Coadministration of nevirapine and clarithromycin (500 mg twice daily) decreased clarithromycin AUC, Cmax and Cmin by 31%, 23% and 56%, respectively. The active clarithromycin metabolite 14-OH clarithromycin increased by 42% (AUC) and 47% (Cmax), with no change in Cmin. Compared to historical controls, nevirapine AUC, Cmax and Cmin increased by 26%, 24% and 28%. Clarithromycin exposure was significantly decreased, 14-OH metabolite exposure increased. Because the clarithromycin active metabolite has reduced activity against Mycobacterium avium-intracellulare complex overall activity against the pathogen may be altered. Alternatives to clarithromycin, such as azithromycin should be considered. Close monitoring for hepatic abnormalities is recommended.
Viramune Summary of Product Characteristics, Boehringer Ingelheim Ltd, November 2019.

Coadministration of nevirapine (200 mg once daily for 2 weeks then 200 mg twice daily for 2 weeks) with clarithromycin (500 mg twice daily), in 15 HIV+ patients, resulted in a 31% ,23% and 57% decrease in clarithromycin AUC, Cmax and Cmin, respectively. 14-OH-clarithromycin AUC and Cmax were increased by 42% and 47%, respectively, and Cmin was unaltered. The effect on nevirapine pharmacokinetics was not significant when compared to historical controls. Because clarithromycin active metabolite has reduced activity against Mycobacterium avium-intracellulare complex, overall activity against this pathogen may be altered. Alternatives to clarithromycin, such as azithromycin, should be considered.
Viramune Prescribing Information, Boehringer Ingelheim Pharmaceuticals Inc, October 2019.

Coadministration of nevirapine (200 mg twice daily) and clarithromycin (500 mg twice daily) was studied in 18 HIV+ individuals. There was a 30% reduction in clarithromycin AUC, a 21% decrease in Cmax and a 46% decrease in Cmin. AUC of 14-OH clarithromycin increased by 58% and Cmax increased by ~60%. Results suggest that NVP increased the metabolic clearance of clarithromycin to its active metabolite resulting in lower steady-state concentrations of parent drug and higher concentrations of metabolite. Coadministration of clarithromycin resulted in a 26% increase in nevirapine AUC, a 24% increase in Cmax and a 28% increase in Cmin.
Effect of the reverse transcriptase inhibitor, nevirapine, on the steady-state pharmacokinetics of clarithromycin in HIV-positive patients. Robinson P, Gigliotti M, Lamson M et al. 6th Conference on Retroviruses and Opportunistic Infections, 1999, abstract 374.

LHPG Comment: Monitoring for hepatic abnormalities and activity against Mycobacterium aviium indicates amber.