What the FDA labels say about taking them together
Clarithromycin and dihydroergotamine
Clarithromycin's FDA label of April 9, 2026 names dihydroergotamine in its contraindications section, and dihydroergotamine's label names clarithromycin too. The dihydroergotamine label: “The use of potent CYP 3A4 inhibitors with dihydroergotamine is, therefore contraindicated.”
Check it at the source: the clarithromycin FDA label on DailyMed (effective April 9, 2026, Solaris Pharma Corporation); the dihydroergotamine FDA label on DailyMed (effective March 6, 2025, Oceanside Pharmaceuticals).
What does the clarithromycin label say about dihydroergotamine?
Clarithromycin label, contraindicationsCONTRAINDICATIONS Hypersensitivity to clarithromycin or any macrolide drug (4.1) Cisapride and pimozide (4.2) History of cholestatic jaundice/hepatic dysfunction with use of clarithromycin (4.3) Colchicine in renal or hepatic impairment (4.4) Lomitapide, lovastatin, and simvastatin (4.5) Ergot alkaloids (ergotamine or dihydroergotamine) (4.6) Lurasidone
Clarithromycin label, drug interactionsErgot Alkaloids: Ergotamine Dihydroergotamine Contraindicated Ergotamine, Dihydroergotamine:
Clarithromycin label, warnings and precautionsThe use of clarithromycin with lomitapide, simvastatin, lovastatin, ergotamine, or dihydroergotamine is contraindicated [see Contraindications (4.5, 4.6) and Drug Interactions (7) ].
Source: FDA drug label (Clarithromycin), Solaris Pharma Corporation, effective April 9, 2026 (SPL set 4d42821d-ce7a-7d64-e063-6294a90a0875), via openFDA; the full label on DailyMed
What does the dihydroergotamine label say about clarithromycin?
Dihydroergotamine label, contraindicationsThe use of potent CYP 3A4 inhibitors (ritonavir, nelfinavir, indinavir, erythromycin, clarithromycin, troleandomycin, ketoconazole, itraconazole) with dihydroergotamine is, therefore contraindicated ( see WARNINGS, CYP 3A4 Inhibitors ).
Dihydroergotamine label, warningsThe use of potent CYP 3A4 inhibitors with dihydroergotamine should therefore be avoided ( see CONTRAINDICATIONS ). Examples of some of the more potent CYP 3A4 inhibitors include: antifungals ketoconazole and itraconazole, the protease inhibitors ritonavir, nelfinavir, and indinavir, and macrolide antibiotics erythromycin, clarithromycin, and troleandomycin.
Trudhesa label (Impel Pharmaceuticals LLC, September 3, 2026), contraindicationsCONTRAINDICATIONS TRUDHESA is contraindicated in patients: with concomitant use of strong CYP3A4 inhibitors, such as protease inhibitors (e.g., ritonavir, nelfinavir, or indinavir), macrolide antibiotics (e.g., erythromycin or clarithromycin), and antifungals (ketoconazole or itraconazole) [see Warnings and Precautions (5.1) and Drug Interactions (7.1) ] with ischemic heart disease (angina pectoris, history of myocardial infarction, or documented silent ischemia) or patients who have clinical symptoms or findings consistent with coronary artery vasospasm, including Prinzmetal's variant angina [see Warnings and Precautions (5.4) ] with uncontrolled hypertension [see Warnings and Precautions …
Trudhesa label (Impel Pharmaceuticals LLC, September 3, 2026), drug interactionsThere have been rare reports of serious adverse events in connection with the coadministration of intravenous administration of dihydroergotamine and strong CYP3A4 inhibitors, such as protease inhibitors (e.g., ritonavir, nelfinavir, indinavir), macrolide antibiotics (e.g., erythromycin, clarithromycin), and antifungals (e.g., ketoconazole, itraconazole), resulting in vasospasm that led to cerebral ischemia and/or ischemia of the extremities [see Warnings and Precautions (5.1) ].
Source: FDA drug label (Trudhesa, NDA213436), Impel Pharmaceuticals LLC, effective September 3, 2026 (SPL set b81397b0-910d-4eb4-8fee-a9a3c9d94d63), via openFDA
Source: FDA drug label (Dihydroergotamine Mesylate), NDA020148 (Bausch), as published by Oceanside Pharmaceuticals, effective March 6, 2025 (SPL set 977de209-c53a-4cb4-9f3f-1e850600a9dc), via openFDA; the full label on DailyMed
These are the labels' own sentences. PlainMeds does not grade interactions; a pharmacist or prescriber can say what they mean for one person's medicines.
Both medicines on the record
| Clarithromycin | Dihydroergotamine | |
|---|---|---|
| Labeled for | Bacterial infections, Acid reflux and ulcers | Migraine |
| Boxed warning | No | Yes |
| Pharmacy cost (NADAC) | $0.466 per tablet 500 mg tablet | $29.44 per mL 4 mg/mL nasal spray |
| Shortage now | No current entry | No current entry |
Source: FDA NDC Directory, CMS NADAC of October 7, 2026 and the FDA Drug Shortage Database (FDA files October 8, 2026)
What next?
- Check more medicines together
- up to five at once