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Simultaneous administration of clarithromycin with lovastatin or simvastatin is contraindicated due to the fact that these statins largely metabolized isoenzyme CYP3A4, and combined use with clarithromycin increases their serum concentrations, which leads to an increased risk of myopathy, including rhabdomyolysis. Cases of rhabdomyolysis have been reported in patients treated with clarithromycin in conjunction with these agents. If necessary, the use of clarithromycin should stop taking lovastatin or simvastatin therapy on time.
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Clarithromycin should be used with caution in combination therapy with other statins. It is recommended to use a statin not dependent on metabolism isoenzymes CYP3A (eg, fluvastatin). In the case of co-administration need are advised to take the lowest dose of the statin. It is necessary to monitor the development of signs and symptoms of myopathy. While the use of atorvastatin is moderately increased atorvastatin plasma concentration, increased risk of myopathy.
Drugs that are inducers of CYP3A (eg, rifampicin, phenytoin, carbamazepine, phenobarbital, St. John's wort) are able to induce metabolism of clarithromycin, which can lead to subtherapeutic concentrations of clarithromycin and reduce its effectiveness. It is necessary to control the plasma concentration of the inductor SYR3A which may rise due to the inhibition of CYP3A clarithromycin.
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When combined with rifabutin rifabutin increased plasma concentration, increases the risk of uveitis, decreases the concentration of clarithromycin in plasma.
When combined with clarithromycin may increase the plasma concentrations of phenytoin, carbamazepine, valproic acid.
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