Erythromycin Disease Interactions
There are 5 disease interactions with erythromycin:
Erythromycin (Includes Erythromycin) ↔ Liver Disease
Severe Potential Hazard, Moderate plausibility
Applies to: Liver Disease, Biliary Obstruction
The use of oral erythromycin, especially erythromycin estolate and erythromycin ethylsuccinate, has been associated with occasional cases of hepatic dysfunction, including elevated liver enzymes and hepatocellular and/or cholestatic hepatitis. Therapy with oral erythromycin should be administered cautiously in patients with liver disease. Additionally, erythromycin is primarily excreted by the liver into the bile. The effect of liver and/or biliary disease on erythromycin clearance is unknown. Empiric dosage adjustments may be appropriate in patients with impaired hepatic or biliary function.
- Diehl AM, Latham P, Boitnott JK, et al "Cholestatic hepatitis from erythromycin ethylsuccinate." Am J Med 76 (1984): 931-4
- Bachman BA, Boyd WP Jr, Brady PG "Erythromycin ethylsuccinate-induced cholestasis." Am J Gastroenterol 77 (1982): 397-400
- Gomezlechon MJ, Carrasquer J, Berenguer J, Castell JV "Evidence of antibodies to erythromycin in serum of a patient following an episode of acute drug-induced hepatitis." Clin Exp Allergy 26 (1996): 590-6
- Sullivan D, Csuka ME, Blanchard B "Erythromycin ethylsuccinate hepatotoxicity." JAMA 243 (1980): 1074
- Kroboth PD, Brown A, Lyon JA, et al "Pharmacokinetics of single-dose erythromycin in normal and alcoholic liver disease subjects." Antimicrob Agents Chemother 21 (1982): 135-40
- Inman WH, Rawson NS "Erythromycin estolate and jaundice." Br Med J 286 (1983): 1954-5
- Gholson CF, Warren GH "Fulminant hepatic failure associated with intravenous erythromycin lactobionate." Arch Intern Med 150 (1990): 215-6
- Keeffe EB, Reis TC, Berland JE "Hepatotoxicity to both erythromycin estolate and erythromycin ethylsuccinate." Dig Dis Sci 27 (1982): 701-4
- Hall KW, Nightingale CH, Gibaldi M, et al "Pharmacokinetics of erythromycin in normal and alcoholic liver disease subjects." J Clin Pharmacol 22 (1982): 321-5
- Barre J, Mallat A, Rosenbaum J, et al "Pharmacokinetics of erythromycin in patients with severe cirrhosis: respective influence of decreased serum binding and impaired liver metabolic capacity." Br J Clin Pharmacol 23 (1987): 753-7
- "Product Information. ERYC (erythromycin)." Parke-Davis, Morris Plains, NJ.
- Howe E, Howe E, Benn RA "Hepatotoxicity due to erythromycin ethylsuccinate." Med J Aust 158 (1993): 142-4
Macrolide Antibiotics (Includes Erythromycin) ↔ Qt Prolongation
Severe Potential Hazard, High plausibility
Applies to: Hypokalemia, Magnesium Imbalance, Arrhythmias
Prolonged cardiac repolarization and QT interval have been reported in patients receiving treatment with macrolides. Providers should weight risks and benefits of using these drugs in patients with known prolongation of the QT interval, history of torsades de pointes, congenital long QT syndrome, bradyarrhythmias, proarrhythmic conditions such as uncorrected hypokalemia or hypomagnesemia, or patients receiving other drugs that prolong the QT interval.
Mdvs (Includes Erythromycin) ↔ Prematurity
Severe Potential Hazard, Moderate plausibility
Applies to: Prematurity/Underweight in Infancy
Parenteral medications formulated in multidose vials often contain benzyl alcohol as a preservative. Their use is considered by drug manufacturers to be contraindicated in neonates, particularly premature infants and infants of low birth weight. When used in bacteriostatic saline intravascular flush and endotracheal tube lavage solutions, benzyl alcohol has been associated with fatalities and severe respiratory and metabolic complications in low-birth-weight premature infants. Thus, single-dose formulations should always be used in infants whenever possible. However, many experts feel that, in the absence of benzyl alcohol-free equivalents, the amount of the preservative present in these formulations should not necessarily preclude their use if they are clearly indicated. The American Academy of Pediatrics considers benzyl alcohol in low doses (such as when used as a preservative in some medications) to be safe for newborns. However, the administration of high dosages of these medications must take into account the total amount of benzyl alcohol administered. The level at which toxicity may occur is unknown.
- "Product Information. Fragmin (dalteparin)." Pharmacia and Upjohn, Kalamazoo, MI.
- ""Inactive" ingredients in pharmaceutical products: update (subject review). American Academy of Pediatrics Committee on Drugs. Available from: URL: http://www.aap.org/policy/re9706.html." Pediatrics 99 (1997): 268-78
- "Product Information. Nuromax (doxacurium)." Glaxo Wellcome, Research Triangle Park, NC.
- "Product Information. Mesnex (mesna)." Bristol-Myers Squibb, Princeton, NJ.
- "Product Information. Tracrium (atracurium)." Glaxo Wellcome, Research Triangle Park, NC.
- "Product Information. Mivacron (mivacurium)." Glaxo Wellcome, Research Triangle Park, NC.
Antibiotics (Includes Erythromycin) ↔ Colitis
Moderate Potential Hazard, Moderate plausibility
Applies to: Colitis/Enteritis (Noninfectious)
Pseudomembranous colitis has been reported with most antibacterial agents and may range in severity from mild to life-threatening, with an onset of up to two months following cessation of therapy. Antibiotic therapy can alter the normal flora of the colon and permit overgrowth of Clostridium difficile, whose toxin is believed to be a primary cause of antibiotic- associated colitis. The colitis is usually characterized by severe, persistent diarrhea and severe abdominal cramps, and may be associated with the passage of blood and mucus. The most common culprits are clindamycin, lincomycin, the aminopenicillins (amoxicillin, ampicillin), and the cephalosporins. Therapy with broad-spectrum antibiotics and other agents with significant antibacterial activity should be administered cautiously in patients with a history of gastrointestinal diseases, particularly colitis. There is some evidence that pseudomembranous colitis, if it occurs, may run a more severe course in these patients and that it may be associated with flares in their underlying disease activity. The offending antibiotic(s) should be discontinued if significant diarrhea occurs during therapy. Stool cultures for Clostridium difficile and stool assay for C. difficile toxin may be helpful diagnostically. A large bowel endoscopy may be considered to establish a definitive diagnosis in cases of severe diarrhea.
- Moriarty HJ, Scobie BA "Pseudomembranous colitis in a patient on rifampicin and ethambutol." N Z Med J 04/23/80 (1980): 294-5
- Thomas E, Mehta JB "Pseudomembranous colitis due to oxacillin therapy." South Med J 77 (1984): 532-3
- Davies J, Beck E "Recurrent colitis following antibiotic-associated pseudomembranous colitis." Postgrad Med J 57 (1981): 599-601
- Saadah HA "Carbenicillin and pseudomembranous enterocolitis." Ann Intern Med 93 (1980): 645
- Lyon JA "Imipenem/cilastatin: the first carbapenem antibiotic." Drug Intell Clin Pharm 19 (1985): 894-8
- Trexler MF, Fraser TG, Jones MP "Fulminant pseudomembranous colitis caused by clindamycin phosphate vaginal cream." Am J Gastroenterol 92 (1997): 2112-3
- Daly JJ, Chowdary KV "Pseudomembranous colitis secondary to metronidazole." Dig Dis Sci 28 (1983): 573-4
- Bauwens JE, McFarland LV, Melcher SA "Recurrent clostridium difficile disease following ciprofloxacin use." Ann Pharmacother 31 (1997): 1090
- O'Meara TF, Simmons RA "Carbenicillin and pseudomembranous enterocolitis." Ann Intern Med 92 (1980): 440-1
- Meadowcroft AM, Diaz PR, Latham GS "Clostridium difficile toxin-induced colitis after use of clindmycin phosphate vaginal cream." Ann Pharmacother 32 (1998): 309-11
- Dan M, Samra Z "Clostridium difficile colitis associated with ofloxacin therapy." Am J Med 87 (1989): 479
- Milstone EB, McDonald AJ, Scholhamer CF Jr "Pseudomembranous colitis after topical application of clindamycin." Arch Dermatol 117 (1981): 154-5
- Harmon T, Burkhart G, Applebaum H "Perforated pseudomembranous colitis in the breast-fed infant." J Pediatr Surg 27 (1992): 744-6
- Ehrenpreis ED, Lievens MW, Craig RM "Clostridium difficile-associated diarrhea after norfloxacin." J Clin Gastroenterol 12 (1990): 188-9
- Burt RA "A review of the drug events reported by 12,917 patients treated with cephalexin." Postgrad Med J 59 (1983): 47-50,51-3
- Cone JB, Wetzel W "Toxic megacolon secondary to pseudomembranous colitis." Dis Colon Rectum 25 (1982): 478-82
- Cannon SR, Dyson PH, Sanderson PJ "Pseudomembranous colitis associated with antibiotic prophylaxis in orthopaedic surgery." J Bone Joint Surg Br 70-B (1988): 600-2
- Miller DL, Sedlack JD, Holt RW "Perforation complicating rifampin-associated pseudomembranous enteritis." Arch Surg 124 (1989): 1082
- Miller SN, Ringler RP "Vancomycin-induced pseudomembranous colitis." J Clin Gastroenterol 9 (1987): 114-5
- Calandra GB, Brown KR, Grad LC, et al "Review of adverse experiences and tolerability in the first 2,516 patients treated with imipenem/cilastatin." Am J Med 78 (1985): 73-8
- Wang C, Calandra GB, Aziz MA, Brown KR "Efficacy and safety of imipenem/cilastatin: a review of worldwide clinical experience." Rev Infect Dis 7 (1985): s528-36
- Osler T, Lott D, Bordley J, et al "Cefazolin-induced pseudomembranous colitis resulting in perforation of the sigmoid colon." Dis Colon Rectum 29 (1986): 140-3
- Parry MF, Rha CK "Pseudomembranous colitis caused by topical clindamycin phosphate." Arch Dermatol 122 (1986): 583-4
- Clissold SP, Todd PA, Campoli-Richards DM "Imipenem/cilastatin: a review of its antibacterial activity, pharmacokinetic properties and therapeutic efficacy." Drugs 33 (1987): 185-241
- Pokorney BH, Nichols TW, Jr "Pseudomembranous colitis. A complication of sulfasalazine therapy in a patient with Crohn's colitis." Am J Gastroenterol 76 (1981): 374-6
- Bingley PJ, Harding GM "Clostridium difficile colitis following treatment with metronidazole and vancomycin." Postgrad Med J 63 (1987): 993-4
- Hutcheon DF, Milligan FD, Yardley JH, Hendrix TR "Cephalosporin-associated pseudomembranous colitis." Am J Dig Dis 23 (1978): 321-6
- Sankarankutty M, McGeorge D, Galasko CS "Pseudomembranous colitis following cephradine prophylaxis." Postgrad Med J 58 (1982): 726-8
- Gordin F, Gibert C, Schmidt ME "Clostridium difficile colitis associated with trimethoprim-sulfamethoxazole given as prophylaxis for pneumocystis carinii pneumonia." Am J Med 96 (1994): 94-5
- Sugarman B "Trimethoprim-sulfamethoxazole, pseudomembranous colitis, and spinal cord injury." South Med J 78 (1985): 711-3
- Bernstein L "Adverse reaction to trimethoprim-sulfamethoxazole, with particular reference to long-term therapy." Can Med Assoc J 112 (1975): s96-8
- Midtvedt T, Carlstedt-Duke B, Hoverstad T, et al "Influence of peroral antibiotics upon the biotransformatory activity of the intestinal microflora in healthy subjects." Eur J Clin Invest 16 (1986): 11-7
- Altamirano A, Bondani A "Adverse reactions to furazolidone and other drugs. A comparative review." Scand J Gastroenterol Suppl 169 (1989): 70-80
- Ring FA, Hershfield NB, Machin GA, Scott RB "Sulfasalazine-induced colitis complicating idiopathic ulcerative colitis." Can Med Assoc J 131 (1984): 43-5
- Golledge CL, Riley TV "Clostridium difficile-associated diarrhoea after doxycycline malaria prophylaxis." Lancet 345 (1995): 1377-8
- Friedman RJ, Mayer IE, Galambos JT, Hersh T "Oxacillin-induced pseudomembranous colitis." Am J Gastroenterol 73 (1980): 445-7
- Edlund C, Lidbeck A, Kager L, Nord CE "Effect of enoxacin on colonic microflora of healthy volunteers." Eur J Clin Microbiol 6 (1987): 298-300
- Van Ness MM, Cattau EL Jr "Fulminant colitis complicating antibiotic-associated pseudomembranous colitis: case report and review of the clinical manifestations and treatment." Am J Gastroenterol 82 (1987): 374-7
- Boriello SP, Jones RH, Phillips I "Rifampicin-associated pseudomembranous colitis." Br Med J 281 (1980): 1180-1
- Klinger D, Radford P, Collin J "Pneumoperitoneum without faecal peritonitis in a patient with pseudomembranous colitis." Br Med J 288 (1984): 1271-2
- "Multum Information Services, Inc. Expert Review Panel"
- Leigh DA, Simmons K, Williams S "Gastrointestinal side effects following clindamycin and lincomycin treatment: a follow up study." J Antimicrob Chemother 6 (1980): 639-45
- Hecht JR, Olinger EJ "Clostridium difficile colitis secondary to intravenous vancomycin." Dig Dis Sci 34 (1989): 148-9
- Hinton NA "The effect of oral tetracycline HCl and doxycycline on the intestinal flora." Curr Ther Res Clin Exp 12 (1970): 341-52
- Brause BD, Romankiewicz JA, Gotz V, Franklin JE Jr, Roberts RB "Comparative study of diarrhea associated with clindamycin and ampicillin therapy." Am J Gastroenterol 73 (1980): 244-8
- Edlund C, Brismar B, Nord CE "Effect of lomefloxacin on the normal oral and intestinal microflora." Eur J Clin Microbiol Infect Dis 1 (1990): 35-9
- Saginur R, Hawley CR, Bartlett JG "Colitis associated with metronidazole therapy." J Infect Dis 141 (1980): 772-4
Macrolide Antibiotics (Includes Erythromycin) ↔ Myasthenia Gravis
Moderate Potential Hazard, Moderate plausibility
Applies to: Myasthenia Gravis
The use of macrolide antibiotics has been reported to exacerbate symptoms of myasthenia gravis and trigger new onset of symptoms of myasthenic syndrome. Limited data suggest presynaptic suppression of acetylcholine release. Therapy with these agents should be administered cautiously in patients with a history of myasthenia gravis.
- May EF, Calvert PC "Aggravation of myasthenia gravis by erythromycin." Ann Neurol 28 (1990): 577-9
- "Product Information. Ery-tab (erythromycin)." Abbott Pharmaceutical, Abbott Park, IL.
erythromycin drug Interactions
There are 758 drug interactions with erythromycin
erythromycin alcohol/food Interactions
There are 2 alcohol/food interactions with erythromycin
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- Drug class: macrolides
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Drug Interaction Classification
|Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.|
|Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.|
|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.|
|No information available.|
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