Stavudine Clarithromycin

Drugs that may affect zidovudine include acetaminophen, atovaquone, bone marrow suppressive/cytotoxic agents (eg, adriamycin, dapsone), clarithromycin, doxorubicin, fluconazole, ganciclovir, methadone, nelfinavir/ritonavir, phenytoin, probenecid, ribavirin, rifamycins, stavudine, trimethoprim, and valproic acid. 

Clarithromycin causes some reduction in the bioavailability of zidovudine, but this is minimised if the two drugs are given at least 2 hours apart. Clarithromycin does not appear to interact with didanosine, stavudine or zalcitabine, and azithromycin does not interact with didanosine or zidovudine. 

A study in 10 HIV-positive subjects found that the addition of clarithromycin 500 mg twice daily to stavudine 30 or 40 mg twice daily had no significant effects on the pharmacokinetics of the stavudine and the incidence of adverse effects did not increase. No special precautions would seem necessary if both drugs are given. 

The authors of the report on didanosine conclude that clarithromycin may safely be given with didanosine, and it also seems likely that didanosine or zidovudine and azithromycin stavudine and clarithromycin and zalcitabine and clarithromycin can be used safely together. 

---