erythromycin (cont.)
Erythromycin prevents digoxin (Lanoxin) from being eliminated by the kidneys;
this in turn causes increased levels of digoxin in the blood. Increased levels
of digoxin can cause disturbances in heart rhythm. Therefore, it is important to
monitor and adjust digoxin doses when treating with erythromycin.
Erythromycin prevents the elimination of warfarin (Coumadin) from the body
which can raise the levels of warfarin in the blood. Warfarin is an
anticoagulant or blood thinner, and an increase in its level in blood can
increase the risk of bleeding. It is important to monitor the effects of
warfarin and adjust warfarin doses when treating with erythromycin.
Erythromycin
inhibits the breakdown of HMG-CoA reductase inhibitors (statins) such as
atorvastatin (Lipitor), lovastatin (Mevacor) and simvastatin (Zocor) by the
liver leading to increased levels of statins in the blood. High levels of
statins could result in severe myopathy (muscle damage) with
rhabdomyolysis
(rapid breakdown of skeletal muscle) that may damage the kidneys or even lead to
death. Erythromycin also can elevate blood levels of some anti-seizure drugs
such as carbamazepine (Tegretol) by preventing the breakdown of the anti-seizure
drug by the liver. Therefore, doses of the anti-seizure drugs may need to be
reduced during treatment with erythromycin.
Due to potential serious and even fatal heart problems, erythromycin should
not be taken with terfenadine (Seldane), astemizole (Hismanal),
pimozide (Orap),
or cisapride (Propulsid).
Grapefruit juice may prevent the breakdown of erythromycin, resulting in
elevated levels of erythromycin in the blood. Therefore, it is important to
avoid eating grapefruit or drinking grapefruit juice during treatment with
erythromycin.
PREGNANCY: Erythromycin crosses the placenta, but its level in the blood of
the fetus is low. There are no adequate studies in
pregnant women, hence
pregnant women should only use erythromycin if it is felt that the benefits of
treatment outweigh the potential but unknown risks.
NURSING MOTHERS: Erythromycin is excreted in
breast milk; however,
erythromycin is considered by the American Academy of Pediatrics to be
compatible with breast-feeding. Caution should be exercised, however, when
erythromycin is prescribed to women who are breast-feeding.
SIDE EFFECTS: The most frequent side effects of erythromycin are nausea,
vomiting, loss of appetite, diarrhea, and abdominal pain. These gastrointestinal
side effects are usually dose-related, i.e., more pronounced with higher doses.
Allergic reactions such as hives, rash, or anaphylaxis (a severe allergic
reaction which can lead to shock and death) have been reported rarely. Abnormal
liver tests and liver damage also may occur with erythromycin.
Reference: FDA Prescribing Information
Last Editorial Review: 2/5/2009
Report Problems to the Food and Drug Administration
You are encouraged to report negative side effects of prescription drugs to the FDA. Visit the FDA MedWatch website or call 1-800-FDA-1088.
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