Macrolides Ergot derivatives

MACROLIDES ERGOT DERIVATIVES t ergotamine/methysergide levels, with risk of toxicity Inhibition of CYP3A4-mediated metabolism of the ergot derivatives Avoid co-administration... 

The interactions of ergot derivatives with erythromycin and troleandomycin are well documented, well establish, and clinically important, whereas information about clarithromycin appears to be eonfined to three possible cases and that relating to oleandomycin to one case. There are no adverse reports about midecamycin, but it is expected to interact similarly. The concurrent use of all of these macrolides and ergot derivatives should be avoided. Some of the cases cited were effectively treated with sodium nitroprusside or naftidrofuryl oxalate, with or without heparin. "" " Spiramycin, and josamycin would not be expected to interact because they do not inhibit CYP3A4. However, there is one unexplained and unconfirmed report of an interaction with josamycin. "... 

Cabergoline is an ergot derivative that is metabolised by the eytochrome P450 isoenzyme CYP3A4 (see also Bromoeriptine and other dopamine agonists + Macrolides , p.678). Itraeonazole is a potent inhibitor of this isoenzyme, and would therefore be expected to inerease cabergoline levels. 

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