Clarithromycin dramatically increases blood levels of CYP3A4-metabolized statins (simvastatin, lovastatin, atorvastatin), raising the risk of severe myopathy and rhabdomyolysis. This interaction has caused fatal cases of rhabdomyolysis leading to acute kidney failure.
How This Interaction Works (Mechanism)
Clarithromycin is a potent CYP3A4 inhibitor and also inhibits P-glycoprotein and OATP1B transporters. These combined effects can increase simvastatin and lovastatin plasma levels by 300 to 1000 percent. Even atorvastatin, which is only partially metabolized by CYP3A4, can see 2 to 4 fold increases. The massively elevated statin levels cause dose-dependent myotoxicity through mitochondrial dysfunction in skeletal muscle.
Source: FDA Drug Safety Communication on Statin Interactions, 2023
Suspend simvastatin and lovastatin during clarithromycin treatment. For atorvastatin, reduce the dose to no more than 20 mg daily or suspend temporarily. Pravastatin and rosuvastatin are safer alternatives during clarithromycin therapy, as they are not significantly metabolized by CYP3A4. If possible, use azithromycin instead of clarithromycin, as it does not inhibit CYP3A4. Resume normal statin dosing 3 days after completing clarithromycin.
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Sources and standards behind this page
What a drug interaction does, and how strongly it is supported, is documented in public labeling and federal safety references rather than in any one summary, and the sources below are the primary ones. They are linked so a reader can check a claim without taking this page's word for it.
- DailyMed carries the current FDA labeling for every marketed drug product, including the warnings and drug interaction sections.
- Drugs@FDA is the federal database of approved drug products and their approval documents.
- FDA: Drug interactions, what you should know explains how drug-drug, drug-food and drug-condition interactions are described on labels.
- FDA Drug Safety Communications publishes the agency's safety alerts and label changes as they are issued.
- FDA MedWatch is the program for reporting and reviewing adverse events, including suspected interactions.
- openFDA provides public access to FDA labeling and adverse event data.
- MedlinePlus drug information is the National Library of Medicine's consumer reference for what a medicine is and how it is taken.
- NIAAA: Harmful interactions documents which medicines interact with alcohol and how.
- NCCIH: Herb-drug interactions summarises the evidence on interactions between herbal products and medicines.
- National Library of Medicine maintains the drug and health databases the sources above draw on.
This page describes how this interaction works and where it is documented. It is not medical advice: a prescriber or pharmacist decides what applies to a particular patient and medication.
Frequently Asked Questions
Clarithromycin and Statins have a severe interaction and should generally not be taken together without close medical supervision. The combination can cause serious, potentially life-threatening side effects. Contact your doctor immediately if you are currently taking both medications.
Clarithromycin dramatically increases blood levels of CYP3A4-metabolized statins (simvastatin, lovastatin, atorvastatin), raising the risk of severe myopathy and rhabdomyolysis. This interaction has caused fatal cases of rhabdomyolysis leading to acute kidney failure.
Yes. Anytime you are taking multiple medications, supplements, or substances, you should inform your doctor and pharmacist. They can evaluate your specific risk factors (age, kidney function, other medications, medical conditions) and determine whether the Clarithromycin and Statins combination is safe for you, or whether adjustments are needed.
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