Clarithromycin
General Information
Macrolide
Formulary antimicrobial: Use in accordance with Trust guidelines.
AWaRe antibiotic classification: 'Watch'. Use as per guidelines.
For all information regarding interactions, contraception, pregnancy and breastfeeding and additional information, see BNF and Summary of Product Characteristics (SPC).
Standard Dose
|
|
Oral dose |
Intravenous dose |
|
Standard dose |
500mg BD |
500mg BD |
Renal and hepatic impairment
Renal impairment
Note: Avoid use in patients with renal impairment if severe hepatic impairment also present.
|
eGFR (mL/min/1.73m2) |
Oral and intravenous |
|
|
10 and above |
Dose as in normal renal function. |
|
|
Less than 10 |
Use half the normal dose i.e. 500mg od Vomiting may be a problem with high doses. |
|
|
HDF/High Flux |
Unknown dialysability. Dose as in eGFR less than 10ml/min/1.73m2 |
|
|
HD/PD |
Not dialysed. Dose as in eGFR less than 10ml/min/1.73m2 |
|
Hepatic impairment
- Mild, moderate and severe hepatic impairment: No dose adjustment is required.
- Severe hepatic failure in combination with renal impairment: Clarithromycin is contraindicated.
- Hepatic dysfunction, including increased liver enzymes and hepatocellular and/or cholestatic hepatitis, with or without jaundice, has been reported with clarithromycin. Monitor LFT’s.
- Patients should be advised to stop treatment and contact their doctor if signs and symptoms of hepatic disease develop, such as anorexia, jaundice, dark urine, pruritus, or tender abdomen.
MHRA Drug Safety Alerts
- MHRA Drug Safety Update (February 2022). Hydroxychloroquine, chloroquine: increased risk of cardiovascular events when used with macrolide antibiotics; reminder of psychiatric reactions
- FDA is advising caution before prescribing clarithromycin to patients with heart disease because of a potential increased risk of heart problems or death that can occur years later.
References
- Aurobindo Pharma - Milpharm Ltd. Clarithromycin 500mg film-coated tablets summary of product characteristics. Electronic medicines compendium. Last revision of the text: 2024 July 03 Accessed via: www.emc.medicines.org.uk Accessed 2/2/26 .
- Hameln Pharma Ltd. Clarithromycin 500mg powder for concentrate for solution for infusion summary of product characteristics. Electronic medicines compendium. Last revision of the text: 14/4/25 Accessed via: www.emc.medicines.org.uk Accessed 2/2/26
- Sanford Guide. Clarithromycin. Last updated 15/1/26. Accessed via: https://webedition.sanfordguide.com Accessed 2/2/26
- The Renal Drug Database. Clarithromycin. Last updated: 5/11/25 Accessed via: https://renaldrugdatabase.com Accessed 2/2/26
- FDA alert clarithromycin (Biaxin): Drug Safety Communication – Potential Increased Risk of Heart Problems or Death in Patients with Heart Disease. 22/2/18. Accessed via: https://www.fda.gov/drugs/fda-drug-safety-podcasts/fda-drug-safety-podcast-fda-review-finds-additional-data-supports-potential-increased-long-term Accessed 2/2/26
- MHRA. Drug Safety update (February 2022) Hydroxychloroquine, chloroquine: increased risk of cardiovascular events when used with macrolide antibiotics; reminder of psychiatric reactions. Accessed via: https://www.gov.uk/drug-safety-update/hydroxychloroquine-chloroquine-increased-risk-of-cardiovascular-events-when-used-with-macrolide-antibiotics-reminder-of-psychiatric-reactions Accessed 2/2/26