Erythromycin Antacids

Interactions Antacids ciclosporin colestipol druas metabolized bv cytochrome P450 3A4 fibrates oral-contraceptiyes warfarin niacin erythromycin diaoxin azole-antifunaals... 

Drugs that may affect HMG-CoA reductase inhibitors include alcohol, amiodarone, antacids, azole antifungals, bile acid sequestrants, cimetidine, cyclosporine, diltiazem, erythromycin, gemfibrozil, isradipine, nefazodone, niacin, nicotinic acid, omeprazole, phenytoin, propranolol, protease inhibitors, ranitidine, rifampin, St. John s wort, and verapamil. 

Azithromycin Drugs that may interact with azithromycin include antacids, cyclosporine, HMG-CoA reductase inhibitors, pimozide, tacrolimus, theophyllines, and warfarin. Also consider all drug interactions with erythromycin. 

Erythromycin Drugs that may be affected by erythromycin include alfentanil, anticoagulants, benzodiazepines, buspirone, carbamazepine, cisapride, cyclosporine, digoxin, disopyramide, ergot alkaloids, felodipine, fluoroquinolones, HMG-CoA reductase inhibitors, lincosamides, methylprednisolone, penicillins, and theophyllines. Drugs that may affect erythromycin include antacids, pimozide, rifamycins, and theophyllines. 

Prednisolone [Corticosteroid] [See Steroids and Table VI-1] Interactions T Effects W/ clarithromycin, erythromycin, estrogen, ketoconazole, OCPs, troleandomycin X effects W/ antacids, aminoglutethimide, barbiturates, cholestyramine, colestipol, phenytoin, rifampin X effects OF anticoagulants, hypoglycemics, INH, salicylates, vaccine toxoids EMS Infxns may be masked OD May cause wt gain, T hair growth, acne, HTN, peripheral edema, and sore muscles symptomatic and supportive... 

With the important exception of additive effects when combined with other CNS depressants, including alcohol, BZDs interact with very few drugs. Disulfiram (see the section The Alcoholic Patient in Chapter 14) and cimetidine may increase BZD blood levels, and diazepam may increase blood levels of digoxin and phenytoin. Antacids may reduce the clinical effects of clorazepate by hindering its biotransformation to desmethyidiazepam. Coadministration of a BZD and another drug known to induce seizures may possibly increase seizure risk, especially if the BZD is abruptly withdrawn. Furthermore, as noted earlier, important interactions have been reported among nefazodone, erythromycin, troleandomycin, and other macrolide antibiotics, as well as itraconazole. In each case, metabolism is inhibited, and triazolam levels can increase significantly. 

Azithromycin is rapidly absorbed and well tolerated orally. It should be administered 1 hour before or 2 hours after meals. Aluminum and magnesium antacids do not alter bioavailability but delay absorption and reduce peak serum concentrations. Because it has a 15-member (not 14-member) lactone ring, azithromycin does not inactivate cytochrome P450 enzymes and therefore is free of the drug interactions that occur with erythromycin and clarithromycin. 

Drug Interactions Gemfibrozil Niacin Erythromycin Cholestyramine Digoxin Cimetidine/ranitidine/ omeprazole Rifampicin Warfarin Itraconazole Gemfibrozil Niacin Erythromycin Propranolol Digoxin Warfarin Antacids Colestipol Digoxin Erythromycin Oral contraceptives Fibrates Niacin Azole antifungals... 

N/V/D, abcl pain, bleeding, fever, T QT Interactions T Effects W/ atazanavir, clar-itliromycin, erythromycin, indinavir, itraconazole, ketoconazole, nefazodone, nelfi-navir, ritonavir, saquinavir, telithromydn 1 effects W/ antacids, carbamazepine, dexamethasone, phenobarbital, phenytoin, rifampicin, St. John s wort EMS Ding contains lactose, may cause D/abd discomfort in pts w/ lactose intolerance OD Sxs unknown symptomatic and supportive... 

Tablets (e.g., quinapril hydrochloride) Capsules (e.g., pancrease) Oral suspensions (e.g., cefuroxime axetil) Injectables (e.g., coumadin) Sterile powders (e.g., cefoxitin) Topicals (e.g., zinc oxide powder) Anti-infectives (e.g., erythromycin ethyl succinate) Anti-coagulants (e.g., warfarin sodium) Anti-asthmatics (e.g., montelukast sodium) Anti-psychotics and anxiolytics Hypnotics and anticonvulsants (e.g., barbiturates) Anti-hypertensives Anti-inflammatories (e.g., indomethacin) Analgesics (e.g., aspirin) Antacids (e.g., aluminum hydroxide) Diuretics Enzymes (e.g., pancreatin) Hormones...

Arayne MS, Sultana N. Erythromycin-antacid interaction. Phar-mazie 1993 48 599-602. 

Clinically important, potentially hazardous interactions with aminophylline, amiodarone, antacids, antineoplastics, arsenic, bepridil, bismuth, bismuth subsalicylate, bretylium, calcium salts, cocoa, didanosine, disopyramide, duloxetine, erythromycin, iron, magnesium salts, meptazinol, methylxanthines, NSAIDs, phenothiazines, procainamide, quinidine, rasagiline, sotalol, sucralfate, tizanidine, tricyclic antidepressants, zinc... 

Clinically important, potentially hazardous interactions with alfuzosin, alprazolam, amphotericin B, anisindione, antacids, aprepitant, astemizole, atorvastatin, bosentan, ciclesonide, cimetidine, clorazepate, conivaptan, cyproterone, dasatinib, dexamethasone, dicumarol, didanosine, eplerenone, erythromycin, ethotoin, fentanyl, fesoterodine, fosamprenavir, fosphenytoin, grapefruit juice, HMG-CoA reductase inhibitors, imatinib, ixabepilone, lapatinib, lopinavir, lovastatin, mephenytoin, methylprednisolone, micafungin, midazolam, nilotinib, pimozide, prednisolone, prednisone, quinidine, rifampin, rimonabant, rivaroxaban, sildenafil, silodosin, simvastatin, sirolimus, solifenacin, temsirolimus, terfenadine, tolvaptan, triazolam, vardenafil, vinblastine, vincristine, warfarin... 

CAUTION. Bioavailability of digoxin gets altered due to the presence of such drugs as antacids, antineoplastic agents, cholestyramine resins, dietary fibre, erythromycin, neomycin, tetracyclines, metoclopramide, sulphasalazine and propantheline. 

Yamreudeewong W, Scavaie I one RP, Lewis GP Effect of antacid coadministration on the bioavailability of erythromycin stearate. Cbn Pharm ( 9Z9) 8, 352-4. 

Aluminium/magnesium hydroxide antacids may reduce the peak levels of azithromycin. Mylanta can prolong the absorption of erythromycin, but this is unlikely to be clinically important Aluminium/magnesium hydroxide antacids do not appear to significantly alter the pharmacokinetics of clarithromycin, roxithromycin or telithromycin. 

The manufacturers of sertindole contraindicate the concurrent use of cimetidine, diltiazem, erythromycin, itraconazole, ketoco-nazole, terfenadine and verapamil because of an increased risk of cardiac arrhythmias. Carbamazepine and phenytoin reduce plasma sertindole levels whereas fluoxetine and paroxetine increase them. No clinically relevant interactions occur with alprazolam, antacids, food or tobacco smoking. 

The adverse effect profile of roflmnilast has been described previously. However, new data became available recently. A systematic review smnmarised the available data on adverse effects and drug reactions of roflmnilast. This systematic review was based on six clinical trials with a total population of 9102 COPD patients, with the study duration ranging between 24 and 52 weeks [89 ]. Roflmnilast is metabolised by CYP 3A4, CYP 2C19 and CYP 1A2. Inhibitors of these enzymes such as erythromycin or ketoconazole were shown to increase the activity and half-life of roflumilast. In contrast, drugs that induced these enzymes, like rifampicin, had the opposite effect, reducing the activity and half-life of roflumilast. Roflumilast did not significantly interact with montelukast, budesonide, or antacids. 

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