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Clarithromycin

Biaxin

RA
UR

Written by R. Author | Reviewed by Uche Ruth

Updated on June 10, 2024

Overview

Clarithromycin (previously known by it's brand name Biaxin) is an antibiotic that's used to treat a variety of bacterial infections in adults and children. It's available as a generic immediate-release tablet and solution taken twice per day and an extended-release tablet taken once per day. Side effects include a metallic or sour taste, nausea, vomiting, and diarrhea.

What is Clarithromycin used for?

How Clarithromycin works

Clarithromycin is a macrolide antibiotic. It works by stopping bacteria from making certain proteins inside their cells. This causes the bacteria to not be able to grow and survive.

Pharmacist tips for Clarithromycin

  • You can take clarithromycin immediate-release tablet or clarithromycin oral suspension with or without food. If it's upsetting your stomach, taking it with food could help.
  • Take clarithromycin extended-release tablet with food. Make sure to swallow it whole. Don't crush, chew, or break the tablet.
  • Take clarithromycin exactly as prescribed. Make sure to finish the entire treatment course, even if you're feeling better. Stopping the medication earlier than prescribed can make your infection come back and become harder to treat.
  • If you develop watery or bloody diarrhea, fever, fatigue, or stomach cramps anytime during treatment or after stopping clarithromycin, seek medical help right away because these could be signs of C. difficile-related diarrhea, which needs to be treated right away.
  • Clarithromycin can leave a metallic or sour taste in your mouth, but this should get better and eventually go away when you stop taking the medication.
  • If you experience diarrhea from taking clarithromycin, let your provider know. If they think the diarrhea isn't too serious, they might recommend that you take a probiotic to help lessen this side effect. If so, make sure to separate the probiotic from clarithromycin by at least 2 hours to prevent clarithromycin from killing the "good" bacteria in the probiotic.
  • Clarithromycin interacts with a lot of commonly-used medications. Make sure to tell your provider about all of the medications you're taking before and during treatment with clarithromycin.

More tips for the oral suspension (liquid)

  • The clarithromycin suspension is available as 125 mg/5 mL and 250 mg/5 mL strengths. Make sure you know which strength of the suspension you have to ensure you're taking the correct dose.
  • Shake the bottle well before measuring out the clarithromycin suspension. Make sure to only use a medication dose cup or syringe from the pharmacy to measure out your dose. Don't use household spoons because they aren't accurate and might cause you to take the wrong dose.
  • Store the clarithromycin suspension at room temperature, don't put it in the refrigerator.
  • The clarithromycin suspension can be stored for up to 14 days after you receive it from the pharmacy. After 14 days, throw away the bottle, even if it still has medication in it.

What are the risks and warnings for Clarithromycin?

Clarithromycin can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.

Severe allergic and skin reactions

Severe allergic reactions to clarithromycin are possible, including life-threatening reactions like facial swelling and anaphylaxis (e.g., closing of the throat). Let your provider know if you have an allergy to antibiotics. If you notice hives, rash, red skin, swelling of the lips or tongue, or difficulty breathing after taking clarithromycin, get medical attention right away.

Additionally, although rare, clarithromycin can cause serious skin reactions, such as Stevens-Johnson syndrome (SJS) and Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS). If you notice changes in your skin, such as rash, blisters, skin reddening, or skin peeling, stop using clarithromycin and get medical attention right away.

Liver damage

Though rare, some people who took clarithromycin reported serious liver problems, including liver failure. Get medical attention right away if you notice swelling of your stomach, stomach pain, yellowing of your skin or the whites of your eyes, stool changes (clay-colored stools), nausea, vomiting, confusion, or dark or brown urine. You might need to stop using the medication to prevent further liver damage.

Drug interactions

Taking clarithromycin with certain medications can give you serious side effects. Make sure to tell your provider about all of the medications you're taking, especially if you take colchicine (Colcrys, Mitigare), Juxtapid (lomitapide), a statin, certain diabetes medications (e.g., insulin, sulfonylureas, meglitinides), quetiapine (Seroquel), oral blood thinners, or benzodiazepines (e.g., alprazolam (Xanax). Don't start any new medications while taking clarithromycin without asking your provider or pharmacist first to make sure the combination is safe to take.

Heart rhythm problems (QT prolongation)

  • Risk factors: Older adults | Low blood potassium or magnesium levels | Kidney problems | Heart rate or heart rhythms problems | Taking other medications that can cause QT prolongation

Clarithromycin can affect your heart rhythm, which can be serious and life-threatening. One example includes lengthening the time period from when the heart pumps and then relaxes. This is known as QT prolongation. Your risk for QT prolongation is higher if you have certain factors, including abnormal electrolyte levels, heart rhythm problems, or are taking other medications that cause heart rhythm problems, such as amiodarone (Pacerone), among others. If you feel your chest pounding, have trouble breathing, have chest pain, or feel faint or lightheaded while taking clarithromycin, call 911 right away.

Possible higher risk of death from heart problems

  • Risk factors: Blood vessel-related heart problems

Though very rare, some studies have reported that people with blood vessel-related heart disease who take clarithromycin are at a higher risk of death from heart problems compared to people who take other antibiotics. While the connection is unclear, your provider will weigh the risks and benefits of this medication for you, especially if you have heart problems. Speak to your provider if you have any concerns.

Infectious diarrhea

Although rare, clarithromycin can raise your risk of getting infected with a bacteria called Clostridioides difficile (C. diff), which can cause severe diarrhea. Antibiotics change the amount of normal bacteria in your stomach and intestines. This can cause C. diff to overgrow in your gut and lead to an infection. It's important to recognize the difference between diarrhea as a side effect of clarithromycin and this type of infectious diarrhea. C. diff-related diarrhea can cause rapid heart rate, foul-smelling diarrhea, fever, nausea, frequent bowel movements (even up to 15 times per day) and is an emergency. If you have any of these symptoms, get medical attention right away so you can get tested for C. diff infection and receive treatment.

Worsening of certain muscle problems (myasthenia gravis)

If you have myasthenia gravis, taking clarithromycin can worsen symptoms like muscle weakness and difficulty breathing. Ask your provider about safer antibiotics if you have myasthenia gravis.

Strengths

Bottle of oral suspension

  • 50ml of 125mg/5ml
  • 100ml of 125mg/5ml
  • 50ml of 250mg/5ml
  • 100ml of 250mg/5ml

Tablet

  • 50mg
  • 500mg

Dosages

Your provider will prescribe a dose based on the type of infection you have, how severe it is, if you have kidney problems, and if you're taking a medication that interacts with clarithromycin.

  • Clarithromycin immediate-release tablet and clarithromycin suspension:
    • Adults
      • Bronchitis: The typical dose is 250 mg to 500 mg by mouth every 12 hours for 7 to 14 days.
      • Sinus infection: The typical dose is 500 mg by mouth every 12 hours for 14 days.
      • Pneumonia: The typical dose is 250 mg by mouth every 12 hours for 7 to 14 days.
      • Strep throat and tonsil infection: The typical dose is 250 mg by mouth every 12 hours for 10 days.
      • Skin infection: The typical dose is 250 mg by mouth every 12 hours for 7 to 14 days.
      • Treatment and prevention of infections in people with HIV: The typical dose is 500 mg by mouth every 12 hours.
      • H. pylori infection (in combination with other medications): The typical dose is 500 mg by mouth every 8 to 12 hours for 10 to 14 days.
    • Children: Your child's provider will determine the dose based on their body weight. The typical dose is 7.5 mg/kg (up to the adult dose) by mouth every 12 hours for 10 days.
  • Clarithromycin extended-release tablet:
    • Bronchitis and pneumonia (adults only): The typical dose is 1 gram by mouth once daily for 7 days.
    • Sinus infections (adults only): The typical dose is 1 gram by mouth once daily for 14 days.

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Interactions

Clarithromycin may interact with certain medications or supplements. Always let your doctor and pharmacist know about any other medications or supplements (including prescribed and over-the-counter medications, vitamins, and dietary or herbal supplements) that you are currently taking. The list below does not include all possible drug interactions with Clarithromycin. Please note that only the generic name of each medication is listed below.

Using this medicine with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.

Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

Side-effects

The following side effects may get better over time as your body gets used to the medication. Let your healthcare provider know immediately if you continue to experience these symptoms or if they worsen over time.

Common Side Effects

Other Side Effects

  • Indigestion
  • Allergic reaction
  • Fungal infection
  • Headache
  • Difficulty sleeping
  • Rash

Serious Side Effects

Contact your healthcare provider immediately if you experience any of the following.

  • Serious allergic or skin reactions: hives, rash, blisters, fever, swelling of the lips or tongue, difficulty breathing, skin reddening, or skin peeling
  • Worsening liver problems or liver failure: swelling of your stomach, yellowing of your skin or the whites of your eyes, confusion, dark or brown urine
  • Abnormal heart rhythm (QT prolongation): chest pounding, trouble breathing, chest pain, feeling faint or lightheaded
  • Infectious (C. difficile-related) diarrhea: rapid heart rate, foul-smelling diarrhea, fever, nausea, frequent bowel movements (even up to 15 times per day)


The following side effects have also been reported

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor immediately if any of the following side effects occur:

Less common

  • Chills
  • Cough
  • Fever
  • Hoarseness
  • Lower back or side pain
  • Painful or difficult urination

Rare

  • Fever with or without chills
  • Itching, skin rash
  • Nausea
  • Severe stomach cramps and pain
  • Stomach tenderness
  • Unusual bleeding or bruising
  • Vomiting
  • Watery and severe diarrhea, which may also be bloody
  • Yellow eyes or skin

Incidence not known

  • Anxiety
  • Black, tarry stools
  • Blistering, peeling, or loosening of the skin
  • Blurred vision
  • Chest pain or discomfort
  • Clay-colored stools
  • Confusion about identity, place, and time
  • Cool, pale skin
  • Dark urine
  • Depression
  • Difficulty with swallowing
  • Dizziness
  • Fainting
  • Fast, slow, pounding, or irregular heartbeat or pulse
  • Feeling of unreality
  • Feeling that others are watching you or controlling your behavior
  • Feeling that others can hear your thoughts
  • Feeling, seeing, or hearing things that are not there
  • Hives
  • Increased hunger
  • Joint or muscle pain
  • Light-colored stools
  • Loss of appetite
  • Nightmares
  • Puffiness or swelling of the eyelids or around the eyes, face, lips, or tongue
  • Recurrent fainting
  • Red skin lesions, often with a purple center
  • Red, irritated eyes
  • Redness, swelling, or soreness of the tongue
  • Seizures
  • Sense of detachment from self or body
  • Severe mood or mental changes
  • Shakiness
  • Skin eruptions
  • Slurred speech
  • Sore throat
  • Sores, ulcers, or white spots in the mouth or on the lips
  • Stomach pain
  • Swollen glands
  • Tightness in the chest
  • Unpleasant breath odor
  • Unusual behavior
  • Unusual tiredness or weakness
  • Vomiting of blood

Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

Less common

  • Belching
  • Bloated or full feeling
  • Change in sensation of taste
  • Excess air or gas in the stomach or bowels
  • Headache
  • Heartburn
  • Indigestion
  • Mild diarrhea
  • Passing gas

Incidence not known

  • Change in sense of smell
  • Continuing ringing or buzzing or other unexplained noise in the ears
  • Feeling of constant movement of self or surroundings
  • Hearing loss
  • Lightheadedness
  • Loss of taste
  • Mood or mental changes
  • Sensation of spinning
  • Shakiness in the legs, arms, hands, or feet
  • Sore mouth or tongue
  • Swelling or inflammation of the mouth
  • Tongue discoloration
  • Tooth discoloration
  • Trouble sleeping
  • Weight loss

Pros and cons of Clarithromycin

pros and cons of clarithromycin

Common Concerns

No. Clarithromycin is a macrolide antibiotic. It works differently from penicillin. Both antibiotics are used to treat similar infections, but they're not the same. This means depending on what infection you have, clarithromycin might be a good option if you're allergic to penicillin.
It's best to avoid drinking alcohol while taking antibiotics like clarithromycin. This is because alcohol can make it harder for your body to heal from an illness and can raise your risk of getting another infection.
There are several medications that interact with clarithromycin, so it's important your provider and pharmacist know about all of the medications you're taking. For example, you shouldn't take clarithromycin with lovastatin or simvastatin (Zocor) because doing so raises your risk for severe liver or muscle problems from these medications. And if you're taking other medications, like atorvastatin (Lipitor), digoxin (Lanoxin), and calcium channel blockers, your provider your provider might need to adjust your medication doses and check in with you about side effects regularly throughout treatment. Make sure to tell your provider about all of the medications you're taking before and during treatment with clarithromycin.
Both clarithromycin and azithromycin (Zithromax) are macrolide antibiotics that work well and can treat similar infections. But only clarithromycin can be used for Helicobacter pylori (H. pylori) infection and only azithromycin (Zithromax) can be used to treat certain types of sexually transmitted infections. Additionally, the length of treatment depends on the type of infection, but in general, it's 7 to 14 days with clarithromycin, whereas with azithromycin (Zithromax), it can range from a single dose to up to 5 days.
If you have healthy kidneys, clarithromycin can stay in your body for about 1.5 days after your last dose. But if you have kidney problems, it can take much longer for your body to clear this medication. So if you're having side effects from clarithromycin, it's possible they could potentially last up until the medication has been cleared from your body. Keep in mind that these time frames are estimated based on the half-life of clarithromycin, which can differ slightly from person to person.
Clarithromycin isn't generally recommended in pregnant females due to the potential risk for problems (e.g., heart problems, cleft palate) seen in animal studies. The risk of harm to human babies isn't completely clear. A 2021 human study found that babies born to pregnant females taking clarithromycin weren't harmed. If you're pregnant, your provider might only prescribe clarithromycin for you if there aren't any safer options and if the benefits of taking this medication is greater than its risk of harm. Let your provider know if you're pregnant before taking clarithromycin.
It's generally considered safe to breastfeed while taking clarithromycin because the levels of the medication are low in breastmilk and unlikely to cause side effects to your baby. But to be safe, tell your provider if you're breastfeeding before starting clarithromycin.

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