Avoid concomitant use if possible, especially in patients with additional risk factors for TdP. as susceptible at 0.5 mcg/mL or less, intermediate at 1 to 4 mcg/mL, and resistant at 8 mcg/mL or more. For the treatment of group A streptococcal pharyngitis, guidelines recommend erythromycin as an alternative for patients allergic to penicillin. If erythromycin is discontinued, resume the original selpercatinib dose after 3 to 5 elimination half-lives of erythromycin. Saquinavir boosted with ritonavir causes dose-dependent QT and PR prolongation. It is not known whether this medicine will harm an unborn baby. Consider taking steps to minimize the risk for QT/QTc interval prolongation and TdP, such as electrolyte monitoring and repletion and ECG monitoring, if concomitant use is necessary. Coadministration may result in increased rilpivirine plasma concentrations. Elexacaftor, tezacaftor, and ivacaftor are CYP3A substrates; erythromycin is a moderate CYP3A inhibitor. Guidelines recommend secondary prophylaxis for 10 years or until age 40 years (whichever is longer) for patients who have experienced rheumatic fever with carditis and have residual heart disease (persistent valvular disease). Drugs with a possible risk for QT prolongation and TdP that should be used cautiously and with close monitoring with anagrelide include erythromycin. Tricyclic antidepressants: (Minor) The use of erythromycin with tricyclic antidepressants is rarely problematic. Concomitant use may also increase loperamide exposure and the risk for other loperamide-related adverse effects; loperamide is a P-gp substrate and erythromycin is a P-gp inhibitor. Coadministration has been associated with an increased risk of hypotension and shock. Concomitant use also increases the risk of QT/QTc prolongation and torsade de pointes (TdP). Consideration should be given to reducing the clozapine dose if necessary. Discontinuation of erythromycin could decrease codeine plasma concentrations, decrease opioid efficacy, and potentially lead to a withdrawal syndrome in those with physical dependence to codeine. Further decrease the zanubrutinib dose as recommended if adverse reactions occur. (Major) If erythromycin and ivacaftor are taken together, administer ivacaftor at the usual recommended dose but reduce the frequency to once daily. Erythromycin ophthalmic preparations are used to treat infections of the eye. Vinblastine: (Moderate) Monitor for an earlier onset and/or increased severity of vinblastine-related adverse reactions, including myelosuppression, constipation, and peripheral neuropathy, if coadministration with erythromycin is necessary. [35507], 400 mg PO every 12 hours. Erythromycin can inhibit colchicine's metabolism via P-glycoprotein (P-gp) and CYP3A4, resulting in increased colchicine exposure. Lumateperone is a CYP3A4 substrate; erythromycin is a moderate CYP3A4 inhibitor. Hydroxyzine: (Major) Concomitant use of hydroxyzine and erythromycin increases the risk of QT/QTc prolongation and torsade de pointes (TdP). Pasireotide: (Major) Concomitant use of pasireotide and erythromycin increases the risk of QT/QTc prolongation and torsade de pointes (TdP). Pemigatinib is a CYP3A4 substrate and erythromycin is a moderate CYP3A4 inhibitor. When ibrutinib was administered with multiple doses of erythromycin, the AUC value of ibrutinib increased by 3-fold. Tolvaptan is a sensitive CYP3A4 substrate; erythromycin is a moderate CYP3A4 inhibitor. Consider taking steps to minimize the risk for QT/QTc interval prolongation and TdP, such as electrolyte monitoring and repletion and ECG monitoring, if concomitant use is necessary. The potential for proarrhythmic events with ibutilide increases with the coadministration of other drugs that prolong the QT interval. The coadministration of eliglustat with both erythromycin and a moderate or strong CYP2D6 inhibitor is contraindicated in all patients. Avoid concomitant use if possible, especially in patients with additional risk factors for TdP. Generic: 5 mg/g (1 g, 3.5 g) Pharmacology Mechanism of Action Inhibits RNA-dependent protein synthesis at the chain elongation step; binds to the 50S ribosomal subunit resulting in blockage of transpeptidation Use: Labeled Indications Coadministration may result in increased plasma concentrations of itraconazole, thereby further increasing the risk for adverse events. Pimavanserin: (Major) Concomitant use of pimavanserin and erythromycin increases the risk of QT/QTc prolongation and torsade de pointes (TdP). Dolutegravir; Rilpivirine: (Major) Close clinical monitoring is advised when administering erythromycin with rilpivirine due to an increased potential for rilpivirine-related adverse events, including QT prolongation. Generic name: erythromycin ophthalmic [ e-RITH-row-MYE-sin-off-THAL-mik ] Brand names: Eyemycin, Ilotycin, Roymicin. Avoid concomitant use if possible, especially in patients with additional risk factors for TdP. There is no assurance that periodic monitoring of creatinine phosphokinase (CPK) will prevent the occurrence of myopathy. Avoid concomitant use if possible, especially in patients with additional risk factors for TdP. Buprenorphine; Naloxone: (Major) Concomitant use of buprenorphine and erythromycin increases the risk of QT/QTc prolongation and torsade de pointes (TdP). Emtricitabine; Tenofovir Disoproxil Fumarate: (Moderate) Coadministration of tenofovir disoproxil fumarate with erythromycin may result in increased plasma concentrations of tenofovir, leading to an increase in tenofovir-related adverse effects. If concomitant use is unavoidable, periodically monitor ECGs and electrolytes; an interruption of ceritinib therapy, dose reduction, or discontinuation of therapy may be necessary if QT prolongation occurs. Caffeine; Sodium Benzoate: (Moderate) Inhibitors of the hepatic CYP4501A2, such as erythromycin, may inhibit the hepatic oxidative metabolism of caffeine. Disopyramide: (Major) Cases of life-threatening interactions have been reported for disopyramide when given with erythromycin. Amlodipine is a CYP3A substrate and erythromycin is a moderate CYP3A inhibitor. Coadministration may result in elevated concentrations of conivaptan. According to the manufacturer, patients receiving clozapine in combination with an inhibitor of CYP3A4 should be monitored for adverse reactions. Consider taking steps to minimize the risk for QT/QTc interval prolongation and TdP, such as electrolyte monitoring and repletion and ECG monitoring, if concomitant use is necessary. Erythromycin is an inhibitor of CYP3A4, and rifabutin is a substrate of CYP3A4. Parenteral erythromycin is available as the gluceptate or lactobionate. [48677]. Coadministration with other moderate CYP3A inhibitors increased buspirone exposure by 3.4 to 6-fold and was accompanied by increased buspirone-related adverse reactions. It may not be safe to breast-feed while using this medicine. Consider if alternative antibiotic therapy is appropriate. Hydrocodone is a substrate for CYP3A4. The risk of developing myopathy, rhabdomyolysis, and acute renal failure is substantially increased if lovastatin is administered concomitantly with strong CYP3A4 inhibitors including erythromycin. Erythromycin is an inhibitor of CYP3A4 and P-gp. Diltiazem is a CYP3A4 substrate and erythromycin is a moderate CYP3A4 inhibitor. Amisulpride causes dose- and concentration- dependent QT prolongation. Concomitant use may also increase the risk for QT/QTc prolongation and torsade de pointes (TdP). Some experts suggest that Bartonella titers also decrease by 4-fold before discontinuing suppressive therapy.[34362]. Due to a slow onset of action and the increased risk of the development of bacterial resistance, topical antibiotic monotherapy is not recommended. Consider taking steps to minimize the risk for QT/QTc interval prolongation and TdP, such as electrolyte monitoring and repletion and ECG monitoring, if concomitant use is necessary. Lumacaftor; Ivacaftor: (Major) Lumacaftor; ivacaftor may decrease the therapeutic efficacy of erythromycin; avoid concurrent use if possible. Consider taking steps to minimize the risk for QT/QTc interval prolongation and TdP, such as electrolyte monitoring and repletion and ECG monitoring, if concomitant use is necessary. Tell each of your healthcare providers about all medicines you use, including prescription and over-the-counter medicines, vitamins, and herbal products. Sirolimus is a CYP3A and P-gp substrate and erythromycin is a moderate CYP3A and P-gp inhibitor. In addition to potential pharmacokinetic interactions, erythromycin may cause QT prolongation and exhibit additive electrophysiologic effects with Class III antiarrhythmics. If these agents are used together, obtain an ECG and serum electrolytes prior to the start of gemtuzumab and as needed during treatment. Isoniazid, INH; Pyrazinamide, PZA; Rifampin: (Major) Caution is warranted with the concomitant use of erythromycin and rifampin as this may result in reduced erythromycin Cmax and increased clearance. Finerenone: (Moderate) Monitor serum potassium during initiation or dose adjustment of either finerenone or erythromycin; a finerenone dosage reduction may be necessary. Avoid concomitant use if possible, especially in patients with additional risk factors for TdP. Nirmatrelvir; Ritonavir: (Major) Consider temporary discontinuation of erythromycin during treatment with ritonavir-boosted nirmatrelvir and for at least 2 to 3 days after treatment completion; if not feasible, consider alternative COVID-19 therapy. Lemborexant: (Major) Avoid coadministration of lemborexant and erythromycin as concurrent use is expected to significantly increase lemborexant exposure and the risk of adverse effects. No dosage adjustment is required in patients with atrial fibrillation. Fatalities have been reported. erythromycin ophthalmic (Rx) - Medscape Drugs & Diseases Patients who have shown macrolide hypersensitivity or sensitivity to any macrolide antibiotic should not be given erythromycin. Lopinavir; Ritonavir: (Major) Concomitant use of lopinavir and erythromycin increases the risk of QT/QTc prolongation and torsade de pointes (TdP). Although there are no studies examining the effects of ranolazine in patients receiving other QT prolonging drugs, coadministration of such drugs may result in additive QT prolongation. There have been reports of infantile hypertrophic pyloric stenosis (IHPS) occurring in infants following erythromycin therapy. Tamoxifen: (Major) Concomitant use of tamoxifen and erythromycin increases the risk of QT/QTc prolongation and torsade de pointes (TdP). 40mg/kg/day PO in 3 to 4 divided doses (Max: 2 g/day) for 5 to 7 days. Fostemsavir: (Major) Use erythromycin and fostemsavir together with caution. Erythromycin Ophthalmic: Generic, Uses, Side Effects, Dosages However, because armodafinil is itself an inducer of the CYP3A4 isoenzyme, drug interactions due to CYP3A4 inhibition by other medications may be complex and difficult to predict. Betrixaban is a substrate of P-gp; erythromycin inhibits P-gp. Ivacaftor is a CYP3A substrate and erythromycin is a moderate CYP3A inhibitor. Midostaurin: (Major) Concomitant use of erythromycin and midostaurin increases the risk of QT/QTc prolongation and torsade de pointes (TdP). In addition, ketoconazole is a strong CYP3A4 inhibitor, and may increase exposure to erythromycin, a CYP3A4 substrate. [48677]. Drug class: Ophthalmic anti-infectives. If erythromycin is used with theophylline therapy, patients should be monitored for elevated theophylline levels and/or theophylline toxicity. Avoid concomitant use if possible, especially in patients with additional risk factors for TdP. Hydrocodone; Ibuprofen: (Moderate) Consider a reduced dose of hydrocodone with frequent monitoring for respiratory depression and sedation if concurrent use of erythromycin is necessary. The FDA-approved labeling states that up to 100 mg/kg/day (Max: 4 g/day) may be given for more severe infections; however, this is rarely done in clinical practice. Use erythromycin with caution in patients with conditions that may increase the risk of QT prolongation including bradycardia, AV block, heart failure, stress-related cardiomyopathy, myocardial infarction, stroke, or in patients receiving medications known to prolong the QT interval or cause electrolyte imbalances. Elagolix: (Contraindicated) Concomitant use of elagolix and strong organic anion transporting polypeptide (OATP) 1B1 inhibitors such as erythromycin is contraindicated. Brexpiprazole: (Moderate) Because brexpiprazole is primarily metabolized by CYP3A4 and CYP2D6, the manufacturer recommends that the brexpiprazole dose be reduced to one-quarter (25%) of the usual dose in patients receiving a moderate to strong inhibitor of CYP3A4 in combination with a moderate to strong inhibitor of CYP2D6. Ticagrelor: (Moderate) Coadministration of ticagrelor and erythromycin may result in increased exposure to ticagrelor which may increase the bleeding risk. However, if concomitant therapy is necessary, close monitoring of tacrolimus blood concentrations and of the QT interval is warranted. The pravastatin labeling recommends caution during concurrent use. Erythromycin is a CYP3A4 inhibitor and a P-glycoprotein (P-gp) substrate. Concomitant use increases mavacamten exposure, which may increase the risk of adverse drug reactions. The FDA-approved dosage is 400 mg PO every 6 hours for 7 days following initial IV therapy. Propafenone: (Major) Concomitant use of propafenone and erythromycin increases the risk of QT/QTc prolongation and torsade de pointes (TdP). Both erythromycin and vemurafenib have been associated with QT prolongation. Encorafenib: (Major) Avoid coadministration of encorafenib and erythromycin due to increased encorafenib exposure and QT prolongation. WebHow should this medicine be used? Patients receiving estrogens should be monitored for an increase in adverse events. Add rifampin and treat complicated infections for 3 months. 40 to 50 mg/kg/day (Max: 2 g/day) IV divided every 6 hours for 14 days as an adjunct to diphtheria antitoxin. Twice-daily dosing is not recommended with doses more than 1 g/day. Saturated Erythromycin PledgetsApply solution to cleansed affected area by gently rubbing pledgets over affected skin. 3 mg/kg/dose IV every 8 hours has been studied in hospitalized patients with diabetic gastroparesis. It is recommended to avoid this combination when codeine is being used for cough. During long-term antibiotic administration, the risk for drug interaction with OCs is less clear, but alternative or additional contraception may be advisable in selected circumstances. If erythromycin is discontinued, monitor the patient carefully and consider increasing the opioid dosage if appropriate. Vinorelbine is a CYP3A4 substrate and erythromycin is a moderate CYP3A4 inhibitor. a seizure; hearing problems (rare); pancreatitis --severe pain in your upper stomach spreading to your back, nausea and vomiting; or. QT prolongation should be expected with the administration of arsenic trioxide. Erythromycin potently inhibits the metabolism of certain statins via the CYP3A4 isoenzyme and increase the risk of myopathy and rhabdomyolysis. Osilodrostat: (Major) Concomitant use of osilodrostat and erythromycin increases the risk of QT/QTc prolongation and torsade de pointes (TdP). Buspirone is a sensitive CYP3A substrate and erythromycin is a moderate CYP3A inhibitor. Ophthalmic erythromycin comes as an ointment to apply to the eyes. It is usually applied up to six times a day for eye infections. Ophthalmic erythromycin is usually applied one time in the hospital soon after delivery to prevent eye infections in newborn babies. Trazodone: (Major) Concomitant use of trazodone and erythromycin increases the risk of QT/QTc prolongation and torsade de pointes (TdP). The clinical significance of this interaction has not been established, monitor for effectiveness of rosuvastatin and for myopathy and adjust treatment as clinically indicated. 500 mg PO every 6 hours for 14 days. Solifenacin: (Major) Consider the potential risk for additive QT prolongation if solifenacin is administered with erythromycin. Brincidofovir: (Moderate) Postpone the administration of erythromycin for at least three hours after brincidofovir administration and increase monitoring for brincidofovir-related adverse reactions (i.e., elevated hepatic enzymes and bilirubin, diarrhea, other gastrointestinal adverse events) if concomitant use of brincidofovir and erythromycin is necessary. All rights reserved. Concomitant use may increase daridorexant exposure and the risk for daridorexant-related adverse effects. Avoid concomitant use if possible, especially in patients with additional risk factors for TdP. Follow all directions on your medicine label and package. For patients with oncology indications and tuberous sclerosis complex (TSC)-associated renal angiomyolipoma, reduce the initial dose of everolimus to 2.5 mg PO once daily; the dose may be increased to 5 mg PO once daily if the 2.5 mg dose is tolerated. After opening your eyes, you may have blurred vision for a short time. Discontinuation of erythromycin could decrease codeine plasma concentrations, decrease opioid efficacy, and potentially lead to a withdrawal syndrome in those with physical dependence to codeine. Leuprolide: (Major) Concomitant use of leuprolide and erythromycin increases the risk of QT/QTc prolongation and torsade de pointes (TdP). Coadministration with erythromycin increased the AUC and Cmax of relugolix by 6.2-fold. Consider taking steps to minimize the risk for QT/QTc interval prolongation and TdP, such as electrolyte monitoring and repletion and ECG monitoring, if concomitant use is necessary. Naldemedine: (Major) Monitor for potential naldemedine-related adverse reactions if coadministered with erythromycin. [65012] Additionally, in another large population-based cohort study (n = 139,938 live births) assessing systemic antibiotic exposure during the first trimester of pregnancy (n = 15,469 exposures) and the risk of major birth defects, macrolide exposure was associated with an increased risk of digestive system malformations (adjusted odds ratio (aOR) 1.46, 95% CI 1.04 to 2.06, 35 exposed cases). This action is probably due to agonism at the motilin receptors. In physiologically based pharmacokinetic (PBPK) simulations, the Cmax and AUC values of acalabrutinib were increased by 2- to almost 3-fold when acalabrutinib was coadministered with moderate CYP3A inhibitors. Colchicine: (Major) Due to the risk for serious colchicine toxicity including multi-organ failure and death, avoid coadministration of colchicine and erythromycin in patients with normal renal and hepatic function unless the use of both agents is imperative. QT prolongation and TdP have also been observed during haloperidol treatment. Dronabinol: (Major) Use caution if coadministration of dronabinol with erythromycin is necessary, and monitor for an increase in dronabinol-related adverse reactions (e.g., feeling high, dizziness, confusion, somnolence). Nanoparticle Albumin-Bound Sirolimus: (Major) Avoid concomitant use of sirolimus and erythromycin. Pitolisant: (Major) Concomitant use of pitolisant and erythromycin increases the risk of QT/QTc prolongation and torsade de pointes (TdP). If you wear contact lenses, you may need to stop wearing them until your eyes feel better. Isoniazid, INH; Rifampin: (Major) Caution is warranted with the concomitant use of erythromycin and rifampin as this may result in reduced erythromycin Cmax and increased clearance. Ergotamine; Caffeine: (Moderate) Inhibitors of the hepatic CYP4501A2, such as erythromycin, may inhibit the hepatic oxidative metabolism of caffeine. Siponimod therapy prolonged the QT interval at recommended doses in a clinical study. Concomitant use of another moderate CYP3A inhibitor increased daridorexant overall exposure 2.4-fold. Pledgets/swabs, topical solution: Apply to the affected area (s) 2 times a day. Coadministration with a moderate CYP3A inhibitor in elderly hypertensive patients increased systemic exposure to amlodipine by 60%. Azelastine; Fluticasone: (Minor) Coadministration of orally administered azelastine (4 mg twice daily) with erythromycin (500 mg three times daily for 7 days) resulted in a slightly lower Cmax and a slightly higher AUC for azelastine compared to azelastine alone. Although a potential interaction has not been studied, erythromycin might negate the effect of alosetron. Erythromycin is associated with QT prolongation and torsade de pointes (TdP). If possible, erythromycin should be discontinued prior to initiating arsenic trioxide therapy. Methadone is also considered to be associated with an increased risk for QT prolongation and TdP, especially at higher doses averaging approximately 400 mg/day in adult patients. Erythromycin administration is associated with QT prolongation and TdP. Avoid concomitant use if possible, especially in patients with additional risk factors for TdP. In combination with rifampin, the median erythromycin Cmax was 0.72 mg/L (range, 0.06 to 1.66), and the median apparent oral clearance was 197 L/hour (range, 102 to 2015). There are no known adverse effects with short-term discontinuation of simvastatin. Available for Android and iOS devices. Coadministration with erythromycin increased the exposure of roflumilast by 70%. When stopping erythromycin, the buprenorphine concentration may decrease, potentially resulting in decreased opioid efficacy or a withdrawal syndrome in patients who had developed physical dependency. (Major) Reduce the dosing frequency of elexacaftor; tezacaftor; ivacaftor to every other day in the morning when coadministered with erythromycin; omit the ivacaftor evening dose and administer in the morning every other day alternating with elexacaftor; tezacaftor; ivacaftor (i.e., recommended dose of elexacaftor; tezacaftor; ivacaftor on day 1 in the morning and recommended dose of ivacaftor on day 2 in the morning). Butalbital; Acetaminophen; Caffeine; Codeine: (Moderate) Concomitant use of codeine with erythromycin may increase codeine plasma concentrations, resulting in greater metabolism by CYP2D6, increased morphine concentrations, and prolonged opioid adverse reactions, including hypotension, respiratory depression, profound sedation, coma, and death. 250 mg PO every 6 hours or 500 mg PO every 12 hours. Breaks in therapy may be considered to reduce treatment burden. Coadministration has been associated with an increased risk of hypotension and shock. Avoid concomitant use if possible, especially in patients with additional risk factors for TdP. Up to 4 g/day may be used. Perindopril; Amlodipine: (Moderate) Monitor for symptoms of hypotension and edema if coadministration of amlodipine with erythromycin is necessary; adjust the dose of amlodipine as clinically appropriate. 500 mg PO 4 times daily for 21 days is recommended as an alternative. Concomitant use can also increase the plasma concentration of buprenorphine, resulting in increased or prolonged opioid effects, particularly when erythromycin is added after a stable buprenorphine dose is achieved. Shorter courses may be appropriate for less extensive infections. Systemic erythromycin has been reported to cause QT prolongation resulting in ventricular arrhythmias of the torsade de pointes type. (Moderate) Concentrations of darunavir may be increased with coadministration, as erythromycin is a CYP3A4 inhibitor and darunavir is a CYP3A4 substrate. Monitor for adverse events of rifabutin, such as neutropenia and rash. Etonogestrel: (Minor) Coadministration of etonogestrel and moderate CYP3A4 inhibitors such as erythromycin may increase the serum concentration of etonogestrel. If erythromycin is discontinued, monitor the patient carefully and consider increasing the opioid dosage if appropriate. Roll eyeball around. However, other mechanisms, such as an effect on OATP1B1, may be involved. CYP3A4 is a primary metabolic pathway for eszopiclone, and increased systemic exposure may result in next-day psychomotor or memory impairment. A second course of treatment may be necessary. Gilteritinib has been associated with QT prolongation. If erythromycin is discontinued, monitor the patient carefully and consider increasing the opioid dosage if appropriate. Also, the antimuscarinic actions of disopyramide can interfere with the motility-enhancing properties of erythromycin in patients receiving erythromycin for this purpose. Avoid concomitant use if possible, especially in patients with additional risk factors for TdP. Avoid concomitant use if possible, especially in patients with additional risk factors for TdP. In addition, methadone is a substrate for CYP3A4 and P-glycoprotein (P-gp), while erythromycin is a CYP3A4 and P-gp inhibitor. Azithromycin may be preferred if the use of a macrolide antibiotic is necessary in a patient receiving felodipine therapy. Monitor patients for respiratory depression and sedation at frequent intervals. Concomitant use with another moderate CYP3A inhibitor increased sparsentan overall exposure by 70%. If concomitant use cannot be avoided, administer erythromycin for less than 14 days; monitor patients closely for adverse reactions (e.g., elevated serum creatine kinase and serum creatinine levels). Ozanimod: (Major) In general, do not initiate ozanimod in patients taking erythromycin due to the risk of additive bradycardia, QT prolongation, and torsade de pointes (TdP). If erythromycin is discontinued, oxycodone plasma concentrations will decrease resulting in reduced efficacy of the opioid and potential withdrawal syndrome in a patient who has developed physical dependence to oxycodone.