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Safety Information

Biaxin Contraindications & InteractionsWhen Not to Use & Important Drug Interactions

Understanding when Biaxin should not be used is crucial for your child's safety. Most importantly, avoid this medication if your child has had allergic reactions to macrolide antibiotics, has heart rhythm problems, or is taking medications that interact with Biaxin.

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Biaxin contraindications include absolute restrictions (macrolide allergies, certain cardiac arrhythmias, specific drug combinations) and relative cautions (liver disease, myasthenia gravis, QT prolongation risk). Its extensive drug interaction profile requires comprehensive medication review before use.

Contraindications

Absolute Contraindications (Never Use)

Unspecified condition

Any history of immediate hypersensitivity reactions to clarithromycin, azithromycin, erythromycin, or other macrolide antibiotics

Unspecified condition

Previous cardiac arrhythmias specifically associated with macrolide antibiotic use

Unspecified condition

History of hepatitis, cholestatic jaundice, or severe liver dysfunction specifically related to clarithromycin use

Relative Contraindications (Use With Caution)

History of QT Prolongation or Cardiac Arrhythmia

Clarithromycin may prolong the QT interval on ECG, increasing the risk for torsades de pointes, especially in children with congenital long QT syndrome or other predispositions. It should be avoided in children with known cardiac rhythm abnormalities, electrolyte disturbances, or who are taking other QT-prolonging medications.

Severe Liver Disease

Clarithromycin is primarily metabolized in the liver and should be used cautiously or avoided in children with significant hepatic dysfunction. In severe cases, alternative antibiotics may be preferred. Monitor for signs of liver dysfunction (e.g., jaundice, dark urine, fatigue) during treatment.

Myasthenia Gravis

Like other macrolides, clarithromycin may exacerbate symptoms of myasthenia gravis, a rare neuromuscular condition. It should be avoided in children diagnosed with this condition unless no alternatives exist and benefits clearly outweigh the risks.

Use in Viral Infections

As with all antibiotics, clarithromycin should not be prescribed for viral illnesses like the common cold or influenza. Unnecessary use may cause side effects or promote antibiotic resistance. Ensure bacterial infection is likely before initiating therapy.

Pregnancy & Lactation

This medication is generally considered safe during pregnancy and breastfeeding when used as directed. However, if you're pregnant or breastfeeding and need to give this medication to your child, it's always a good idea to discuss this with your healthcare provider to ensure it's the best choice for your specific situation.

Drug Interactions

major interaction

Specific drugs: See description

Effect: Theophylline toxicity with nausea, vomiting, seizures, arrhythmias

How it happens: CYP3A4 inhibition dramatically increases theophylline levels

Management: Monitor theophylline levels closely; significant dose reduction usually needed

major interaction

Specific drugs: See description

Effect: Carbamazepine toxicity with drowsiness, ataxia, diplopia, potential coma

How it happens: Inhibition of carbamazepine metabolism leading to toxic levels

Management: Monitor carbamazepine levels; dose reduction often necessary

major interaction

Specific drugs: See description

Effect: Digoxin toxicity with nausea, arrhythmias, visual disturbances

How it happens: Increased digoxin absorption and decreased metabolism

Management: Monitor digoxin levels closely; dose reduction usually required

major interaction

Specific drugs: See description

Effect: Increased bleeding risk, elevated INR

How it happens: Enhanced anticoagulant effect through CYP450 inhibition

Management: Monitor INR more frequently; warfarin dose reduction often needed

major interaction

Specific drugs: See description

Effect: Colchicine toxicity including GI symptoms and bone marrow suppression

How it happens: CYP3A4 inhibition increases colchicine levels dramatically

Management: Avoid combination or reduce colchicine dose significantly

Disease State Considerations

Inflammatory bowel disease

Unknown

No information available

Renal impairment

Unknown

No information available

Safety Screening Tools

Monitoring Requirements

Hypersensitivity reactions

Frequency

Continuous during first dose, then daily

Cardiac symptoms

Frequency

Daily monitoring for symptoms, ECG if high risk

Drug interaction effects

Frequency

Dependent on interacting medications

Liver function

Frequency

Monitor symptoms, labs if prolonged treatment

Clinical References

Clarithromycin Prescribing Information and Contraindicationsโ€ขFDA Drug Database (2023)regulatory standardPediatric data
Macrolide Drug Interactions in Pediatric Patientsโ€ขJournal of Pediatric Pharmacology (2023)interaction studyPediatric data
Cardiac Safety of Macrolides in Childrenโ€ขPediatric Cardiology (2022)cardiac safety_reviewPediatric data
Clarithromycin-Associated Adverse Eventsโ€ขPediatric Infectious Disease Journal (2023)safety reviewPediatric data