Clarithromycin Shortage: A Provider Briefing for 2026

Clarithromycin remains a workhorse macrolide antibiotic across primary care, pulmonology, gastroenterology, and infectious disease. As we move through 2026, providers should be aware of the current supply landscape and how it may affect prescribing decisions and patient access.

This briefing covers the current shortage status, prescribing implications, cost and access issues, and tools to help your patients find this medication when local pharmacies are out of stock.

Current Supply Status

As of early 2026, Clarithromycin tablets are not listed on the FDA Drug Shortage Database or the ASHP Current Drug Shortages list. National supply of 250 mg and 500 mg immediate-release tablets, as well as 500 mg extended-release tablets, is generally adequate.

However, the oral suspension formulation (125 mg/5 mL and 250 mg/5 mL) has experienced intermittent availability issues since 2019-2020. Fewer manufacturers produce the suspension compared to solid oral dosage forms, making it more susceptible to supply chain disruptions. Pediatric prescribers should be especially aware of this ongoing variability.

Timeline of Supply Issues

• 2019-2020: Manufacturing disruptions led to intermittent shortages of the oral suspension. Tablet supply remained stable.
• 2020-2021: Broader generic antibiotic supply chain stress during the pandemic affected distribution, though Clarithromycin was not among the most severely impacted drugs.
• 2022-2024: Supply largely stabilized for all formulations. Sporadic regional stockouts reported during peak respiratory seasons.
• 2025-2026: No active FDA or ASHP shortage listing for any Clarithromycin formulation. Local pharmacy-level stockouts continue to occur seasonally, primarily driven by demand surges and just-in-time inventory practices.

Prescribing Implications

Brand Discontinuation

Biaxin and Biaxin XL (AbbVie) have been discontinued in the US market. All currently available Clarithromycin is generic, manufactured by companies including Teva, Sandoz, Sun Pharma, and Aurobindo. This is clinically transparent — bioequivalence standards ensure comparable efficacy — but may cause confusion for patients who search for or request the brand name.

Drug Interaction Profile

Clarithromycin remains one of the most interaction-prone antibiotics in common use. As a potent CYP3A4 and P-glycoprotein inhibitor, it has contraindicated combinations with:

• Pimozide, cisapride (QT prolongation / fatal arrhythmia risk)
• Ergotamine, dihydroergotamine (risk of ergotism)
• Lovastatin, simvastatin (rhabdomyolysis risk)
• Colchicine in patients with renal or hepatic impairment (fatal toxicity reports)
• Lomitapide

Clinically significant interactions requiring dose adjustments or monitoring also exist with warfarin, digoxin, carbamazepine, cyclosporine, theophylline, midazolam, and calcium channel blockers. A thorough medication reconciliation is essential before prescribing. For a patient-facing resource on this topic, see: Clarithromycin Drug Interactions: What to Avoid.

FDA Cardiovascular Safety Warning

In 2018, the FDA issued a safety communication based on a 10-year follow-up of the CLARICOR trial, noting an increased risk of heart problems or death in patients with coronary artery disease who received short courses of Clarithromycin. While the mechanism remains unclear, prescribers should weigh this risk when treating patients with known cardiovascular disease and consider alternatives (particularly Azithromycin or Doxycycline) in this population.

Availability Picture by Formulation

Cost and Access Considerations

Generic Clarithromycin is affordable for most patients, but cost can still be a barrier for the uninsured:

• Insurance copay: $5-$25 (Tier 1/Tier 2 on most formularies)
• Cash price without coupons: $110-$148 for 14-day supply of 500 mg tablets
• With discount programs: $16-$50 via GoodRx, SingleCare, or RxSaver
• No prior authorization required by most commercial or Medicare plans
• No active manufacturer savings program (generic-only market)

For uninsured or underinsured patients, resources include NeedyMeds, RxAssist, 340B program pricing at community health centers, and state pharmaceutical assistance programs.

Tools and Resources for Your Practice

Medfinder for Providers

Medfinder for Providers helps you and your staff identify pharmacies with Clarithromycin in stock. Instead of sending patients out with a prescription and hoping their pharmacy has it, you can proactively direct them to a location with confirmed availability.

Helping Patients Navigate Stockouts

When a patient reports they can't fill a Clarithromycin prescription:

1. Check Medfinder for nearby pharmacy stock
2. Consider alternative formulations (ER vs IR, different strength)
3. Evaluate whether an alternative antibiotic is appropriate
4. If switching to Azithromycin, note the shorter course and different tissue penetration profile
5. Document the reason for any formulary change in the patient's chart

Alternative Antibiotic Selection

When Clarithromycin is unavailable or contraindicated, evidence-based alternatives include:

• Azithromycin: Preferred substitute for most respiratory indications. Fewer drug interactions. Does not require dose adjustment in renal impairment. Lower QT prolongation risk.
• Amoxicillin or Amoxicillin/Clavulanate: First-line for sinusitis, otitis media, and many community-acquired respiratory infections.
• Doxycycline: Excellent atypical coverage. Preferred for patients with macrolide allergy. Not for pediatric patients under 8.
• Levofloxacin/Moxifloxacin: Reserve for patients who cannot tolerate or have failed first-line agents. FDA boxed warning regarding fluoroquinolone-associated risks (tendon rupture, peripheral neuropathy, CNS effects).

For H. pylori eradication, if Clarithromycin is unavailable or resistance is suspected, consider bismuth quadruple therapy (bismuth subsalicylate + metronidazole + tetracycline + PPI) as an alternative regimen.

Looking Ahead

Clarithromycin supply is expected to remain stable through 2026 for tablet formulations. Key factors to monitor:

• Oral suspension availability: Remains the most vulnerable formulation. Consider discussing tablet-swallowing strategies with older pediatric patients or exploring compounding options.
• Respiratory season demand: Plan ahead during fall and early winter. Proactive formulary management and patient education can prevent access crises.
• Macrolide resistance trends: Growing macrolide resistance in certain respiratory pathogens (e.g., S. pneumoniae, H. pylori) may shift prescribing away from Clarithromycin over time.

Final Thoughts

Clarithromycin remains widely available in 2026, with no active national shortage. Providers should be aware of potential seasonal stockouts, oral suspension variability, and the drug's extensive interaction profile. Tools like Medfinder for Providers can streamline the process of connecting patients with available supply.

For a patient-facing companion to this briefing, see: Clarithromycin Shortage Update: What Patients Need to Know in 2026. For a practical workflow guide, see: How to Help Your Patients Find Clarithromycin in Stock.