MACROLIDES AND NNRTIS

Delavirdine may increase clarithromycin exposure (AUC doubled), whereas efavirenz and nevirapine may reduce clarithromycin levels (by about 30 to 40%) and increase the levels of the active metabolite of clarithromycin. A neuropsychiatric reaction was attributed to the use of clarithromycin in a man taking nevirapine.
The manufacturer of delavirdine recommends that when clarithromycin is used concurrently the dose of clarithromycin should be reduced only in patients with renal impairment. Further study and experience of the use of efavirenz or nevirapine with clarithromycin is needed. Until then, caution is warranted.