Clarithromycin (Biaxin) and Ketamine Therapy | Tovani Health
Biaxin (Clarithromycin) — Macrolide antibiotic (CYP3A4 inhibitor)
Verdict at Tovani Health
Compatible; CYP3A4 inhibition during the course can raise ketamine levels.
Clarithromycin and ketamine are compatible with timing awareness. Clarithromycin is a strong CYP3A4 inhibitor and the most potent macrolide for this interaction (azithromycin is much weaker, erythromycin sits between them). Courses are typically 7-14 days; we time sessions around the course.
If you take Biaxin regularly and are considering at-home ketamine therapy, the combination is safe with monitoring or dose adjustment. This page covers the brief pharmacologic context and what we do at intake.
How Biaxin interacts with ketamine
Clarithromycin strongly inhibits CYP3A4 throughout dosing and for several days after the last dose. Ketamine clearance via CYP3A4 slows, raising plasma exposure for a given dose.
What we do at intake
Disclose any active clarithromycin course. We typically wait until the course is complete and a few days of washout have passed before running a session.
Bottom line
Clarithromycin and ketamine are compatible with timing awareness. Clarithromycin is a strong CYP3A4 inhibitor and the most potent macrolide for this interaction (azithromycin is much weaker, erythromycin sits between them). Courses are typically 7-14 days; we time sessions around the course.
Ready to find out if at-home ketamine fits your situation?
We’ll note that you’re on Biaxin (Clarithromycin) at intake. The eligibility check takes 5 minutes and gives you an honest answer about whether at-home ketamine fits your specific situation.
FL and NJ residents only. Benjamin Soffer, DO — Tovani Health.
Sources
The verdict and clinical guidance on this page are based on the following peer-reviewed literature and FDA prescribing information.
- Ketamine: A Review of Clinical Pharmacokinetics and Pharmacodynamics in Anesthetic and Pain Therapy. Peltoniemi MA, Hagelberg NM, Olkkola KT, Saari TI. Clinical Pharmacokinetics. 2016. PMID: 27028535
Reviews CYP3A4 inhibitor effects on ketamine PK.
Clinically reviewed
Reviewed by Benjamin Soffer, DO on May 16, 2026. Dr. Soffer is a board-certified physician (American Board of Internal Medicine) licensed in Florida and New Jersey, prescribing at-home ketamine therapy through Tovani Health.
This page is general information about how this medication interacts with at-home ketamine therapy at Tovani Health. It is not a substitute for medical advice from your prescribing physician about your specific situation. Always discuss medication changes with the doctor who prescribed them.