azithromycin

AKA  Zithromax®, Zithromax Z-Pak®, Zmax SR®, ACT-Azithromycin®, Apo-Azithromycin®, Dom-Azithromycin®, GD-Azithromycin®, JAMP-Azithromycin®, MAR-Azithromycin, Mylan-Azithromycin®, PMS-Azithromycin®, PRO-Azithromycin®, Riva-Azithromycin®, Sandoz-Azithromycin®, Teva-Azithromycin® and others
Purpose  [+]   Antibiotic, Anti-Infective
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Warning Severity
Alcohol
Alcohol
(Booze, ethyl or ethanol, adult beverage, brew, brewski, liquor, drink, shot, sauce, rot gut, hooch, giggle juice, moonshine, jello shots, wobbly pop)
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Interaction
No information currently available.

Think First
Mixing azithromycin with alcohol doesn't seem to change the risk of drinking alcohol. This means, your usual dose of azithromycin and 1 or 2 drinks.

Think First
Remember, 1 drink = 1 beer, 1 glass of wine or 1 shot of liquor.

Think First
If you are depressed, blue, or moody, alcohol is a 'downer' and will make you feel worse.

Warning Severity
Tobacco
Tobacco
(smokes, butts, cigs, cigars, darts, stogies, cancer sticks, chew, dip)
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Interaction
No information currently available.

Unknown Dangers
Unknown dangers.

Warning Severity
Caffeine
Caffeine
(coffee, java, joe, soda, pop, tea, energy drinks (Red Bull®, Monster®, Rock Star®, Amp®, NOS®, Full Throttle®, 5-hour Energy Drink®, Beaver Buzz®), chocolate, cocoa)
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Interaction
No information currently available.

Unknown Dangers
Unknown dangers.

Warning Severity
Cannabis/ Hash
Cannabis/ Hash
(marijuana, mary jane, BC bud, blunt, chronic, J, jay, joint, hemp, pot, grass, herb, 420, dope, THC, weed, reefer, ganja, gangster, skunk, hydro, hash oil, weed oil, hash brownies, grease, boom, honey oil, K2, spice, poppers)
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Interaction
No information currently available.

Unknown Dangers
Unknown dangers.

Warning Severity
Cocaine/ Crack
Cocaine/ Crack
(coke, snow, flake, nose candy, blow, lady white, stardust, rock, crystal, bazooka, moon rock, tar)
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Interaction
QTc interval prolongation has been observed with azithromycin. Concomitant use with cocaine may result in an arrhythmia with the potential to develop Torsades de Pointes.

Mechanism
Both azithromycin and cocaine can cause QTc interval prolongation. When used together, these effects may be additive.

Significance
Due to increased risk of QTc interval prolongation, it is recommended to avoid concomitant use of cocaine and azithromycin.
Serious Risk for Harm
Both cocaine and azithromycin can cause abnormal heart rhythm. Mixing these two medications could make the chance of having a deadly abnormal heart beat more likely, so this cocktail should be avoided.

Warning Severity
Opioids
Opioids
(codeine, Tylenol #3®, cody, meperidine, Demerol®, DXM, dextromethorphan, robo, skittles, morphine, morph, monkey, methadone, bupe, sub, or dollies, oxycodone, Oxycontin®, hillbilly heroin, OxyNeo®, OC, oxy, roxy, percs, fentanyl, Sublimaze®, Duragesic®, china white, hydrocodone, Hycodan®, Vicodin®, suboxone®, buprenorphine, vike, heroin, H, horse, junk, smack, brown sugar, black tar, down, china white, purple drank, W18, carfentanil, elephant tranquilizer, loperamide, lope, lean)
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Interaction
METHADONE: QTc prolongation has been observed with azithromycin. Concomitant use with methadone may result in an arrhythmia with the potential to develop Torsades de Pointes.

A 47 year old male on methadone maintenance therapy (10 mg TID) was three days into a course of azithromycin therapy when he experienced symptoms of nausea and palpitations, followed by cyanosis and unconsciousness. ECG revealed sinus tachycardia and a QTc interval of 490 msec.

LOPERAMIDE: QTc prolongation has been observed with azithromycin. Concomitant use with high-dose loperamide (>100 mg/day) may result in an arrhythmia with the potential to develop Torsades de Pointes.

Mechanism
METHADONE: Both azithromycin and methadone can cause QTc interval prolongation. When used together, these effects may be additive.

LOPERAMIDE: Both azithromycin and high dose loperamide can cause QTc interval prolongation. When used together, these effects may be additive.

Significance
METHADONE: Due to increased risk of QTc interval prolongation, it is recommended to avoid concomitant use of methadone and azithromycin.

LOPERAMIDE: Due to increased risk of QTc interval prolongation, it is recommended to avoid concomitant use of high-dose loperamide (>100 mg/day) and azithromycin.
Serious Risk for Harm
METHADONE: Both azithromycin and methadone can cause abnormal heart rhythm. Mixing these two medications could make the chance of having a deadly abnormal heart beat more likely, so this cocktail should be avoided.

Serious Risk for Harm
LOPERAMIDE: Use of both azithromycin and very high doses of loperamide (more than 100 mg in one day) can cause abnormal heart rhythm. Mixing these two medications could make the chance of having a deadly abnormal heart beat more likely, so this cocktail should be avoided.

Unknown Dangers
OTHER OPIOIDS: Unknown dangers.

Warning Severity
Amphetamines/ Stimulants
Amphetamines/ Stimulants
(uppers, ecstasy, E, X, Molly, mesc, XTC, love drug, MDA, MDE, Eve, MDMA, adam, disco biscuit, bennies, black beauties, Dexedrine®, Adderall®, dexies, Ritalin®, speed, crystal, meth, ice, glass, crank, tweak, cat, qat, kat, khat, bath salts, Ivory Wave, Vanilla Sky, Cloud 9)
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Interaction
No information currently available.

Unknown Dangers
Unknown dangers.

Warning Severity
Phencyclidine/ Ketamine
Phencyclidine/ Ketamine
(PCP, angel dust, PeaCe Pill, rocket fuel, love boat, embalming fluid, elephant tranquilizer, hog, illy, wet, wet stick, dipper, toe tag, cadillac, snorts, or surfer, Special K, vitamin K, CVR, cat tranquilizer, cat valium, jet, kit kat, Ketalar®)
Learn more about this substance »
Interaction
No information currently available.

Unknown Dangers
Unknown dangers.

Warning Severity
LSD/ Hallucinogens
LSD/ Hallucinogens
(acid, blotter, cartoon acid, hit, purple haze, trip, white lightning, raggedy ann, sunshine, window-pane, microdot, boomers, buttons, mesc, peyote, salvia, morning glory seeds, flying saucers, licorice drops, pearly gates, magic mushrooms, shrooms)
Learn more about this substance »
Interaction
No information currently available.

Unknown Dangers
Unknown dangers.

Warning Severity
Benzodiazepines
Benzodiazepines
(benzos, downers, tranquilizers, tranks, Ativan®, Halcion®, Klonopin®, Rivotril®, Restoril®, Serax®, Valium®, Xanax®, Rohypnol® (roofies, rope, the forget or date rape pill))
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Interaction
MIDAZOLAM: Azithromycin 750 mg had no effect on the metabolism of 10 or 15 mg doses of orally administered midazolam and did not affect the performance on psychomotor tests in 64 healthy subjects. Another study also found no interaction between azithromycin and midazolam.

OTHER BENZODIAZEPINES: Unknown dangers.

Mechanism
MIDAZOLAM: Unlike other macrolides, azithromycin does not inhibit CYP3A4 to a significant degree.

Significance
Azithromycin may be a preferred choice when a macrolide is prescribed for a patient receiving benzodiazepines.
Think First
MIDAZOLAM: Mixing azithromycin with midazolam doesn't seem to change the risk of taking midazolam.

Unknown Dangers
OTHER BENZODIAZEPINES: Unknown dangers.

Think First
Benzodiazepines are 'downers'. If you are depressed, blue, or moody, benzodiazepines can make this worse.



References

  [+]
Baxter K, ed. Stockley's Drug Interactions [online]. London: Pharmaceutical Press. 2017; Aug 23, 2017.       

Lexi-Comp ONLINE, Lexi-Comp ONLINE Interaction Analysis, Hudson, Ohio: Lexi-Comp, Inc.; 2017; Aug 23, 2017.   

Magnano AR, Talathoti NB, Hallur R et al. Effect of acute cocaine administration on the QTc interval of habitual users. Am J Cardiol 2006;15:1244-6.   

Mattila MJ, Vanakoski J, Idanpaan-Heikkila JJ. Azithromycin Does Not Alter the Effect of Oral Midazolam on Human Performance. Eur J Clin Pharmacol 1994;47:49-52.  

Upadhyay A, Bodar V, Malekzadegan M et al. Loperamide Induced Life Threatening Ventricular Arrhythmia. Case Rep Cardiol 2016;2016:5040176.   

Wills S. Drugs of Abuse, 2nd edition. Great Britain: Pharmaceutical Press 2005.  

Winton JC, Twilla JD et al. Sudden cardiac arrest in a patient on chronic methadone after the addition of azithromycin. Am J Med Sci 2013;345:160-2.   

Yeates RA, Laufen H, Zimmermann T. Interaction Between Midazolam and Clarithromycin: Comparison With Azithromycin. Int J Clin Pharmacol Ther 1996;34:400-5.  

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