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Can you take Erythromycin with Tolterodine?

1 drug interaction and 19 additional warnings found for the following 2 drugs:

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Drug interactions

Moderate drug interactions

Moderate:

erythromycin tolterodine

Applies to: erythromycin and tolterodine

Erythromycin may increase the blood levels and effects of tolterodine.

High levels of tolterodine can increase the risk of an irregular heart rhythm that may be serious and potentially life-threatening, although it is a relatively rare side effect.

You may be more susceptible if you have:

  • a heart condition called congenital long QT syndrome
  • other cardiac diseases
  • conduction abnormalities
  • electrolyte disturbances (for example, magnesium or potassium loss due to severe or prolonged diarrhea or vomiting)

Your doctor may be able to prescribe alternatives that do not interact, or you may need a dose adjustment or more frequent monitoring to safely use both medications. Talk to your doctor if you have any questions or concerns.

You should seek immediate medical attention if you develop sudden dizziness, lightheadedness, fainting, shortness of breath, or heart palpitations during treatment with these medications, whether together or alone.

Contact your doctor if you experience heart palpitations, difficulty urinating, dry mouth, constipation, blurred vision, headache, drowsiness, dizziness, and/or abdominal pain.

Do not drive or operate heavy machinery until the effects of tolterodine have been determined.

It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Food/lifestyle interactions

Moderate food/lifestyle interactions

Moderate:

erythromycin Food/Lifestyle

Applies to: erythromycin

Food decreases the levels of erythromycin in your body. Take erythromycin on an empty stomach at least 30 minutes before or 2 hours after a meal. This will make it easier for your body to absorb the medication.

However, some erythromycin products may be taken without regard to meals. Ask your healthcare provider about your particular prescription if you are uncertain of how to take it.

Grapefruits and grapefruit juice may increase erythromycin levels but how this may affect you is not known. Do not increase or decrease the amount of grapefruit products in your diet without first talking to your doctor.

Minor food/lifestyle interactions

Minor:

erythromycin Alcohol (Ethanol)

Applies to: erythromycin

Information for this minor interaction is available on the professional version.

Disease interactions

17 potential interactions Applies to: 15 conditions, including Arrhythmia, Hypokalemia, Myasthenia Gravis, Dementia, and Urinary Retention.

Arrhythmia

Moderate:

erythromycin

Erythromycin has a moderate potential interaction with Arrhythmia.

Macrolides have been associated with prolongation of the QT interval and infrequent cases of arrhythmia. Clarithromycin and erythromycin should be avoided in: patients with known prolongation of the QT interval, ventricular cardiac arrhythmia, including torsades de pointes; patients with proarrhythmic conditions such as uncorrected hypokalemia or hypomagnesemia, clinically significant bradycardia, or receiving other drugs that prolong the QT interval.

Biliary Obstruction

Major:

erythromycin

Erythromycin has a major potential interaction with 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.

Central Nervous System Disorders

Moderate:

tolterodine

Tolterodine has a moderate potential interaction with Central Nervous System Disorders.

Tolterodine is associated with anticholinergic central nervous system (CNS) effects. If a patient experiences anticholinergic CNS effects, dose reduction or drug discontinuation should be considered. Tolterodine should be used with caution in patients with Parkinson's disease and in patients with preexisting dementia treated with cholinesterase inhibitors due to the risk of aggravation of symptoms.

Dementia

Moderate:

tolterodine

Tolterodine has a moderate potential interaction with Dementia.

Tolterodine is associated with anticholinergic central nervous system (CNS) effects. If a patient experiences anticholinergic CNS effects, dose reduction or drug discontinuation should be considered. Tolterodine should be used with caution in patients with Parkinson's disease and in patients with preexisting dementia treated with cholinesterase inhibitors due to the risk of aggravation of symptoms.

Gastrointestinal Obstruction

Major:

tolterodine

Tolterodine has a major potential interaction with Gastrointestinal Obstruction.

The use of tolterodine is contraindicated in patients with GI obstruction, ileus, or obstructive uropathy. Tolterodine exerts anticholinergic activity by competitive antagonism of muscarinic receptors.

Glaucoma/Intraocular Hypertension

Major:

tolterodine

Tolterodine has a major potential interaction with Glaucoma/Intraocular Hypertension.

The use of tolterodine is contraindicated in patients with uncontrolled angle-closure (narrow angle) glaucoma. Tolterodine exerts anticholinergic activity and can result in increased intraocular pressure and loss of accommodation.

Hypokalemia

Moderate:

erythromycin

Erythromycin has a moderate potential interaction with Hypokalemia.

Macrolides have been associated with prolongation of the QT interval and infrequent cases of arrhythmia. Clarithromycin and erythromycin should be avoided in: patients with known prolongation of the QT interval, ventricular cardiac arrhythmia, including torsades de pointes; patients with proarrhythmic conditions such as uncorrected hypokalemia or hypomagnesemia, clinically significant bradycardia, or receiving other drugs that prolong the QT interval.

Liver Disease

Major:

erythromycin

Erythromycin has a major potential interaction with Liver Disease.

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.

Moderate:

tolterodine

Tolterodine has a moderate potential interaction with Liver Disease.

Tolterodine undergoes biotransformation in the liver of extensive metabolizers to an active metabolite. Poor metabolizers have a greater concentration of active parent and less active metabolite, however the net activity of tolterodine is expected to be the same. The pharmacokinetic disposition of tolterodine can be significantly altered in patients with hepatic dysfunction. Therapy with tolterodine should be administered cautiously in patients with severe hepatic impairment and dosage should be reduced to no greater than 1 mg twice daily.

Long QT Syndrome

Moderate:

tolterodine

Tolterodine has a moderate potential interaction with Long QT Syndrome.

Tolterodine has been associated with QT prolongation. The effect on QT interval correlates with plasma concentration of tolterodine. Caution is recommended when prescribing this agent to patients with a known history of QT prolongation or to patients who are taking Class IA (e.g., quinidine, procainamide) or Class III (e.g., amiodarone, sotalol) antiarrhythmic medications.

Magnesium Imbalance

Moderate:

erythromycin

Erythromycin has a moderate potential interaction with Magnesium Imbalance.

Macrolides have been associated with prolongation of the QT interval and infrequent cases of arrhythmia. Clarithromycin and erythromycin should be avoided in: patients with known prolongation of the QT interval, ventricular cardiac arrhythmia, including torsades de pointes; patients with proarrhythmic conditions such as uncorrected hypokalemia or hypomagnesemia, clinically significant bradycardia, or receiving other drugs that prolong the QT interval.

Myasthenia Gravis

Moderate:

erythromycin

Erythromycin has a moderate potential interaction with 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. Therapy with these agents should be administered cautiously in patients with a history of myasthenia gravis.

Moderate:

tolterodine

Tolterodine has a moderate potential interaction with Myasthenia Gravis.

Tolterodine acts as a competitive antagonist of acetylcholine at postganglionic muscarinic receptors. Caution is recommended when using this agent in patients with myasthenia gravis, a disease characterized by decreased cholinergic activity at the neuromuscular junction.

Noninfectious Colitis

Major:

erythromycin

Erythromycin has a major potential interaction with Noninfectious Colitis.

Clostridioides difficile-associated diarrhea (CDAD), formerly pseudomembranous colitis, has been reported with almost all antibacterial drugs and may range from mild diarrhea to fatal colitis. The most common culprits include clindamycin and lincomycin. Antibacterial therapy alters the normal flora of the colon, leading to overgrowth of C difficile, whose toxins A and B contribute to CDAD development. Morbidity and mortality are increased with hypertoxin-producing strains of C difficile; these infections can be resistant to antimicrobial therapy and may require colectomy. CDAD must be considered in all patients who present with diarrhea after antibacterial use. Since CDAD has been reported to occur more than 2 months after antibacterial use, careful medical history is necessary. Therapy with broad-spectrum antibacterials and other agents with significant antibacterial activity should be administered cautiously in patients with history of gastrointestinal disease, particularly colitis; pseudomembranous colitis (generally characterized by severe, persistent diarrhea and severe abdominal cramps, and sometimes associated with the passage of blood and mucus), if it occurs, may be more severe in these patients and may be associated with flares in underlying disease activity. Antibacterial drugs not directed against C difficile may need to be stopped if CDAD is suspected or confirmed. Appropriate fluid and electrolyte management, protein supplementation, antibacterial treatment of C difficile, and surgical evaluation should be started as clinically indicated.

Prematurity/Underweight in Infancy

Major:

erythromycin

Erythromycin has a major potential interaction with 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.

Renal Dysfunction

Moderate:

tolterodine

Tolterodine has a moderate potential interaction with Renal Dysfunction.

The renal elimination of tolterodine and active metabolite is limited and a prolonged half-life is not anticipated in patients with renal impairment. However, the pharmacokinetic disposition of tolterodine has not been evaluated in patients with renal impairment and it is recommended that tolterodine be administered cautiously in patients with compromised renal function.

Urinary Retention

Major:

tolterodine

Tolterodine has a major potential interaction with Urinary Retention.

The use of tolterodine is contraindicated in patients with GI obstruction, ileus, or obstructive uropathy. Tolterodine exerts anticholinergic activity by competitive antagonism of muscarinic receptors.

More resources

erythromycin

A total of 719 drugs are known to interact with erythromycin.

tolterodine

A total of 670 drugs are known to interact with tolterodine.

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.