Atazanavir almost doubled the AUC of
clarithromycin, and reduced the AUC of its active
metabolite by 70%, while
clarithromycin increased the AUC of
atazanavir by 28%.
Reducing the dose of
clarithromycin to avoid high levels may result in subtherapeutic levels of the active
metabolite. The US manufacturer says that, other than for
Mycobacterium avium complex infections, an alternative to
clarithromycin should be considered. If the combination is used they suggest a 50% dose reduction for the
clarithromycin. The UK manufacturer recommends caution.