التداخل بين كلاريثرومايسين وبرافاستاتين

In situations where the concomitant use of clarithromycin tablets with atorvastatin or pravastatin cannot be avoided, atorvastatin dose should not exceed 20 mg daily and pravastatin dose should not exceed 40 mg daily.

Concomitant administration of clarithromycin tablets with HMG-CoA reductase inhibitors (statins) that are extensively metabolized by CYP3A4 (lovastatin or simvastatin) is contraindicated, due to the increased risk of myopathy, including rhabdomyolysis [see Warnings and Precautions ( 5.4 ) and Drug Interactions ( 7 )].

HMG-CoA Reductase Inhibitors (statins): Concomitant use of clarithromycin tablets with lovastatin or simvastatin is contraindicated [see Contraindications ( 4.5 )] as these statins are extensively metabolized by CYP3A4, and concomitant treatment with clarithromycin increases their plasma concentration, which increases the risk of myopathy, including rhabdomyolysis.

Exercise caution when prescribing clarithromycin tablets with atorvastatin or pravastatin.

Use of a statin that is not dependent on CYP3A metabolism (e.g. fluvastatin) can be considered.

Intervention: For patients taking erythromycin or clarithromycin, do not exceed 40 mg pravastatin sodium once daily [see Dosage and Administration ( Error!

There are pravastatin sodium dosage restrictions for patients taking cyclosporin and select macrolide antibiotics [see Dosage and Administration ( Error!

Select Macrolide Antibiotics Clinical Impact: The risk of myopathy and rhabdomyolysis is increased by concomitant use of clarithromycin or erythromycin with pravastatin sodium.

Other macrolides (e.g., azithromycin) have the potential to increase pravastatin sodium exposures and increase the risk of myopathy and rhabdomyolysis when used concomintantly.