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Drug Interactions between azithromycin and cabergoline

This report displays the potential drug interactions for the following 2 drugs:

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Interactions between your drugs

Moderate

azithromycin cabergoline

Applies to: azithromycin and cabergoline

MONITOR: Coadministration with certain macrolide antibiotics may significantly increase the plasma concentrations of ergot derivatives. The mechanism is macrolide inhibition of CYP450 3A4, the isoenzyme responsible for the metabolic clearance of ergotamine and related drugs. Macrolides that may significantly inhibit CYP450 3A4 include clarithromycin, erythromycin and troleandomycin, and clinical ergotism has been reported in patients receiving ergotamine or dihydroergotamine with these agents. Azithromycin is generally believed to have little, if any, effect on CYP450 3A4. No interaction with ergot derivatives has been reported in clinical trials with azithromycin; however, no specific drug interaction studies have been performed.

MANAGEMENT: Until more information is available, caution may be advisable when ergot alkaloids are prescribed in combination with azithromycin. Patients should be monitored for potential ergot toxicity including peripheral vasospasm, ischemia, thrombosis, tachycardia, and hypertension. Patients should be advised to notify their physician if they experience potential signs and symptoms of ergotism such as paraesthesia, cyanosis, cold or painful extremities, muscle pain or weakness, abdominal pain, irregular heartbeat, and chest pain or tightness.

References

  1. Leroy F, Asseman P, Pruvost P, Adnet P, Lacroix D, Thery C (1988) "Dihydroergotamine-erythromycin-induced ergotism." Ann Intern Med, 109, p. 249
  2. Matthews NT, Havill JH (1979) "Ergotism with therapeutic doses of ergotamine tartrate." N Z Med J, 89, p. 476-7
  3. Francis H, Tyndall A, Webb J (1984) "Severe vascular spasm due to erythromycin-ergotamine interaction." Clin Rheumatol, 3, p. 243-6
  4. Hayton AC (1969) "Precipitation of acute ergotism by triacetyloleandomycin." N Z Med J, 69, p. 42
  5. (2002) "Product Information. D.H.E. 45 (dihydroergotamine)." Sandoz Pharmaceuticals Corporation
  6. Ghali R, De Lean J, Douville Y, Noel HP, Labbe R (1993) "Erythromycin-associated ergotamine intoxication: arteriographic and electrophysiologic analysis of a rare cause of severe ischemia of the lower extremities and associated ischemic neuropathy." Ann Vasc Surg, 7, p. 291-6
  7. Horowitz RS, Dart RC, Gomez HF (1996) "Clinical ergotism with lingual ischemia induced by clarithromycin-ergotamine interaction." Arch Intern Med, 156, p. 456-8
  8. (2001) "Product Information. Migranal (dihydroergotamine nasal)." Novartis Pharmaceuticals
  9. Dresser GK, Spence JD, Bailey DG (2000) "Pharmacokinetic-pharmacodynamic consequences and clinical relevance of cytochrome P450 3A4 inhibition." Clin Pharmacokinet, 38, p. 41-57
  10. Bird PA, Sturgess AD (2000) "Clinical ergotism with severe bilateral upper limb ischaemia precipitated by an erythromycin - ergotamine drug interaction." Aust N Z J Med, 30, p. 635-6
  11. Eadie MJ (2001) "Clinically significant drug interactions with agents specific for migraine attacks." Cns Drugs, 15, p. 105-18
  12. Ausband SC, Goodman PE (2001) "An unusual case of clarithromycin associated ergotism." J Emerg Med, 4, p. 411-3
  13. (2004) "Product Information. Cafergot (caffeine-ergotamine)." Novartis Pharmaceuticals
  14. Nakatsuka A, Nagai M, Yabe H, et al. (2006) "Effect of clarithromycin on the pharmacokinetics of cabergoline in healthy controls and in patients with Parkinson's disease." J Pharmacol Sci, 100, p. 59-64
  15. Cerner Multum, Inc. "UK Summary of Product Characteristics."
View all 15 references

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Drug and food interactions

Moderate

cabergoline food

Applies to: cabergoline

GENERALLY AVOID: Alcohol may potentiate some of the pharmacologic effects of CNS-active agents. Use in combination may result in additive central nervous system depression and/or impairment of judgment, thinking, and psychomotor skills.

MANAGEMENT: Patients receiving CNS-active agents should be warned of this interaction and advised to avoid or limit consumption of alcohol. Ambulatory patients should be counseled to avoid hazardous activities requiring complete mental alertness and motor coordination until they know how these agents affect them, and to notify their physician if they experience excessive or prolonged CNS effects that interfere with their normal activities.

References

  1. Warrington SJ, Ankier SI, Turner P (1986) "Evaluation of possible interactions between ethanol and trazodone or amitriptyline." Neuropsychobiology, 15, p. 31-7
  2. Gilman AG, eds., Nies AS, Rall TW, Taylor P (1990) "Goodman and Gilman's the Pharmacological Basis of Therapeutics." New York, NY: Pergamon Press Inc.
  3. (2012) "Product Information. Fycompa (perampanel)." Eisai Inc
  4. (2015) "Product Information. Rexulti (brexpiprazole)." Otsuka American Pharmaceuticals Inc
View all 4 references

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Therapeutic duplication warnings

No warnings were found for your selected drugs.

Therapeutic duplication warnings are only returned when drugs within the same group exceed the recommended therapeutic duplication maximum.

See also

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Drug Interaction Classification

These classifications are only a guideline. The relevance of a particular drug interaction to a specific individual is difficult to determine. Always consult your healthcare provider before starting or stopping any medication.
Major Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.
Moderate Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.
Minor Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.
Unknown No interaction information available.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

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