Monitor for increased GI bleeding if a patient regularly consumes alcohol and NSAIDs. Use Caution/Monitor. Fluoxetine prolongs the QT interval; the prescribing information for fluoxetine recommends avoiding concurrent use of other drugs that may prolong the QT interval; risk may be increased with higher doses and/or when associated with hypokalemia; drugs that prolong the QTc interval may potentiate the effects of beta2 agonists on the cardiovascular system. Monitor Closely (1)ketorolac, vortioxetine. amiloride and ketorolac both increase serum potassium. ibrutinib will increase the level or effect of fluoxetine by anticoagulation. Either increases toxicity of the other by serotonin levels. clarithromycin decreases effects of penicillin G aqueous by pharmacodynamic antagonism. Avoid or Use Alternate Drug. Increases risk of torsades de pointes. Minor/Significance Unknown. Avoid concomitant use of rivaroxaban and combined Pgp and strong CYP3A4 inhibitors. fluoxetine increases effects of insulin detemir by unspecified interaction mechanism. Monitor Closely (1)ticagrelor will increase the level or effect of cabozantinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. This drug is available at a higher level co-pay. Monitor Closely (1)tecovirimat will decrease the level or effect of ticagrelor by affecting hepatic/intestinal enzyme CYP3A4 metabolism. metronidazole will increase the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Each drug may increase the photosensitizing effect of the other. Avoid or Use Alternate Drug. Use Caution/Monitor. Minor/Significance Unknown. Avoid or Use Alternate Drug. If interruption not possible, patients requiring therapy with a drug that prolongs QT should be closely monitored. Avoid or Use Alternate Drug. Contraindicated (1)clarithromycin will increase the level or effect of methylergonovine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. metronidazole, sulfamethoxazole. Use Caution/Monitor. Minor/Significance Unknown. Use Caution/Monitor. Monitor Closely (2)clarithromycin will increase the level or effect of risperidone by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. ketorolac and tenecteplase both increase anticoagulation. Consider clarithromcycin dose reduction in patients with renal impairment. Monitor Closely (1)fluoxetine increases levels of axitinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated. Use Caution/Monitor. Avoid or Use Alternate Drug. Serious - Use Alternative (3)tipranavir will increase the level or effect of clarithromycin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Consult your pharmacist or local waste disposal company. Avoid or Use Alternate Drug. Avoid if possible; if concomitant use is unavoidable, reduce ceritinib dose by ~33%; after discontinuation of strong CYP3A inhibitor, resume at previous dose.ceritinib and clarithromycin both increase QTc interval. Serious - Use Alternative (1)fluoxetine, vandetanib. Avoid or Use Alternate Drug. Minor/Significance Unknown.clarithromycin will increase the level or effect of aliskiren by P-glycoprotein (MDR1) efflux transporter. ibrutinib will increase the level or effect of mefenamic acid by anticoagulation. Either increases toxicity of the other by pharmacodynamic synergism. Use Caution/Monitor. Minor/Significance Unknown. Avoid or Use Alternate Drug. Serious - Use Alternative (1)darunavir increases levels of ticagrelor by affecting hepatic/intestinal enzyme CYP3A4 metabolism. clarithromycin will increase the level or effect of artemether/lumefantrine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Monitor sensitive CYP3A4 substrates for effectiveness if coadministered. Minor/Significance Unknown. Please confirm that you would like to log out of Medscape. Contraindicated. Use Caution/Monitor. Monitor Closely (1)ketorolac increases and norepinephrine decreases serum potassium. Use Caution/Monitor. Serious - Use Alternative (1)protriptyline and clarithromycin both increase QTc interval. Contraindicated.Serious - Use Alternative (1)clarithromycin increases levels of ergoloid mesylates by decreasing metabolism. fluoxetine, ibuprofen IV. Make sure lab personnel and all your doctors know you use this drug. May lower seizure threshold; keep bupropion dose as low as possible. Serious - Use Alternative (1)mebendazole increases toxicity of metronidazole by Other (see comment). Monitor Closely (1)elvitegravir/cobicistat/emtricitabine/tenofovir DF, ketorolac. Increased risk of bleeding during concomitant use of medications that increase potential for bleeding. clarithromycin and toremifene both increase QTc interval. Applies only to oral form of both agents. Contraindicated.Minor (1)ketorolac will increase the level or effect of nabumetone by acidic (anionic) drug competition for renal tubular clearance. Serious - Use Alternative (1)ketorolac, tacrolimus. This document does not contain all possible drug interactions. clarithromycin will decrease the level or effect of estropipate by altering intestinal flora. posaconazole will increase the level or effect of clarithromycin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. As an alternant antiiplatelet agent, prasugrel can be used with nirmatrelvir/ritonavir unless the patient has a clinical condition which contraindicates its use in which case an alternative antiplatelet agent should be considered. Use Caution/Monitor. Minor/Significance Unknown. Avoid or Use Alternate Drug.fluoxetine and nortriptyline both increase serotonin levels. lopinavir increases levels of ticagrelor by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Use Caution/Monitor. idecabtagene vicleucel. Use Caution/Monitor. May inhibit the conversion of losartan to its active metabolite E-3174. ketorolac increases and ethacrynic acid decreases serum potassium. sodium sulfate/?magnesium sulfate/potassium chloride increases effects of fluoxetine by unknown mechanism. fluoxetine and levalbuterol both increase QTc interval. Serious - Use Alternative (1)clarithromycin will increase the level or effect of larotrectinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. metronidazole will increase the level or effect of finerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. metronidazole increases levels of naldemedine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Coadministration may potentiate the CNS-depressant effects of each drug. ticagrelor, reteplase. If you stop taking this medication early, you may have a higher risk of getting a heart attack or stroke. fluphenazine and clarithromycin both increase QTc interval. Mechanism: Displacement of GABA from receptors in brain. Monitor patients already on buprenorphine subdermal implant who require newly-initiated treatment with CYP3A4 inhibitors for signs and symptoms of overmedication. Contraindicated. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Minor (1)ketorolac, alendronate. clarithromycin increases levels of panobinostat by affecting hepatic/intestinal enzyme CYP3A4 metabolism. ketorolac and alteplase both increase anticoagulation. Contraindicated. Coadministration may result in a significant decrease in renal function. clarithromycin will increase the level or effect of atogepant by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Use Caution/Monitor. Use Caution/Monitor.Serious - Use Alternative (1)tolfenamic acid, ketorolac. Avoid or Use Alternate Drug. clarithromycin will decrease the level or effect of thiamine by altering intestinal flora. Use Caution/Monitor. Monitor Closely (2)fenoprofen and ketorolac both increase anticoagulation. Enhanced risk of peripheral neuropathy. Treatment for: Mantle Cell Lymphoma, Chronic Lymphocytic Leukemia, Waldenstrm Macroglobulinemia, Graft-versus-host disease, Lymphoma. Use Caution/Monitor. pegaspargase increases effects of ketorolac by pharmacodynamic synergism. Modify Therapy/Monitor Closely.Serious - Use Alternative (1)clarithromycin will increase the level or effect of venlafaxine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. arformoterol and fluoxetine both increase QTc interval. clarithromycin decreases effects of typhoid vaccine live by pharmacodynamic antagonism. Use Caution/Monitor. If unable to avoid coadministration with strong CYP3A4 inhibitors, monitor closely for adverse reactions and consider decreasing dose accordingly. Monitor Closely (1)clarithromycin will increase the level or effect of oxybutynin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Monitor Closely (1)metronidazole will increase the level or effect of tipranavir by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. fluoxetine will increase the level or effect of lofexidine by affecting hepatic enzyme CYP2D6 metabolism. Minor/Significance Unknown. Avoid or Use Alternate Drug. clarithromycin increases levels of indacaterol, inhaled by Other (see comment). After discontinuation of the strong or moderate CYP3A4 inhibitor for 3 elimination half-lives, resume selumetinib dose that was taken before initiating the inhibitor. Monitor Closely (1)mipomersen, ketorolac. Comment: May result in renal function deterioration, particularly in elderly or volume depleted individuals. Monitor Closely (2)fluoxetine will increase the level or effect of tolbutamide by affecting hepatic enzyme CYP2C9/10 metabolism. Avoid or Use Alternate Drug. levoketoconazole will increase the level or effect of clarithromycin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. drospirenone and ketorolac both increase serum potassium. Applies only to oral form of both agents. Potential for increased toxicity. Use Caution/Monitor. metronidazole will increase the level or effect of itraconazole by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid or Use Alternate Drug. Use Caution/Monitor.fluoxetine, ibuprofen. Monitor Closely (1)encorafenib, clarithromycin. Avoid or Use Alternate Drug. . Either increases toxicity of the other by pharmacodynamic synergism. Minor/Significance Unknown. Risk of weakness, dyspnea, chest pain. Either increases toxicity of the other by pharmacodynamic synergism. Avoid or Use Alternate Drug. Avoid or Use Alternate Drug.trazodone and clarithromycin both increase QTc interval. Adjust dose of drugs that are CYP3A4 substrates as necessary. Use Caution/Monitor. Either increases toxicity of the other by decreasing renal clearance. If unable to avoid fedratinib coadministration with strong CYP3A4 inhibitors, decrease fedratinib dose to 200 mg/day. Minor/Significance Unknown. Monitor CYP3A4 substrates coadministered with stiripentol for increased or decreased effects. An increased risk of bleeding may occur in patients taking a vitamin-K antagonist or an antiplatelet agent with selumetinib. Either increases toxicity of the other by pharmacodynamic synergism. Increased risk of upper GI bleeding SSRIs inhib. rucaparib will increase the level or effect of clarithromycin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor (1)ketorolac decreases effects of imidapril by pharmacodynamic antagonism. Increased risk of GI ulceration. Use Caution/Monitor. Comment: Risk of acute renal failure. Other Indications & Uses. This website also contains material copyrighted by 3rd parties. Serious - Use Alternative (2)clarithromycin will increase the level or effect of irinotecan by P-glycoprotein (MDR1) efflux transporter. Monitor Closely (1)ketorolac increases and dobutamine decreases serum potassium. Use Caution/Monitor. Minor/Significance Unknown. Use Caution/Monitor. Avoid or Use Alternate Drug. Minor (1)metronidazole will increase the level or effect of armodafinil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid coadministration of fexinidazole with drugs known to block potassium channels or prolong QT interval. Modify Therapy/Monitor Closely. Either increases effects of the other by immunosuppressive effects; risk of infection. Effect of interaction is not clear, use caution. Avoid or Use Alternate Drug. clarithromycin increases levels of ticagrelor by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Monitor Closely (2)diflunisal and ketorolac both increase anticoagulation. Avoid or Use Alternate Drug. Avoid or Use Alternate Drug. Modify Therapy/Monitor Closely.Serious - Use Alternative (1)clarithromycin increases levels of dabrafenib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Carefully titrate remimazolam dose if administered with opioid analgesics and/or sedative/hypnotics. Avoid or Use Alternate Drug. Use Caution/Monitor. It comes as a capsule. Minor (1)metronidazole will increase the level or effect of imipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Monitor Closely (1)clarithromycin will increase the level or effect of gentamicin by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug. Avoid or Use Alternate Drug. clopidogrel, ketorolac. ibuprofen. Coadministration of strong CYP3A4 inhibitors with midazolam intranasal causes higher midazolam systemic exposure, which may prolong sedation. If possible, avoid concurrent use. ibrutinib will increase the level or effect of prasugrel by anticoagulation. Contraindicated.Minor (1)ketorolac will increase the level or effect of mefenamic acid by acidic (anionic) drug competition for renal tubular clearance. affecting hepatic/intestinal enzyme CYP3A4 metabolism. Dronabinol is a CYP3A4 substrate. Minor (1)metronidazole will increase the level or effect of estradiol vaginal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Minor (1)furosemide, fluoxetine. Use Caution/Monitor.clarithromycin will increase the level or effect of docetaxel by P-glycoprotein (MDR1) efflux transporter. . If CYP3A4 inhibitor discontinued, increase fedratinib dose to 300 mg/day for 2 weeks, and then 400 mg/day thereafter as tolerated. Monitor Closely (1)clarithromycin decreases effects of piperacillin by pharmacodynamic antagonism. Closely monitor for arrhythmias and events (eg, syncope, heart palpitations) since lonafarnib effect on QT interval is unknown. Contraindicated (1)phenelzine and fluoxetine both increase serotonin levels. ketorolac decreases effects of irbesartan by pharmacodynamic antagonism. Avoid or Use Alternate Drug. melatonin increases effects of ketorolac by anticoagulation. Minor/Significance Unknown. Monitor Closely (1)ketorolac increases and chlorothiazide decreases serum potassium. clarithromycin will increase the level or effect of pemigatinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.Monitor Closely (1)clarithromycin will increase the level or effect of saquinavir by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug. serotonin uptake by platelets. ketorolac and Siberian ginseng both increase anticoagulation. clarithromycin and pimavanserin both increase QTc interval. Applies only to oral forms of hormone. Avoid or Use Alternate Drug. clarithromycin will increase the level or effect of donepezil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. efavirenz and fluoxetine both increase QTc interval. Chronic Graft Versus Host Disease (cGVHD) in adult and pediatric patients age 1 year and older after failure of one or more lines of systemic therapy. Use Caution/Monitor. Contraindicated. Avoid simvastatin doses greater than 40 mg. ticagrelor will increase the level or effect of sonidegib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. If clarithromycin is necessary, no dose adjustment required with normal renal function; however, reduce clarithromycin dose by 50% with CrCl 30-60 mL/min and by 75% with CrCl <30 mL/min. Either increases toxicity of the other by pharmacodynamic synergism. Monitor Closely (1)fluoxetine will increase the level or effect of galantamine by affecting hepatic enzyme CYP2D6 metabolism. elvitegravir/cobicistat/emtricitabine/tenofovir DF decreases levels of fluoxetine by affecting hepatic enzyme CYP2C9/10 metabolism. Monitor for adverse reactions if coadministered with P-gp substrates where minimal concentration changes may lead to serious or life-threatening toxicities. Coadministration with moderate CYP3A4 inhibitors, reduce ibrutinib dose to 280 mg qDay (B-cell malignancies) or Contraindicated. Minor (1)ethacrynic acid, fluoxetine. ketorolac and salsalate both increase serum potassium. for some patients with acute lymphoblastic leukemia to a full approval and expanded the approved indications for its use. Either increases effects of the other by anticoagulation. clarithromycin, cholera vaccine. Modify Therapy/Monitor Closely.Serious - Use Alternative (1)fluoxetine and amoxapine both increase serotonin levels. Contraindicated. Minor/Significance Unknown. Avoid or Use Alternate Drug. cimetidine will increase the level or effect of clarithromycin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. clarithromycin increases levels of lurasidone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. serotonin uptake by platelets. Coadministration of lurasidone and strong CYP3A4 inhibitors is contraindicated. clarithromycin will increase the level or effect of osimertinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. clarithromycin increases levels of tisotumab vedotin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely.Serious - Use Alternative (2)fluoxetine and clomipramine both increase serotonin levels. Effect of interaction is not clear, use caution. Avoid or Use Alternate Drug. Avoid or Use Alternate Drug. Use Caution/Monitor. Minor (1)ketorolac increases levels of paromomycin by decreasing renal clearance. Comment: Increased risk of CNS stimulation and seizures with high doses of fluoroquinolones. Coadministration of mild CYP3A4 inhibitors with midazolam intranasal may cause higher midazolam systemic exposure, which may prolong sedation. ketorolac and piroxicam both increase serum potassium. Use Caution/Monitor. Minor (1)pleurisy root decreases effects of fluoxetine by unspecified interaction mechanism. Avoid or Use Alternate Drug. fluoxetine increases effects of glimepiride by unspecified interaction mechanism. Use Caution/Monitor. metronidazole will increase the level or effect of felodipine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Closely monitor for increased adverse reactions and modify dose of darolutamide as needed when coadministered with drugs that are both P-gp and strong or moderate CYP3A4 inhibitors. If coadministration with strong or moderate CYP3A4 inhibitors is unavoidable, reduce pexidartinib dose (refer to drug monograph dosage modifications). Avoid or Use Alternate Drug. Monitor Closely (1)metronidazole will increase the level or effect of amiodarone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. tenofovir DF, ketorolac. Get medical help right away if you have any symptoms of liver damage, including: nausea/vomiting that doesn't stop, dark urine, stomach/abdominal pain, yellowing eyes/skin.A very serious allergic reaction to this drug is rare. Minor/Significance Unknown. Avoid or Use Alternate Drug. ketoprofen will increase the level or effect of ketorolac by acidic (anionic) drug competition for renal tubular clearance. dofetilide increases toxicity of clarithromycin by QTc interval. Coadministration of doravirine and CYP3A4 inhibitors may increase plasma concentrations and toxicities of doravirine. Use Caution/Monitor.Serious - Use Alternative (1)meclofenamate, ketorolac. Avoid or Use Alternate Drug.duloxetine and fluoxetine both increase serotonin levels. Use Caution/Monitor. Contraindicated. Methylene blue may increase serotonin as a result of MAO-A inhibition. clarithromycin will increase the level or effect of atorvastatin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. metronidazole will increase the level or effect of erythromycin ethylsuccinate by affecting hepatic/intestinal enzyme CYP3A4 metabolism.
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