Does clarithromycin interact with sertraline? (3+ potential dangers)

In this article, we have discussed whether clarithromycin, an antibiotic, interacts with sertraline, an antidepressant. We will also discuss some case studies and discuss the potential side effects of taking the two together.

Does clarithromycin interact with sertraline?

Yes, clarithromycin can interact with sertraline. These two medications do have the potential for pharmacokinetic interactions. This is because clarithromycin, a macrolide antibiotic, can inhibit cytochrome P450 enzymes, which are responsible for the metabolism and deactivation of sertraline, halting its effects (1). 

When the antidepressant stays in your body for longer than intended, this increases the chances of side effects and can lead to complications in certain individuals. 

Furthermore, clarithromycin may also cause more pronounced side effects when taken concomitantly with sertraline. So, it’s best to talk to your doctor before taking sertraline and clarithromycin together. 

It is also important to inform your doctor about all the medications you’re taking, as a doctor may prescribe clarithromycin without knowing that you are currently being treated with sertraline. Giving your complete medication history to your provider is essential to ensure your safety.

What does research suggest?

Some research studies have discussed the potential interactions between clarithromycin and sertraline. 

One case study involved a 90-year-old geriatric patient who presented with hallucinations and psychological side effects after taking clarithromycin with several other prescription medications, one of which was sertraline (2). 

Her medical team discontinued clarithromycin within 24 hours, after which the side effects began to fade away, and hallucinations stopped (2). 

The medical team responsible for that patient deduced that hallucinations and psychological side effects experienced by the patient were linked to a potential interaction between clarithromycin and sertraline or quinine – another medication that she was taking (2). 

Several other research studies also talk about the pharmacokinetic interactions between clarithromycin and sertraline. 

One research study indicated that clarithromycin is a potent inhibitor of cytochrome P450 3A4 enzymes, which are responsible for the metabolism of SSRIs, including sertraline (1,3). 

This inhibition of the CYP450 system by clarithromycin accounts for most of the pharmacokinetic interactions associated with this antibiotic (1). 

These studies show how sertraline can interact with clarithromycin and cause side effects. It can also lead to serotonin syndrome, which is a rare but life-threatening complication.

What are the effects of clarithromycin-sertraline interaction?

The interaction between clarithromycin and sertraline can have several potential effects, including:

Serotonin syndrome

Clarithromycin inhibits the enzyme responsible for metabolising SSRIs like sertraline, leading to an increased concentration of sertraline in the body. This can elevate the risk of serotonin syndrome, which is a life-threatening condition associated with symptoms like: (4)

  • Agitation or restlessness
  • Confusion
  • Rapid heart rate
  • Dilated pupils
  • Loss of muscle coordination or twitching muscles
  • Excessive sweating
  • Shivering or goosebumps
  • High blood pressure
  • Dilated pupils
  • Diarrhoea
  • Headache
  • High fever
  • Shivering or tremors
  • In severe cases, it can lead to seizures or unconsciousness

QTc prolongation

Both clarithromycin and sertraline have the potential to prolong the QTc interval. When taken together, this risk is significantly increased and it may also increase the chances of cardiac arrhythmias. (1)

Gastrointestinal side effects

Both medications can individually cause gastrointestinal (GI) side effects. When taken together, the risk of experiencing more severe GI side effects increases, such as nausea, vomiting, or diarrhoea. There’s also an increased risk of GI bleeding when these medications are used together.


The combination of clarithromycin and sertraline, especially in the case of polypharmacy where several other medications are also added to the regimen, can lead to hallucinations. (2)

What to do if you have taken clarithromycin with sertraline?

If you have taken clarithromycin and sertraline together and you feel unwell, please seek immediate medical attention. As stated earlier, this combination can cause life-threatening side effects in some individuals, such as serotonin syndrome and cardiac abnormalities. 

These symptoms should be properly managed to avoid further complications, and the combination should be discontinued.

What antibiotics are safe to take with sertraline?

Antibiotics like amoxicillin, doxycycline, etc., can be used as alternatives to clarithromycin for certain bacterial infections while taking sertraline. It’s best to discuss this with your healthcare provider and talk about the safest antibiotic to help your infection without affecting your antidepressant. 

Both bacterial infections and depression require proper treatment. When left untreated, these conditions can cause complications and affect the quality of your life. 

As a pharmacist, I know many patients who take antibiotics safely with antidepressants to manage both their infection and depression. Antibiotics are taken for a shorter duration – ranging from 3-14 days typically. Antidepressants, on the other hand, are taken for much longer than that. 

So, these meds can be paired for a week or two when prescribed by a qualified healthcare provider. However, the choice of antibiotic, the need to space the two meds out, and dosage strengths should be carefully determined. 

The choice of antibiotic depends on the kind of infection one is experiencing. So, it’s best to consult with your provider and stick to the prescribed medications.


  1. Westphal JF. Macrolide-induced clinically relevant drug interactions with cytochrome P-450A (CYP) 3A4: an update focused on clarithromycin, azithromycin and dirithromycin. Br J Clin Pharmacol. 2000 Oct;50(4):285-95. doi: 10.1046/j.1365-2125.2000.00261.x. PMID: 11012550; PMCID: PMC2015000. 
  1. Clarithromycin/quinine/sertraline interaction: Visual hallucinations: case report. Reactions Weekly. 2022;1900(1):105. doi: 10.1007/s40278-022-12457-7. Epub 2022 Apr 2. PMCID: PMC8972755. 
  1. Singh HK, Saadabadi A. Sertraline. 2023 Feb 13. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan–. PMID: 31613469. Available from: 
  1. Simon LV, Keenaghan M. Serotonin Syndrome. 2023 Jul 17. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan–. PMID: 29493999. Available from:

Was this helpful?

Thanks for your feedback!