Critical
Clarithromycin × Lovastatin
Macrolide antibiotic×HMG-CoA reductase inhibitor (statin)
Mechanism
Clarithromycin inhibits CYP3A4 – lovastatin (sensitive substrate) rises 8-fold. Rhabdomyolysis risk.
Symptoms
Myalgia, weakness, dark urine, rising CK within 5-10 days.
Management
Combination contraindicated. Switch lovastatin to pravastatin or rosuvastatin during the course.
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.
Sources
- FDA: Mevacor (lovastatin) prescribing information (2014)
- FDA: Mevacor (lovastatin) prescribing information – CYP3A4 contraindications (2014)– FDA Mevacor label, Contraindications §4
- FDA: Biaxin (clarithromycin) prescribing information – CYP3A4 inhibition (2018)– FDA Biaxin label, Drug Interactions §7