episodes • q12hr to maintain serum levels • Store at room temperature • Suspension: Shake well, store at room temperature, discard after 2 wk • Extended release: Give with food
Source page 293
Extracted information for clarithromycin only.
Assess: • Infection: wound characteristics, urine, stool, sputum, WBC, temperature; C&S prior to product therapy; product may be given as soon as culture is taken; C&S may be repeated after treatment • Bleeding: check INR if anticoagulants are taken • Hypersensitivity: allergies before treatment, reaction to each medication • Heart failure: increased risk of heart- related disease and death in some pa- tients; use caution in those with in- creased CV risk, and weigh benefits and risk • QT prolongation, ventricular dys- rhythmias: monitor ECG, cardiac status in those with underlying cardiac abnor- malities • Clostridium difficile–associated diarrhea (CDAD): monitor for diarrhea, cramping, blood in stools, fever; report immediately to prescriber; may start up to several weeks after conclusion of treat- ment • Serious skin reaction: Stevens- Johnson syndrome, toxic epidermal necrolysis; product should be discontin- ued immediately; may occur after ther- apy is concluded • Pregnancy/breastfeeding: no well- controlled studies; use in pregnancy only if benefits outweigh fetal risk; ex- creted in breast milk, use caution in breastfeeding
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Evaluate: • Therapeutic response: C&S negative for infection, prevention of endocarditis
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CLINICAL CONSIDERATIONS
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Patient and caregiver information: • To take with full glass of water; may give with food to decrease GI symptoms; to take extended release with food • To report sore throat, fever, fatigue; may indicate superinfection • To notify prescriber of diarrhea, dark urine, pale stools, yellow discoloration of eyes or skin, severe abdominal pain • To take at evenly spaced intervals; to complete dosage regimen; to notify pre- scribers of all products used • To notify prescriber if pregnancy is suspected or planned or if breastfeeding TREATMENT OF HYPERSEN- SITIVITY: Withdraw product, main- tain airway, administer EPINEPHrine, aminophylline, O2, IV corticosteroids
Source pages 294, 295
Extracted information for clarithromycin only.
PHARMACOKINETICS Regular release: peak 2-2.5 hr; duration 12 hr; extended release: peak 5-7 hr; half-life 5-7 hr; metabolized by liver; excreted in bile, feces; possible inhibition of P-glycoprotein, protein binding 70%
Source page 294
Filter the extracted dose blocks for this individual drug.
Acute exacerbation of chronic bronchitis
• Child: PO 15 mg/kg 1 hr prior to procedure MAC prophylaxis/treatment
Candidate age grouping · source page 293
Acute exacerbation of chronic bronchitis
• Child: PO 7.5 mg/kg q12hr × 10 days, max 500 mg/dose for MAC Renal dose
Candidate age grouping · source page 293
Acute exacerbation of chronic bronchitis
• Adult/child: PO CCr 30-60 mL/min decrease dose by 50% if using with rito- navir; <30 mL/min, reduce dose by 50%, if used with ritonavir reduce by 75%
Candidate age grouping · source page 293