In such patients, the dosage of caffeine containing medications or the ingestion of caffeine containing products may need to be reduced. If these agents are used together, obtain an ECG and serum electrolytes prior to the start of gemtuzumab and as needed during treatment. [64408], 333 mg PO every 8 hours in combination with oral amoxicillin for 5 days, following 48 hours of IV therapy. Erythromycin administration is associated with QT prolongation and TdP. Acetaminophen; Oxycodone: (Moderate) Consider a reduced dose of oxycodone with frequent monitoring for respiratory depression and sedation if concurrent use of erythromycin is necessary. (Moderate) Use caution and the lowest atorvastatin dose necessary if coadministration with erythromycin is necessary due to an increased risk of myopathy and rhabdomyolysis. Elbasvir; Grazoprevir: (Moderate) Administering elbasvir; grazoprevir with erythromycin may cause the plasma concentrations of all three drugs to increase; thereby increasing the potential for adverse effects (i.e., elevated ALT concentrations and hepatotoxicity). Pemigatinib: (Major) Avoid coadministration of pemigatinib and erythromycin due to the risk of increased pemigatinib exposure which may increase the risk of adverse reactions. Avoid concomitant use if possible, especially in patients with additional risk factors for TdP. If erythromycin is discontinued, the original encorafenib dose may be resumed after 3 to 5 elimination half-lives of erythromycin. 30 to 50 mg/kg/day (Max: 2 g/day) PO divided every 6 to 8 hours for 14 days as an adjunct to diphtheria antitoxin. Does erythromycin eye ointment have any side effects? Carefully weigh the potential benefits and risk of combined therapy. Tezacaftor; Ivacaftor: (Major) Adjust the tezacaftor; ivacaftor dosing schedule when coadministered with erythromycin; coadministration may increase tezacaftor; ivacaftor exposure and adverse reactions. Vandetanib: (Major) Concomitant use of vandetanib and erythromycin increases the risk of QT/QTc prolongation and torsade de pointes (TdP). Tasimelteon: (Moderate) Caution is recommended during concurrent use of tasimelteon and erythromycin. Tenofovir disoproxil fumarate is a P-gp substrate and erythromycin is a P-gp inhibitor. If concomitant use is unavoidable, administer erythromycin at least 6 hours after relugolix and monitor for adverse reactions. Shorter courses may be appropriate for less extensive infections. Use combination with caution and monitor for evidence of bleeding. Additive QT prolongation may also occur. Seek emergency medical attention or call the Poison Help line at 1-800-222-1222. erythromycin ophthalmic may cause blurred vision and may impair your reactions. Consider taking steps to minimize the risk for QT/QTc interval prolongation and TdP, such as electrolyte monitoring and repletion and ECG monitoring, if concomitant use is necessary. Moxifloxacin: (Major) Concomitant use of erythromycin and moxifloxacin increases the risk of QT/QTc prolongation and torsade de pointes (TdP). For the treatment of group A streptococcal pharyngitis, guidelines recommend erythromycin as an alternative for patients allergic to penicillin. Relugolix: (Major) Avoid concomitant use of relugolix and oral erythromycin. Further decrease the zanubrutinib dose as recommended if adverse reactions occur. Consult a cardiologist regarding appropriate monitoring if siponimod use is required. Amlodipine; Olmesartan: (Moderate) Monitor for symptoms of hypotension and edema if coadministration of amlodipine with erythromycin is necessary; adjust the dose of amlodipine as clinically appropriate. Use of these drugs together may increase the risk of developing torsade de pointes-type ventricular tachycardia. Brincidofovir is an OATP1B1/3 substrate and erythromycin is an OATP1B1/3 inhibitor. 15 to 20 mg/kg/day IV divided every 6 hours for 7 to 14 days. Consider a dose reduction of benzhydrocodone until stable drug effects are achieved. In addition, erythromycin may theoretically increase plasma concentrations of flecainide via inhibition of CYP3A4. Coadministration may result in elevated concentrations of conivaptan. Follow all directions on your prescription label and read all medication guides or instruction sheets. Digoxin is a P-gp substrate and erythromycin is a P-gp inhibitor. Protein binding is extensive at 75% to 90%. Add rifampin and treat complicated infections for 3 months. Hydrocodone is a CYP3A4 substrate, and coadministration with CYP3A4 inhibitors like erythromycin can increase hydrocodone exposure resulting in increased or prolonged opioid effects including fatal respiratory depression, particularly when an inhibitor is added to a stable dose of hydrocodone. Consider taking steps to minimize the risk for QT/QTc interval prolongation and TdP, such as electrolyte monitoring and repletion and ECG monitoring, if concomitant use is necessary. Stop wearing contact lenses. Tazemetostat: (Major) Avoid coadministration of tazemetostat with erythromycin as concurrent use may increase tazemetostat exposure and the frequency and severity of adverse reactions. Squeeze out a ribbon of ointment into the lower eyelid pocket without touching the tip of the tube to your eye. 400 mg PO twice daily has been recommended to reduce exacerbation rates. Coadministration of single oral doses of erythromycin 800 mg and zaleplon 10 mg resulted in a 34% increase in zaleplon peak concentrations and a 20% increase in zaleplon exposure. Moderate CYP3A4 inhibitors can increase flibanserin concentrations, which can cause severe hypotension and syncope. In addition, donepezil is partially metabolized by CYP3A4 and coadministration with CYP3A4 inhibitors, such as erythromycin, may increase donepezil concentrations, potentially resulting in dose-related toxicity. Azithromycin may be preferred if the use of a macrolide antibiotic is necessary in a patient receiving nicardipine therapy. However, coadministration with another moderate CYP3A inhibitor in healthy volunteers did not significantly change amlodipine exposure. Dienogest; Estradiol valerate: (Minor) As erythromycin inhibits CYP3A4 activity, serum estrogen concentrations and estrogenic-related side effects (e.g., nausea, breast tenderness) may potentially increase when coadministered with either estrogens or combined hormonal contraceptives. Atazanavir; Cobicistat: (Major) Avoid concurrent use of erythromycin with regimens containing cobicistat and atazanavir or darunavir; use of an alternative antibiotic is recommended. Avoid concomitant use if possible, especially in patients with additional risk factors for TdP. Erythromycin is an inhibitor of CYP3A4, one of the isoenzymes responsible for the metabolism of clozapine. For patients who have experienced rheumatic fever without carditis, prophylaxis is recommended for 5 years or until age 21 years (whichever is longer). Benzyl alcohol may also cause allergic reactions, therefore, parenteral erythromycin formulations should not be used in patients with benzyl alcohol hypersensitivity. This could lead to bacteria in the drug, which may cause severe eye problems or loss of eyesight. Avoid initiation of erythromycin in patients who are on stable treatment with mavacamten 2.5 mg per day because a lower dose of mavacamten is not available. Use of elagolix with drugs that inhibit OATP1B1 may increase elagolix plasma concentrations. Betrixaban is a substrate of P-gp; erythromycin inhibits P-gp. Coadministration is not recommended in patients younger than 6 months. Ixabepilone: (Moderate) Monitor for ixabepilone toxicity and reduce the ixabepilone dose as needed if concurrent use of erythromycin is necessary. Dronabinol is a CYP2C9 and 3A4 substrate; erythromycin is a moderate inhibitor of CYP3A4. Additionally, consider dosage reduction of buprenorphine until stable drug effects are achieved. After discontinuation of erythromycin, resume the previous dose of zanubrutinib. Decreased biliary excretion of entacapone may occur if these agents are given concurrently. Zaleplon: (Moderate) Monitor for an increase in zaleplon-related adverse effects if concomitant use with erythromycin is necessary. Nintedanib: (Moderate) Dual inhibitors of P-glycoprotein (P-gp) and CYP3A4, such as erythromycin, are expected to increase the exposure and clinical effect of nintedanib. TdP and complete atrioventricular block have been reported. Zavegepant is an OATP1B3 substrate and erythromycin is an OATP1B3 inhibitor. Tramadol; Acetaminophen: (Moderate) Administration of CYP3A4 inhibitors such as erythromycin with tramadol may affect the metabolism of tramadol leading to altered tramadol exposure. Avoid concomitant use if possible, especially in patients with additional risk factors for TdP. Erythromycin is associated with QT prolongation and TdP. Concurrent administration of ketoconazole decreased the clearance of docetaxel by 49% as compared to giving docetaxel alone. Erythromycin ethylsuccinate film-coated tablets: Swallow whole; do not crush, break, or chew. Nifedipine: (Major) Avoid administration of erythromycin and nifedipine, particularly in geriatric patients. Diphenoxylate; Atropine: (Minor) Diphenoxylate/difenoxin decreases GI motility. Efavirenz: (Major) Consider alternative therapy as the coadministration of efavirenz and erythromycin may increase the risk for QT prolongation and torsade de pointes (TdP). Sufentanil: (Moderate) Because the dose of the sufentanil sublingual tablets cannot be titrated, consider an alternate opiate if erythromycin must be administered. Oliceridine is a CYP3A4 substrate and erythromycin is a moderate CYP3A4 inhibitor. The clinical implications of these pharmacokinetic interactions are uncertain, but some studies have used the interaction to dose-reduce methylprednisolone in acutely asthmatic patients without compromising steroid efficacy. Avanafil is a sensitive CYP3A4 substrate and erythromycin is a moderate CYP3A4 inhibitor. Avoid concomitant use if possible, especially in patients with additional risk factors for TdP. Elderly patients 65 years and older may be at increased risk for QT prolongation and may be more susceptible to the development of torsades de pointes than younger patients. Romidepsin: (Major) Romidepsin is a substrate for CYP3A4 and P-glycoprotein (P-gp). Cobimetinib is a P-glycoprotein (P-gp) substrate as well as a CYP3A substrate in vitro; erythromycin is a moderate inhibitor of both CYP3A and P-gp. Droperidol administration is associated with an established risk for QT prolongation and torsades de pointes (TdP). Betrixaban: (Major) Avoid betrixaban use in patients with severe renal impairment receiving erythromycin. Daclatasvir: (Moderate) Concurrent administration of daclatasvir, a CYP3A4 substrate, with erythromycin, a moderate CYP3A4 inhibitor, may increase daclatasvir serum concentrations. Add rifampin and treat complicated infections for 3 months. Fentanyl is a CYP3A4 substrate, and coadministration with CYP3A4 inhibitors like erythromycin can increase fentanyl exposure resulting in increased or prolonged opioid effects including fatal respiratory depression, particularly when an inhibitor is added to a stable dose of fentanyl. If coadministration cannot be avoided in adults and pediatric patients 12 years and older with BSA greater than 1.5 m2, reduce the entrectinib dose to 200 mg PO once daily. Concurrent use may increase berotralstat exposure and the risk of adverse effects. 400 mg PO every 6 hours for 7 days. Trifluoperazine: (Minor) Due to the potential for QT prolongation and torsade de pointes (TdP), caution is advised when administering erythromycin with trifluoperazine. Simulation suggests a moderate inhibitor may increase tezacaftor exposure 2-fold. Twice-daily dosing is not recommended with doses more than 1 g/day.[28251]. Acetaminophen; Hydrocodone: (Moderate) Consider a reduced dose of hydrocodone with frequent monitoring for respiratory depression and sedation if concurrent use of erythromycin is necessary. 250 mg PO every 6 hours or 500 mg PO every 12 hours. What do I need to tell the doctor BEFORE my child takes this drug? Copyright 1996-2023 Cerner Multum, Inc. Erythromycin eye ointment is an effective treatment for bacterial eye infections. Nisoldipine is a CYP3A4 substrate and erythromycin is a moderate CYP3A4 inhibitor. Red Yeast Rice: (Contraindicated) The concurrent use of erythromycin is not recommended during lovastatin therapy. (Moderate) Concentrations of darunavir may be increased with coadministration, as erythromycin is a CYP3A4 inhibitor and darunavir is a CYP3A4 substrate. Erythromycin 5 mg/gram ophthalmic ointment. Zanubrutinib: (Major) Decrease the zanubrutinib dose to 80 mg PO twice daily if coadministered with erythromycin. Glecaprevir and erythromycin are both substrates and inhibitors of P-glycoprotein (P-gp). Coadministration with a moderate CYP3A inhibitor in elderly hypertensive patients increased systemic exposure to amlodipine by 60%. However, coadministration with another moderate CYP3A inhibitor in healthy volunteers did not significantly change amlodipine exposure. 1 g PO in combination with neomycin 1 g PO. Coadministration may decrease plasma concentrations of these active metabolites, decreasing the effectiveness of ifosfamide treatment. Monitoring for adverse effects, such as CNS effects and extrapyramidal symptoms, is advisable during coadministration. Consider the benefits of breast-feeding, the risk of potential drug exposure, and the risk of an untreated or inadequately treated condition. When possible, alternative antibiotics should be considered. Gemtuzumab Ozogamicin: (Major) Use gemtuzumab ozogamicin and erythromycin together with caution due to the potential for additive QT interval prolongation and risk of torsade de pointes (TdP). Ciprofloxacin: (Major) Concomitant use of ciprofloxacin and erythromycin increases the risk of QT/QTc prolongation and torsade de pointes (TdP). Avoid concomitant use if possible, especially in patients with additional risk factors for TdP. Cobicistat is a substrate of CYP3A4 and a P-gp inhibitor, while both atazanavir and darunavir are CYP3A4 substrates. Another review concurred with these data, but noted that individual patients have been identified who experienced significant decreases in plasma concentrations of combined OC components and who appeared to ovulate; the agents most often associated with these changes were rifampin, tetracyclines, and penicillin derivatives. Coadministration may increase the exposure of duvelisib. Coadministration with another moderate CYP3A4 inhibitor is predicted to increase the ivosidenib single-dose AUC to 173% of control based on physiologically-based pharmacokinetic modeling, with no change in Cmax. Consider taking steps to minimize the risk for QT/QTc interval prolongation and TdP, such as electrolyte monitoring and repletion and ECG monitoring, if concomitant use is necessary. Concomitant use may increase omaveloxolone exposure and the risk for omaveloxolone-related adverse effects. It is recommended to avoid this combination when hydrocodone is being used for cough. Erythromycin is an inhibitor of the hepatic isoenzyme CYP3A4; rilpivirine is metabolized by this isoenzyme. However, coadministration with another moderate CYP3A inhibitor in healthy volunteers did not significantly change amlodipine exposure. Amlodipine; Celecoxib: (Moderate) Monitor for symptoms of hypotension and edema if coadministration of amlodipine with erythromycin is necessary; adjust the dose of amlodipine as clinically appropriate. Carbamazepine: (Moderate) Monitor carbamazepine concentrations closely during coadministration of erythromycin; carbamazepine dose adjustments may be needed. Follow all directions on your medicine label and package. During long-term antibiotic administration, the risk for drug interaction with OCs is less clear, but alternative or additional contraception may be advisable in selected circumstances. If these agents are used in combination, the patient should be carefully monitored for aripiprazole-related adverse reactions. Taking these drugs together may result in elevated concentrations of erythromycin, cobicistat, atazanavir and darunavir. Systemic concentrations of eletriptan may be increased. If erythromycin is discontinued, monitor the patient carefully and consider increasing the opioid dosage if appropriate. Venlafaxine: (Major) Concomitant use of erythromycin and venlafaxine increases the risk of QT/QTc prolongation and torsade de pointes (TdP). Patients receiving estrogens should be monitored for an increase in adverse events. Avoid concomitant use if possible, especially in patients with additional risk factors for TdP. Specifically, as monotherapy, the median erythromycin Cmax was 1.34 mg/L (range, 0.4 to 3.16), and the median apparent oral clearance was 96 L/hour (range, 37 to 250). If erythromycin is discontinued, monitor the patient carefully and consider increasing the opioid dosage if appropriate. Coadministration is contraindicated in patients with renal or hepatic impairment because colchicine accumulation may be greater in these populations. Erythromycin ophthalmic preparations are used to treat infections of the eye. Also, supratherapeutic doses of rilpivirine (75 to 300 mg/day) have caused QT prolongation; caution is advised when administering rilpivirine with other drugs that may prolong the QT or PR interval, such as erythromycin. Consideration should be given to reducing the clozapine dose if necessary. Erythromycin is an inhibitor of CYP3A4 and P-gp. In another placebo-controlled trial, trauma patients treated with erythromycin 250 mg IV every 6 hours reached a higher percentage of target enteral nutrition volume at 48 hours compared to those that received placebo (58% vs. 44%, p = 0.011); however, there was no difference in the amount of feeding tolerated over the course of the entire study. When combined, dose 1 tezacaftor; ivacaftor combination tablet every other day in the morning and 1 ivacaftor tablet every other day in the morning on alternate days (i.e., tezacaftor/ivacaftor tablet on Day 1 and ivacaftor tablet on Day 2). Avoid concomitant use if possible, especially in patients with additional risk factors for TdP. In addition, when chronically coadministering erythromycin ( > 30 days) with conjugated estrogens; bazedoxifene, adequate diagnostic measures, including directed or random endometrial sampling when indicated by signs and symptoms of endometrial hyperplasia, should be undertaken to rule out malignancy in postmenopausal women with undiagnosed persistent or recurring abnormal genital bleeding. Eliglustat: (Major) In intermediate or poor CYP2D6 metabolizers (IMs or PMs), coadministration of erythromycin (including erythromycin; sulfisoxazole) and eliglustat is not recommended. Coadministration is not recommended in patients younger than 6 months. Discontinuation of erythromycin could decrease codeine plasma concentrations, decrease opioid efficacy, and potentially lead to a withdrawal syndrome in those with physical dependence to codeine. Consider taking steps to minimize the risk for QT/QTc interval prolongation and TdP, such as electrolyte monitoring and repletion and ECG monitoring, if concomitant use is necessary. Erythromycin is a CYP3A4 inhibitor. Triptorelin: (Major) Concomitant use of triptorelin and erythromycin increases the risk of QT/QTc prolongation and torsade de pointes (TdP). Coadministration with a moderate CYP3A inhibitor in elderly hypertensive patients increased systemic exposure to amlodipine by 60%. In addition, coadministration of erythromycin, a CYP3A4 inhibitor, with alfuzosin, a CYP3A4 substrate, may result in elevated alfuzosin plasma concentrations. Concomitant use may result in elevated plasma concentrations of dronabinol. Consider taking steps to minimize the risk for QT/QTc interval prolongation and TdP, such as electrolyte monitoring and repletion and ECG monitoring, if concomitant use is necessary. Use the lowest possible atorvastatin dose. Eszopiclone: (Moderate) Clinically relevant interaction, possibly requiring a reduction of eszopiclone dose, may occur when eszopiclone is administered with erythromycin (a moderate CYP3A4 inhibitor). Erythromycin is a moderate inhibitor of CYP3A4. Erythromycin is excreted mainly by the liver. Consider taking steps to minimize the risk for QT/QTc interval prolongation and TdP, such as electrolyte monitoring and repletion and ECG monitoring, if concomitant use is necessary. In patients with hepatic impairment, a potential additive effect of reduced metabolism may further increase systemic rifaximin exposure. Levoketoconazole: (Contraindicated) Avoid concomitant use of ketoconazole and erythromycin due to an increased risk for torsade de pointes (TdP) and QT/QTc prolongation. WebUSP 0.5% (Sterile) Rx only DESCRIPTION Erythromycin ophthalmic ointment, USP belongs to the macrolide group of antibiotics. Carefully weigh the potential benefits and risk of combined therapy. Consider adding a second antibiotic if lesions do not respond within the first few days of therapy. Avoid concomitant use if possible, especially in patients with additional risk factors for TdP. Concurrent use of CYP3A4 or P-gp inhibitors with doxorubicin has resulted in clinically significant interactions. This product is available in the following dosage forms: Portions of this document last updated: Feb. 01, 2023. Imatinib: (Moderate) Any agent that inhibits cytochrome P450 3A4, such as erythromycin, may decrease the metabolism of imatinib and increase imatinib concentrations leading to an increased incidence of adverse reactions. Absorption takes place mainly in the duodenum. (Moderate) Inhibitors of the hepatic CYP4501A2, such as erythromycin, may inhibit the hepatic oxidative metabolism of caffeine.
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