Major
Clarithromycin × Ciclosporin
Macrolide antibiotic×Immunosuppressants. Calcineurin inhibitors
Mechanism
Clarithromycin inhibits CYP3A4. Cyclosporine rises 2-3 fold – nephrotoxicity.
Symptoms
Rising creatinine, tremor within 5-7 days.
Management
Reduce cyclosporine by 50%, check blood level on day 3. Better – azithromycin.
Check the full regimen, not just this pair
Opens the checker with these two drugs prefilled. Add the rest of the regimen and recompute additive risks.