Erythromycin

Renal impairment

Hepatic impairment
Use with caution in hepatic impairment, particularly if patients with acute hepatic insufficiency receive high doses of erythromycin as it may cause idiosyncratic hepatotoxicity.

Not known to be harmful

• Contraindications: Acute porphyria.
• Increased risk of ototoxicity in renal impairment, especially at high doses

Erythromycin: caution required due to cardiac risks (QT interval prolongation); drug interaction with rivaroxaban (December 2020)

Link here

Be aware of reports of cardiotoxicity (QT interval prolongation) with macrolide antibiotics, in particular with erythromycin and clarithromycin

Erythromycin should not be given to patients with:

• a history of QT interval prolongation (congenital or documented acquired QT interval prolongation) or ventricular cardiac arrhythmia, including torsades de pointes
• electrolyte disturbances (hypokalaemia or hypomagnesaemia due to the risk of arrhythmia associated with QT interval prolongation)

Consider the potential benefit of treatment against the cardiac risks when prescribing in patients at increased risk of a cardiac event. Patients in whom caution is needed are those with:

• cardiac disease or heart failure
• conduction disturbances or clinically relevant bradycardia
• those concomitantly taking other medicines associated with QT interval prolongation

Direct patients to the patient information leaflet (PIL) and remind at-risk patients of the importance of seeking medical attention if they develop signs or symptoms of a cardiac event.

Erythromycin may interact with rivaroxaban and increase the risk of bleeding – consider this interaction when prescribing antibiotics and follow precautions in the product information if concomitant use is necessary. Discuss with pharmacy for further advice.

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 Erythromycin. Accessed via www.medicines.org.uk 26/03/18. Last updated 23/06/16
2. The Renal Drug Database. Erythromycin. Accessed via renaldrugdatabase.com 26/03/18. Last updated 22/02/18
3. Drugs in Pregnancy and Lactation. Briggs G et al. 6^th Edition.
4. MHRA. Drug Safety update (December 2020) Erythromycin: caution required due to cardiac risks (QT interval prolongation); drug interaction with rivaroxaban. Accessed at https://www.gov.uk/drug-safety-update/erythromycin-caution-required-due-to-cardiac-risks-qt-interval-prolongation-drug-interaction-with-rivaroxaban
5. MHRA. Drug Safety update (February 2022) Hydroxychloroquine, chloroquine: increased risk of cardiovascular events when used with macrolide antibiotics; reminder of psychiatric reactions. Accessed at https://www.gov.uk/drug-safety-update/hydroxychloroquine-chloroquine-increased-risk-of-cardiovascular-events-when-used-with-macrolide-antibiotics-reminder-of-psychiatric-reactions