Skip to main content

Drug Interactions between E.E.S.-200 and Epitol

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

Edit list (add/remove drugs)

Interactions between your drugs

Major

erythromycin carBAMazepine

Applies to: E.E.S.-200 (erythromycin) and Epitol (carbamazepine)

MONITOR CLOSELY: Some macrolide antibiotics can significantly increase serum carbamazepine levels. The mechanism is probably inhibition of hepatic CYP450 3A4 isoenzymes. Severe carbamazepine toxicity has been reported. At the same time, carbamazepine may induce the CYP450 3A4 metabolism of macrolides. This may lead to sub-therapeutic levels of macrolides and a decreased antibiotic effect.

MANAGEMENT: Monitoring of carbamazepine blood levels is recommended, and the patient should be carefully observed for signs of carbamazepine toxicity. Patients should be advised to report signs of carbamazepine toxicity (nausea, visual disturbances, dizziness, or ataxia) to their physicians. The carbamazepine dosage may require reduction. Monitor for a reduction in the antimicrobial effects of the macrolide if this combination must be used. Alternative antimicrobial therapy, if available, is generally recommended for patients on carbamazepine.

References

  1. Jaster PJ, Abbas D "Erythromycin-carbamazepine interaction." Neurology 36 (1986): 594-5
  2. Vajda FJ, Bladin PF "Carbamazepine-erythromycin-base interaction." Med J Aust Jan (1984): 81
  3. Wong YY, Ludden TM, Bell RD "Effect of erythromycin on carbamazepine kinetics." Clin Pharmacol Ther 33 (1983): 460-4
  4. Berrettini WH "A case of erythromycin-induced carbamazepine toxicity." J Clin Psychiatry 47 (1986): 147
  5. Mesdjian E, Dravet C, Cenraud B, Roger J "Carbamazepine intoxication due to triacetyloleandomycin administration in epileptic patients." Epilepsia 21 (1980): 489-96
  6. Hedrick R, Williams F, Morin R, Lamb WA, Cate JC "Carbamazepine-erythromycin interaction leading to carbamazepine toxicity in four epileptic children." Ther Drug Monit 5 (1983): 405-7
  7. Goulden KJ, Camfield P, Dooley JM, et al. "Severe carbamazepine intoxication after coadministration with erythromycin." J Pediatr 109 (1986): 135-8
  8. Dravet C, Mesdjian E, Cenraud B, Roger J "Interaction between carbamazepine and triacetyloleandomycin." Lancet 1 (1977): 810-1
  9. "Product Information. Tegretol (carbamazepine)." Novartis Pharmaceuticals PROD (2002):
  10. "Product Information. Ery-Tab (erythromycin)." Abbott Pharmaceutical (2022):
  11. Albani F, Riva R, Baruzzi A "Clarithromycin-carbamazepine interaction: a case report." Epilepsia 34 (1993): 161-2
  12. Stafstrom CE, Nohria V, Loganbill H, Nahouraii R, Boustany RM, Delong GR "Erythromycin-induced carbamazepine toxicity: a continuing problem." Arch Pediatr Adolesc Med 149 (1995): 99-101
  13. Metz DC, Getz HD "Helicobacter pylori gastritis therapy with omeprazole and clarithromycin increases serum carbamazepine levels." Dig Dis Sci 40 (1995): 912-5
  14. Amsden GW "Macrolides versus azalides: a drug interaction update." Ann Pharmacother 29 (1995): 906-17
  15. Dammann HG "Therapy with omeprazole and clarithromycin increases serum carbamazepine levels in patients with h-pylori gastritis." Dig Dis Sci 41 (1996): 519
  16. Keranen T, Jolkkonen J, Jensen PK, Menge GP, Andersson P "Absence of interaction between oxcarbazepine and erythromycin." Acta Neurol Scand 86 (1992): 120-3
  17. Cerner Multum, Inc. "UK Summary of Product Characteristics." O 0
  18. Cerner Multum, Inc. "Australian Product Information." O 0
  19. "Product Information. Equetro (carBAMazepine)." Validus Pharmaceuticals LLC
View all 19 references

Switch to consumer interaction data

Drug and food interactions

Moderate

erythromycin food

Applies to: E.E.S.-200 (erythromycin)

ADJUST DOSING INTERVAL: Food may variably affect the bioavailability of different oral formulations and salt forms of erythromycin. The individual product package labeling should be consulted regarding the appropriate time of administration in relation to food ingestion. Grapefruit juice may increase the plasma concentrations of orally administered erythromycin. The proposed mechanism is inhibition of CYP450 3A4-mediated first-pass metabolism in the gut wall by certain compounds present in grapefruits. In an open-label, crossover study consisting of six healthy subjects, the coadministration with double-strength grapefruit juice increased the mean peak plasma concentration (Cmax) and area under the concentration-time curve (AUC) of a single dose of erythromycin (400 mg) by 52% and 49%, respectively, compared to water. The half-life was not affected. The clinical significance of this potential interaction is unknown.

MANAGEMENT: In general, optimal serum levels are achieved when erythromycin is taken in the fasting state, one-half to two hours before meals. However, some erythromycin products may be taken without regard to meals.

References

  1. Welling PG, Huang H, Hewitt PF, Lyons LL "Bioavailability of erythromycin stearate: influence of food and fluid volume." J Pharm Sci 67 (1978): 764-6
  2. Welling PG, Elliott RL, Pitterle ME, et al. "Plasma levels following single and repeated doses of erythromycin estolate and erythromycin stearate." J Pharm Sci 68 (1979): 150-5
  3. Welling PG "Influence of food and diet on gastrointestinal drug absorption: a review." J Pharmacokinet Biopharm 5 (1977): 291-334
  4. Coyne TC, Shum S, Chun AH, Jeansonne L, Shirkey HC "Bioavailability of erythromycin ethylsuccinate in pediatric patients." J Clin Pharmacol 18 (1978): 194-202
  5. Malmborg AS "Effect of food on absorption of erythromycin. A study of two derivatives, the stearate and the base." J Antimicrob Chemother 5 (1979): 591-9
  6. Randinitis EJ, Sedman AJ, Welling PG, Kinkel AW "Effect of a high-fat meal on the bioavailability of a polymer-coated erythromycin particle tablet formulation." J Clin Pharmacol 29 (1989): 79-84
  7. Kanazawa S, Ohkubo T, Sugawara K "The effects of grapefruit juice on the pharmacokinetics of erythromycin." Eur J Clin Pharmacol 56 (2001): 799-803
View all 7 references

Switch to consumer interaction data

Moderate

carBAMazepine food

Applies to: Epitol (carbamazepine)

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

In a small, randomized, crossover study, the administration of carbamazepine with grapefruit juice (compared to water) increased plasma drug concentrations by approximately 40%. The proposed mechanism is inhibition of CYP450 3A4-mediated first-pass metabolism in the gut wall by certain compounds present in grapefruits.

MANAGEMENT: Patients receiving carbamazepine should be advised to avoid or limit consumption of alcohol. Given the drug's narrow therapeutic index, patients receiving carbamazepine therapy should preferably avoid the regular consumption of grapefruits and grapefruit juice to prevent any undue fluctuations in plasma drug levels. Patients should be advised to report signs of carbamazepine toxicity (nausea, visual disturbances, dizziness, or ataxia) to their physicians.

References

  1. "Product Information. Tegretol (carbamazepine)." Novartis Pharmaceuticals PROD (2002):
  2. Garg SK, Kumar N, Bhargava VK, Prabhakar SK "Effect of grapefruit juice on carbamazepine bioavailability in patients with epilepsy." Clin Pharmacol Ther 64 (1998): 286-8
  3. Bailey DG, Dresser GR, Kreeft JH, Munoz C, Freeman DJ, Bend JR "Grapefruit-felodipine interaction: Effect of unprocessed fruit and probable active ingredients." Clin Pharmacol Ther 68 (2000): 468-77

Switch to consumer interaction data

Minor

erythromycin food

Applies to: E.E.S.-200 (erythromycin)

Ethanol, when combined with erythromycin, may delay absorption and therefore the clinical effects of the antibiotic. The mechanism appears to be due to slowed gastric emptying by ethanol. Data is available only for erythromycin ethylsuccinate. Patients should be advised to avoid ethanol while taking erythromycin salts.

References

  1. Morasso MI, Chavez J, Gai MN, Arancibia A "Influence of alcohol consumption on erythromycin ethylsuccinate kinetics." Int J Clin Pharmacol 28 (1990): 426-9

Switch to consumer interaction data

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

Report options

Loading...
QR code containing a link to this page

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.

Medical Disclaimer