Azithromycin

Renal impairment

Hepatic impairment

Avoid in severe liver disease

Use only if potential benefit outweighs risks and only if no safer alternative. Discuss with pharmacy.

• MHRA Drug Safety Update (February 2022). Hydroxychloroquine, chloroquine: increased risk of cardiovascular events when used with macrolide antibiotics; reminder of psychiatric reactions

  • Consider the benefits and risks before prescribing systemic azithromycin or other systemic macrolide antibiotics (erythromycin or clarithromycin) to patients being treated with hydroxychloroquine or chloroquine. An observational study has shown that co-administration of azithromycin with hydroxychloroquine in patients with rheumatoid arthritis is associated with an increased risk of cardiovascular events (including angina or chest pain and heart failure) and cardiovascular mortality.
  • If there is a clinical need to prescribe systemic macrolide antibiotics with hydroxychloroquine or chloroquine, use caution in patients with risk factors for cardiac events and follow advice in the product information for each medicine.
  • Be vigilant for psychiatric reactions, especially in the first month of treatment; events have been reported in patients with no prior history of psychiatric disorders.
  • Report suspected adverse drug reactions on a Yellow Card.
  • Advise patients and carers to:
    • seek urgent medical help if you have any signs of problems with your heart (for example, palpitations, fainting, chest pain, or unexplained breathlessness)
    • speak to their doctor as soon as possible if you or your family members or caregivers notice any new or worsening mental health symptoms

1. Summary of Product Characteristics (SPC) for Azithromycin 250mg Capsules. Accessed via www.medicines.org.uk 26/03/18. Last updated 10/01/18
2. The Renal Drug Database. Azithromycin. Accessed via renaldrugdatabase.com 26/03/18. Last updated 20/02/18
3. BNF online accessed via www.medicinescomplete.com 19/12/18