Can I take Clarithromycin and Sertraline together?

Using clarithromycin with sertraline can cause serious heart rhythm issues and in some cases, serotonin syndrome.

Speak to your doctor before taking these together. They may prefer to prescribe a different antibiotic that does not interact with your antidepressant.

Why this happens

Clarithromycin slows down the liver's ability to break down sertraline, leading to higher levels of the antidepressant in your blood.

Additionally, both medicines have the potential to affect the electrical activity of the heart (known as QT prolongation), and using them together increases this risk.

How to know if you're having a drug interaction

You may be experiencing a drug interaction between clarithromycin and sertraline if you notice symptoms such as:

• Agitation or confusion.

• Rapid heartbeat or high blood pressure.

• Heavy sweating, shivering, or fever.

• Muscle twitching, stiffness, or tremor.

• Nausea, vomiting, or diarrhoea.

• Headache or dizziness.

• Unusual drowsiness.

What you should do

Seek immediate medical help if you have any of the above symptoms.

Important precautions

Depression and anxiety disorders

You may experience an increase in suicidal thoughts or the urge to self-harm when first starting sertraline or changing the dose. This is more common in young adults under 25. Contact your doctor or go to hospital immediately if you notice any changes in your mood or behaviour.

Heart rhythm disorders (long QT syndrome)

Both medicines can affect your heart rhythm. Taking them together significantly increases the risk of a serious heart problem called QT prolongation.

Seek immediate medical help if you feel a racing heartbeat, palpitations, or dizziness.

Bleeding risk

Sertraline increases your risk of bleeding. Seek medical advice before taking anti-inflammatory painkillers such as ibuprofen or aspirin, as the combination can cause serious stomach bleeding.

Serotonin Syndrome

Do not take sertraline with other medicines that increase serotonin (such as St John’s Wort or certain painkillers like tramadol), as this can cause a life-threatening reaction involving high fever, agitation, and muscle rigidity.

Low sodium levels (hyponatremia)

Sertraline can cause a serious drop in blood sodium levels, especially in older patients or those taking diuretics. Seek medical help if you experience extreme confusion, weakness, or unsteady gait.

Food and drink warnings

Alcohol

You should avoid drinking alcohol while taking sertraline. Alcohol can increase the sedative effects of the medicine, making you feel more drowsy or dizzy, and may worsen your underlying condition.

It is best to avoid or strictly limit alcohol while taking clarithromycin. While there is no direct chemical interaction, both alcohol and clarithromycin can cause side effects like nausea, dizziness, and stomach upset. Combining them can make these symptoms worse and may put extra strain on your liver.

Grapefruit juice

Avoid drinking large amounts of grapefruit juice. Grapefruit contains compounds that can increase the levels of sertraline in your blood, which may increase the risk of side effects.

Caffeine (Coffee, Tea, Energy Drinks)

Sertraline can sometimes cause nervousness or tremors. Consuming high amounts of caffeine may worsen these side effects or increase feelings of anxiety. It is advisable to monitor your caffeine intake.

Using other medicines

Taking multiple medicines? Our Medicines Interaction Checker helps you check whether your prescriptions, over-the-counter medicines, and supplements are safe to take together. Simply search for your medicines to see potential interactions and what to do about them.

Disclaimer

This information is for general educational purposes only and should not be relied upon as a substitute for professional medical advice. Always consult your GP, pharmacist, or another qualified healthcare professional before making decisions about your medications. Individual circumstances may vary, and only a healthcare professional who knows your medical history can provide personalised guidance.