Clarithromycin × Methylprednisolone

Methylprednisolone is broken down in the liver by CYP3A4, and clarithromycin inhibits this enzyme. A considerable rise in methylprednisolone blood levels has been observed with clarithromycin (methylprednisolone SmPC). Higher levels increase the risk of systemic corticosteroid adverse effects (methylprednisolone SmPC).

Moon face, central obesity, abdominal striae, high blood pressure, high blood glucose (Cushing's syndrome). After prolonged combined use and abrupt withdrawal, adrenal insufficiency with low blood pressure and weakness may occur.

Avoid the combination unless the benefit outweighs the risk of systemic corticosteroid adverse effects: the methylprednisolone SmPC sets this rule for all CYP3A4 inhibitors and names clarithromycin separately as a drug that considerably raises methylprednisolone levels (methylprednisolone SmPC). If the combination is needed, monitor the patient closely for systemic corticosteroid adverse effects throughout the clarithromycin course (methylprednisolone SmPC; clarithromycin SmPC). The US Food and Drug Administration (FDA) advises titrating the methylprednisolone dose to avoid steroid toxicity when drugs that slow its clearance are added (methylprednisolone FDA label).