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DRUG INTERACTIONS
Drug Interactions
Erythromycin use in patients who are receiving high doses of theophylline may be associated with an increase in serum theophylline levels and potential theophylline toxicity. In case of theophylline toxicity and/or elevated serum theophylline levels, the dose of theophylline should be reduced while the patient is receiving concomitant erythromycin therapy.
Hypotension, bradyarrhythmias, and lactic acidosis have been observed in patients receiving concurrent verapamil, belonging to the calcium channel blockers drug class.
Concomitant administration of erythromycin and digoxin has been reported to result in elevated digoxin serum levels.
There have been reports of increased anticoagulant effects when erythromycin and oral anticoagulants were used concomitantly. Increased anticoagulation effects due to interactions of erythromycin with various oral anticoagulants may be more pronounced in the elderly.
Erythromycin is a substrate and inhibitor of the 3A isoform subfamily of the cytochrome p450 enzyme system (CYP3A). Coadministration of erythromycin and a drug primarily metabolized by CYP3A may be associated with elevations in drug concentrations that could increase or prolong both the therapeutic and adverse effects of the concomitant drug. Dosage adjustments may be considered, and when possible, serum concentrations of drugs primarily metabolized by CYP3A should be monitored closely in patients concurrently receiving erythromycin.
The following are examples of some clinically significant CYP3A based drug interactions. Interactions with other drugs metabolized by the CYP3A isoform are also possible. The following CYP3A based drug interactions have been observed with erythromycin products in post-marketing experience:
Ergotamine/dihydroergotamine
Concurrent use of erythromycin and ergotamine
or dihydroergotamine has been associated in some patients with acute
ergot toxicity characterized by severe peripheral vasospasm and dysesthesia.
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OVERDOSAGE
In case of overdosage, erythromycin should be discontinued. Overdosage should be handled with the prompt elimination of unabsorbed drug and all other appropriate measures should be instituted.
Erythromycin is not removed by peritoneal dialysis or hemodialysis.
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CONTRAINDICATIONS
Erythromycin is contraindicated in patients with known hypersensitivity to this antibiotic.
Erythromycin is contraindicated in patients taking terfenadine, astemizole, pimozide, or cisapride. (See PRECAUTIONS - Drug Interactions.)
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REFERENCES
- Clinical and Laboratory Standards Institute. Methods
for Dilution Antimicrobial Susceptibility Tests for Bacteria that
Grow Aerobically, 7th ed. Approved Standard, CLSI Document
M07-A7, Vol. 26(2). CLSI, Wayne, PA, Jan. 2006.
- Clinical and Laboratory Standards Institute. Performance
Standards for Antimicrobial Susceptibility Testing, 18th Informational
Supplement, CLSI Document M100-S18, Vol 28(1). CLSI, Wayne, PA, Jan.
2008.
- Clinical and Laboratory Standards Institute. Performance
Standards for Antimicrobial Disk Susceptibility Tests, 9th
ed. Approved Standard CLSI Document M02-A9, Vol. 26(1). CLSI, Wayne,
PA, Jan. 2006.
- Committee on Rheumatic Fever, Endocarditis, and Kawasaki
Disease of the Council on Cardiovascular Disease in the Young, the
American Heart Association: Prevention of Rheumatic Fever. Circulation. 78(4):1082-1086, October 1988.
- Honein, M.A., et. al.: Infantile hypertrophic pyloric stenosis
after pertussis prophylaxis with erythromycin: a case review and
cohort study. The Lancet 1999;354 (9196):2101-5.
Filmtab—Film-sealed tablets, Abbott.
Abbott Laboratories
North Chicago, IL 60064, U.S.A.
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