MajorMacrolide antibiotic×Atypical antipsychotic, selective 5-HT2A inverse agonist
Updated · Methodology
Mechanism
Clarithromycin inhibits CYP3A4 – pimavanserin rises 2-3 fold. Added QT prolongation.
Symptoms
QT prolongation, dizziness, peripheral edema.
Management
Reduce pimavanserin to 10 mg/day. 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.
Summary of a multi-drug list →
Medicine list: everything you take in one place →
Sources
- FDA: Nuplazid (pimavanserin) prescribing information (2023)– FDA Nuplazid label
- AEMPS: Ficha técnica: Claritromicina (nº registro 75638), sección 4.5 (2025)– AEMPS, CIMA, nº registro 75638, sección 4.5