Clarimycin is used to treat bacterial infections in many different parts of the body. It is also used in combination with other medicines to treat duodenal ulcers caused by H. pylori. Clarimycin is also used to prevent and treat Mycobacterium avium complex (MAC) infection.
Clarimycin belongs to the class of medicines known as macrolide antibiotics. It works by killing bacteria or preventing their growth. However, Clarimycin will not work for colds, flu, or other virus infections.
Clarimycin is available only with your doctor's prescription.
Once a medicine has been approved for marketing for a certain use, experience may show that it is also useful for other medical problems. Although this use is not included in product labeling, Clarimycin is used in certain patients with the following medical condition:
An indication is a term used for the list of condition or symptom or illness for which the medicine is prescribed or used by the patient. For example, acetaminophen or paracetamol is used for fever by the patient, or the doctor prescribes it for a headache or body pains. Now fever, headache and body pains are the indications of paracetamol. A patient should be aware of the indications of medications used for common conditions because they can be taken over the counter in the pharmacy meaning without prescription by the Physician.
Acute Bacterial Exacerbation of Chronic Bronchitis
Clarimycin tablets, Clarimycin for oral suspension and Clarimycin extended-release tablets are indicated in adults for the treatment of mild to moderate infections caused by susceptible isolates due to Haemophilus influenzae, Haemophilus parainfluenzae, Moraxella catarrhalis, or Streptococcus pneumoniae.
Acute Maxillary Sinusitis
Clarimycin tablets, Clarimycin for oral suspension and Clarimycin extended-release tablets (in adults) are indicated for the treatment of mild to moderate infections caused by susceptible isolates due to Haemophilus influenzae, Moraxella catarrhalis, or Streptococcus pneumoniae.
Clarimycin tablets, Clarimycin for oral suspension and Clarimycin extended-release tablets are indicated for the treatment of mild to moderate infections caused by susceptible isolates due to:
Haemophilus influenzae (in adults)
Haemophilus parainfluenzae (Clarimycin extended-release tablets in adults)
Moraxella catarrhalis (Clarimycin extended-release tablets in adults)
Mycoplasma pneumoniae, Streptococcus pneumoniae, Chlamydophila pneumoniae (Clarimycin extended-release tablets [in adults]; Clarimycin tablets and Clarimycin for oral suspension [in adults and pediatric patients])
Clarimycin tablets and Clarimycin for oral suspension are indicated for the treatment of mild to moderate infections caused by susceptible isolates due to Streptococcus pyogenes as an alternative in individuals who cannot use first line therapy.
Uncomplicated Skin and Skin Structure Infections
Clarimycin tablets and Clarimycin for oral suspension are indicated for the treatment of mild to moderate infections caused by susceptible isolates due to Staphylococcus aureus, or Streptococcus pyogenes.
Acute Otitis Media
Clarimycin tablets and Clarimycin for oral suspension are indicated in pediatric patients for the treatment of mild to moderate infections caused by susceptible isolates due to Haemophilus influenzae, Moraxella catarrhalis, or Streptococcus pneumoniae.
Treatment and Prophylaxis of Disseminated Mycobacterial Infections
Clarimycin tablets and Clarimycin for oral suspension are indicated for the treatment of mild to moderate infections caused by susceptible isolates due to Mycobacterium avium or Mycobacterium intracellulare in patients with advanced HIV infection.
Helicobacter pylori Infection and Duodenal Ulcer Disease
Clarimycin tablets are given in combination with other drugs in adults as described below to eradicate H. pylori. The eradication of H. pylori has been demonstrated to reduce the risk of duodenal ulcer recurrence.
Clarimycin tablets in combination with amoxicillin and PREVACID (lansoprazole) or PRILOSEC (omeprazole) delayed-release capsules, as triple therapy, are indicated for the treatment of patients with H. pylori infection and duodenal ulcer disease (active or five-year history of duodenal ulcer) to eradicate H. pylori.
Clarimycin tablets in combination with PRILOSEC (omeprazole) capsules are indicated for the treatment of patients with an active duodenal ulcer associated with H. pylori infection. Regimens which contain Clarimycin tablets as the single antibacterial agent are more likely to be associated with the development of Clarimycin resistance among patients who fail therapy. Clarimycin-containing regimens should not be used in patients with known or suspected Clarimycin resistant isolates because the efficacy of treatment is reduced in this setting.
Limitations of Use
Clarimycin extended-release tablets are indicated only for acute maxillary sinusitis, acute bacterial exacerbation of chronic bronchitis, and community-acquired pneumonia in adults. The efficacy and safety of Clarimycin extended-release tablets in treating other infections for which Clarimycin tablets and Clarimycin for oral suspension are approved have not been established.
There is resistance to macrolides in certain bacterial infections caused by Streptococcus pneumoniae and Staphylococcus aureus. Susceptibility testing should be performed when clinically indicated.
To reduce the development of drug-resistant bacteria and maintain the effectiveness of Clarimycin and other antibacterial drugs, Clarimycin should be used only to treat or prevent infections that are proven or strongly suspected to be caused by susceptible bacteria. When culture and susceptibility information are available, they should be considered in selecting or modifying antibacterial therapy. In the absence of such data, local epidemiology and susceptibility patterns may contribute to the empiric selection of therapy.
How should I use Clarimycin?
Use Clarimycin extended-release tablets as directed by your doctor. Check the label on the medicine for exact dosing instructions.
Take Clarimycin extended-release tablets by mouth with food.
Swallow Clarimycin extended-release tablets whole. Do not break, crush, or chew before swallowing.
If you are also taking zidovudine, do not take it within 2 hours before or after Clarimycin extended-release tablets.
Clarimycin extended-release tablets works best if it is taken at the same time each day.
To clear up your infection completely, take Clarimycin extended-release tablets for the full course of treatment. Keep taking it even if you feel better in a few days.
Do not miss any doses. If you miss a dose of Clarimycin extended-release tablets, take it as soon as possible. If it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not take 2 doses at once.
Ask your health care provider any questions you may have about how to use Clarimycin extended-release tablets.
Uses of Clarimycin in details
There are specific as well as general uses of a drug or medicine. A medicine can be used to prevent a disease, treat a disease over a period or cure a disease. It can also be used to treat the particular symptom of the disease. The drug use depends on the form the patient takes it. It may be more useful in injection form or sometimes in tablet form. The drug can be used for a single troubling symptom or a life-threatening condition. While some medications can be stopped after few days, some drugs need to be continued for prolonged period to get the benefit from it.
Use: Labeled Indications
Chronic obstructive pulmonary disease, acute exacerbation: Treatment of acute bacterial exacerbation of chronic bronchitis in adults due to susceptible Haemophilus influenzae, Haemophilus parainfluenzae, Moraxellacatarrhalis, or Streptococcus pneumoniae.
Helicobacter pylori eradication: Eradication of Helicobacter pylori to reduce the risk of duodenal ulcer recurrence as a component of combination therapy (triple therapy) in adults with H. pylori infection and duodenal ulcer disease (active or 5-year history of duodenal ulcer).
Limitations of use: Regimens that contain Clarimycin as the single antibacterial agent are more likely to be associated with the development of Clarimycin resistance. Clarimycin-containing regimens should not be used in patients with known or suspected Clarimycin-resistant isolates (efficacy is reduced).
Mycobacterial (nontuberculous) infection: Prophylaxis and treatment of disseminated mycobacterial infections due to Mycobacterium avium complex (MAC) in patients with advanced HIV infection.
Otitis media: Treatment of acute otitis media in pediatric patients due to susceptible H. influenzae, M. catarrhalis, or S. pneumoniae.
Pneumonia, community-acquired: Treatment of community-acquired pneumonia due to susceptible Mycoplasma pneumoniae, S. pneumoniae, or Chlamydophila pneumoniae (adult and pediatric patients) and H. influenzae, H. parainfluenzae, or M. catarrhalis (adults).
Skin/skin structure infection: Treatment of uncomplicated skin/skin structure infection due to susceptible Staphylococcus aureus or Streptococcus pyogenes.
Streptococcal pharyngitis: Treatment of pharyngitis/tonsillitis due to susceptible S. pyogenes (alternative agent for patients with severe penicillin allergy).
Off Label Uses
Bartonella spp. infection
Based on the US Department of Health and Human Services guidelines for prevention and treatment of opportunistic infections in adults and adolescents with HIV, Clarimycin is an effective and recommended alternative agent for treatment or long-term suppression of bartonellosis infection.
Clinical experience also suggests the utility of Clarimycin for the treatment of cat scratch disease.
Oral Suspension (Pediatric Suspension): Each 5 ml of the granules for suspension contains 250 mg of Clarimycin.
Clarimycin is a semisynthetic macrolide antibiotic obtained by substitution of a CH3O group for the hydroxyl (OH) group in position 6 of the erythromycin lactonic ring. Specifically, Clarimycin is 6-O-methyl erythromycin A. The white to off-white antibiotic powder is practically odorless, essentially insoluble in water and slightly soluble in ethanol, methanol and acetonitrile. Its molecular weight is 747.96.
Clarimycin Paediatric Suspension is an oral dosage form of Clarimycin for use primarily in children.
Clarimycin Paediatric Suspension: Granule Component and Coating:Carbopol carbomers, povidone, hypromellose phthalate, castor oil. Other Ingredients: Sucrose, xanthan gum, silicon dioxide, potassium sorbate, citric acid, maltodextrin, titanium dioxide, fruit punch flavor.
Clarimycin/Clarimycin Forte: Respiratory Tract/Skin and Soft Tissue Infections:Adults and Children ≥12 years: Usual Dose: 250 mg twice daily for 7 days, although this may be increased to 500 mg twice daily for up to 14 days in severe infections.
Children <12 years: Use Clarimycin Paediatric Suspension. The use of Clarimycin IR has not been studied in children <12 years.
Eradication of H. pylori:Adults and Elderly Triple Therapy Regimen: Clarimycin 500 mg twice daily in conjunction with amoxicillin 1000 mg twice daily and a proton-pump inhibitor in standard dose twice daily for 7 days.
Dual Therapy Regimen: Clarimycin 500 mg 3 times daily in conjunction with omeprazole 40 mg once daily for 14 days, followed by omeprazole 40 mg once daily for an additional 14 days. Supportive studies have been conducted with omeprazole 40 mg once daily for 14 days.
Renal Impairment: Dosage adjustments are not usually required except in patients with severe renal impairment (creatinine clearance <30 mL/min). If adjustment is necessary, the total daily dosage should be reduced by ½ eg, 250 mg once daily or 250 mg twice daily in more severe infections.
Clarimycin may be given without regard to meals as food does not affect the extent of bioavailability.
Clarimycin MR: Adults and Children >12 years: Usual Recommended
Dosage: 1 modified-release tab daily to be taken with food. In more severe infections, the dosage can be increased to 2 tabs daily. The usual duration of treatment is 7-14 days.
Children <12 years: Use Clarimycin Paediatric Suspension. The use of Clarimycin MR has not been studied in children <12 years.
Renal Impairment: Clarimycin MR should not be used in patients with renal impairment (creatinine clearance <30 mL/min). Clarimycin immediate-release tablets may be used in this patient population.
Do not crush or chew Clarimycin MR tablets.
Clarimycin Paediatric Suspension: Children 6 months to 12 years: Clinical trials have been conducted using Clarimycin Pediatric Suspension in children 6 months-12 years. Therefore, children 6 months-12 years of age should use Clarimycin Pediatric Suspension (granules for oral suspension).
Dosage: 7.5 mg/kg twice daily up to a maximum dose of 500 mg twice daily for nonmycobacterial infections. The usual duration of treatment is for 5-10 days depending on the pathogen involved and the severity of the condition. The prepared suspension can be taken with or without meals, and can be taken with milk.
Table 3 is a suggested guide for determining
Dosage: See Table 3.
Patients with Renal Impairment: In children with creatinine clearance <30 mL/min, the dosage of Clarimycin should be reduced by ½ ie, up to 250 mg once daily or 250 mg twice daily in more severe infections. Dosage should not be continued >14 days in these patients.
Patients with Mycobacterial Infections: In children with disseminated or localized mycobacterial infections (M. avium, M. intracellulare, M. chelonae, M. fortuitum, M. kansasii), the recommended dose is 15-30 mg/kg/day in 2 divided doses.
Treatment with Clarimycin should continue as long as clinical benefit is demonstrated. The addition of other antimycobacterial agents may be of benefit.
Clarimycin: Data available to date indicate that Clarimycin is metabolized primarily by the hepatic cytochrome P-450 3A (CYP3A) isozyme. This is an important mechanism determining many drug interactions.
The metabolism of other drugs by this system may be inhibited by concomitant administration with Clarimycin and may be associated with elevations in serum levels of drug classes known or suspected to be metabolized by the same CYP450 and CYP3A isozyme.
Other Drug Interactions: Elevated digoxin serum concentrations have been reported in patients receiving Clarimycin tablets and digoxin concomitantly. Monitoring of serum digoxin levels should be considered.
There have been post-marketing reports of Torsades de pointes occurring with concurrent use of Clarimycin and quinidine or disopyramide. Serum levels of these medications should be monitored during Clarimycin therapy.
Rhabdomyolysis coincident with the co-administration of Clarimycin and the HMG-CoA reductase inhibitors eg, lovastatin and simvastatin has rarely been reported.
Antiretroviral Drug Interactions: Simultaneous oral administration of Clarimycin tablets and zidovudine to HIV-infected adult patients may result in decreased steady-state zidovudine concentrations. Because Clarimycin appears to interfere with the absorption of simultaneously administered oral zidovudine, this interaction can be largely avoided by staggering the doses of Clarimycin and zidovudine. This interaction does not appear to occur in pediatric HIV-infected patients taking Clarimycin suspension with zidovudine or dideoxyinosine.
A pharmacokinetic study demonstrated that the concomitant administration of ritonavir 200 mg every 8 hrs and Clarimycin 500 mg every 12 hrs resulted in a marked inhibition of the metabolism of Clarimycin.
For patients with renal impairment, the following dosage adjustments should be considered: For patients with CrCl 30-60 mL/min, the dose of Clarimycin should be reduced by 50%. For patients with CrCl <30 mL, the dose of Clarimycin should be decreased by 75%. Doses of Clarimycin >1 g/day should not be co-administered with ritonavir.
Clarimycin OD: As with other macrolide antibiotics, the use of Clarimycin in patients concurrently taking drugs metabolized by the cytochrome P-450 system (eg, cilostazol, methylprednisolone, anticoagulants eg, warfarin, quinidine, sildenafil, ergot alkaloids, alprazolam, triazolam, midazolam, disopyramide, lovastatin, rifabutin, phenytoin, cyclosporin, vinblastine, valproate and tacrolimus) may be associated with elevations in serum levels of these other drugs.
Digoxin: Elevated digoxin serum concentrations have been reported in patients receiving Clarimycin tablets and digoxin concomitantly. Monitoring of serum digoxin levels should be considered.
Quinidine/Disopyramide: There have been post-marketed reports of Torsades de pointes occurring with concurrent use of Clarimycin and quinidine or disopyramide. Electrocardiogram and serum levels of these medications should be monitored during Clarimycin therapy.
HMG-CoA Reductase Inhibitors: As with other macrolides, Clarimycin has been reported to increase concentrations of HMG-CoA reductase inhibitors (eg, statins). Rhabdomyolysis has also been reported in patients taking these drugs concomitantly.
Theophylline, Carbamazepine: The administration of Clarimycin to patients receiving theophylline or carbamazepine has been associated with an increase in serum theophylline or carbamazepine levels.
Concomitant administration of Clarimycin and oral anticoagulants may potentiate the effects of oral anticoagulants. Prothrombin time should be carefully monitored while patients are receiving Clarimycin and oral anticoagulants simultaneously.
Ritonavir: Ritonavir increases AUC, Cmax and Cmin of Clarimycin when administered concurrently. Because of the large therapeutic window for Clarimycin, no dosage reduction should be necessary in patients with normal renal function. However, for patients with renal impairment, the following dosage adjustments should be considered: For patients with CrCl 30-60 mL/min, the dose of Clarimycin should be reduced by 50%. For patients with CrCl <30 mL/min, the dose of Clarimycin should be decreased by 75%. Doses of Clarimycin >1 g/day should not be co-administered with ritonavir.
Efavirenz, Nevirapine, Rifampicin and Rifabutin: Strong inducers of the cytochrome P-450 metabolism system eg, efavirenz, nevirapine, rifampicin and rifabutin may accelerate the metabolism of Clarimycin and thus, lower the plasma levels of Clarimycin. Since the microbiological activities of Clarimycin and 14-OH-Clarimycin are different for different bacteria, the intended therapeutic effect could be impaired during concomitant administration of Clarimycin and enzyme inducers.
Sildenafil, Tadalafil and Vardenafil: Each of these phosphodiesterase inhibitors is metabolized, at least in part, by CYP3A, and CYP3A may be inhibited by concomitantly administered Clarimycin. Reduction in sildenafil, tadalafil and vardenafil dosages should be considered when these drugs are co-administered with Clarimycin.
Triazolam: Drug interactions and CNS effects (eg, somnolence and confusion) with the concomitant use of Clarimycin and triazolam have been reported. Monitoring the patient for increased CNS pharmacological effects is suggested.
Colchicine: When Clarimycin and colchicine are administered together, inhibition of Pgp and/or CYP3A by Clarimycin may lead to increased exposure to colchicine. Patients should be monitored for clinical symptoms of colchicine toxicity.
Itraconazole: Both Clarimycin and itraconazole are substrates and inhibitors of CYP3A. Clarimycin may increase the plasma levels of itraconazole, while itraconazole may increase the plasma levels of Clarimycin. Patients taking itraconazole and Clarimycin concomitantly should be monitored closely for signs and symptoms of increased or prolonged pharmacological effect.
Zidovudine: Simultaneous oral administration of Clarimycin tablets and zidovudine to HIV-infected adult patients may result in decreased steady-state zidovudine concentrations. This interaction does not appear to occur in pediatric HIV-infected patients taking Clarimycin suspension with zidovudine or dideoxyinosine.
The most frequent and common adverse reactions related to Clarimycin therapy for both adult and pediatric populations are abdominal pain, diarrhea, nausea, vomiting and taste perversion. These adverse reactions are usually mild in intensity and are consistent with the known safety profile of macrolide antibiotics.
There was no significant difference in the incidence of these gastrointestinal adverse reactions during clinical trials between the patient population with or without preexisting mycobacterial infections.
The following table displays adverse reactions reported in clinical trials and from post-marketing experience with Clarimycin immediate release, granules for oral suspension, IV and MR.
The reactions considered at least possibly related to Clarimycin are displayed by system organ class and frequency using the following convention: Very common (≥1/10), common (≥1/100 to <1/10), uncommon (≥1/1000 to <1/100) and not known (adverse reactions from post-marketing experience; cannot be estimated from the available data). Within each frequency grouping, adverse reactions are presented in order of decreasing seriousness when the seriousness could be assessed.
There have been post-marketing reports of colchicine toxicity with concomitant use of Clarimycin and colchicine, especially in the elderly, some of which occurred in patients with renal insufficiency. Deaths have been reported in some such patients.
Immunocompromised Patients: In AIDS and other immunocompromised patients treated with the higher doses of Clarimycin over long periods of time for mycobacterial infections, it was often difficult to distinguish adverse events possibly associated with Clarimycin administration from underlying signs of HIV disease or intercurrent illness.
Clarimycin/Clarimycin Forte: In adult patients, the most frequently reported adverse events by patients treated with total daily doses of Clarimycin 1000 mg were: Nausea, vomiting, taste perversion, abdominal pain, diarrhea, rash, flatulence, headache, constipation, hearing disturbance, SGOT and SGPT elevations. Additional low-frequency events included dyspnea, insomnia and dry mouth.
In these immunocompromised patients evaluations of laboratory values were made by analyzing those values outside the seriously abnormal level (ie, the extreme high or low limit) for the specified test. On the basis of this criteria, about 2-3% of these patients who received Clarimycin 1000 mg daily had seriously abnormal elevated levels of SGOT and SGPT, and abnormally low white blood cell and platelet counts. A lower percentage of patients also had elevated BUN levels.
Clarimycin Paediatric Suspension: A limited number of pediatric AIDS patients have been treated with Clarimycin Pediatric Suspension for mycobacterial infections. The most frequently reported adverse events, excluding those due to the patient's concurrent condition, were tinnitus, deafness, vomiting, nausea, abdominal pain, purpuric rash, pancreatitis and increased amylase. Evaluations of laboratory values for these patients were made by analyzing those values outside the seriously abnormal level (ie, the extreme high or low limit) for the specified test. Based on these criteria, 1 pediatric AIDS patient receiving <15 mg/kg/day of Clarimycin had a seriously abnormal (elevated) total bilirubin; of the patients receiving 15 to <25 mg/kg/day of Clarimycin, there was 1 each reported as seriously abnormal SGPT, BUN, and seriously decreased platelet count. None of these seriously abnormal values for these laboratory parameters were reported for patients receiving the highest dosage (≤25 mg/kg/day) of Clarimycin.
Clarimycin is contraindicated in patients with a known hypersensitivity to Clarimycin, erythromycin, or any of the macrolide antibacterial drugs.
Concomitant administration of Clarimycin with cisapride and pimozide is contraindicated [seeDRUG INTERACTIONS (7)].
There have been postmarketing reports of drug interactions when Clarimycin is coadministered with cisapride or pimozide, resulting in cardiac arrhythmias (QT prolongation, ventricular tachycardia, ventricular fibrillation, and torsades de pointes) most likely due to inhibition of metabolism of these drugs by Clarimycin. Fatalities have been reported.
Cholestatic Jaundice/Hepatic Dysfunction
Clarimycin is contraindicated in patients with a history of cholestatic jaundice or hepatic dysfunction associated with prior use of Clarimycin.
Concomitant administration of Clarimycin and colchicine is contraindicated in patients with renal or hepatic impairment.
HMG-CoA Reductase Inhibitors
Do not use Clarimycin concomitantly with HMG-CoA reductase inhibitors (statins) that are extensively metabolized by CYP3A4 (lovastatin or simvastatin), due to the increased risk of myopathy, including rhabdomyolysis.
Concomitant administration of Clarimycin and ergotamine or dihydroergotamine is contraindicated.
Contraindications for Coadministered Drugs
For information about contraindications of other drugs indicated in combination with Clarimycin, refer to their full prescribing information (contraindications section).
DailyMed. "CLARITHROMYCIN: DailyMed provides trustworthy information about marketed drugs in the United States. DailyMed is the official provider of FDA label information (package inserts).". https://dailymed.nlm.nih.gov/dailyme... (accessed September 17, 2018).
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