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Desipramine: Minor Due to a possible risk for QT prolongation and torsade de pointes TdP , azithromycin and tricyclic antidepressants TCAs should be used together cautiously. Clinically relevant QTc prolongation may occur with deutetrabenazine. Dextromethorphan; Promethazine: Moderate Consider the risk of QT prolongation which can be fatal when administering azithromycin to patients on other QT prolonging agents such as promethazine.

Dextromethorphan; Quinidine: Major Due to an increased risk for QT prolongation and torsade de pointes TdP , caution is advised when coadministering quinidine with azithromycin. Quinidine is associated with QT prolongation and TdP, and rare cases of QT prolongation and TdP have been reported during the postmarketing use of azithromycin. Dienogest; Estradiol valerate: Moderate It would be prudent to recommend alternative or additional contraception when oral contraceptives OCs are used in conjunction with antibiotics.

It was previously thought that antibiotics may decrease the effectiveness of OCs containing estrogens due to stimulation of metabolism or a reduction in enterohepatic circulation via changes in GI flora.

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One retrospective study reviewed the literature to determine the effects of oral antibiotics on the pharmacokinetics of contraceptive estrogens and progestins, and also examined clinical studies in which the incidence of pregnancy with OCs and antibiotics was reported. It was concluded that the antibiotics ampicillin, ciprofloxacin, clarithromycin, doxycycline, metronidazole, ofloxacin, roxithromycin, temafloxacin, and tetracycline did not alter plasma concentrations of OCs.

Antituberculous drugs e.


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Based on the study results, these authors recommended that back-up contraception may not be necessary if OCs are used reliably during oral antibiotic use. Another review concurred with these data, but noted that individual patients have been identified who experienced significant decreases in plasma concentrations of combined OC components and who appeared to ovulate; the agents most often associated with these changes were rifampin, tetracyclines, and penicillin derivatives. These authors concluded that because females most at risk for OC failure or noncompliance may not be easily identified and the true incidence of such events may be under-reported, and given the serious consequence of unwanted pregnancy, that recommending an additional method of contraception during short-term antibiotic use may be justified.

During long-term antibiotic administration, the risk for drug interaction with OCs is less clear, but alternative or additional contraception may be advisable in selected circumstances. Data regarding progestin-only contraceptives or for newer combined contraceptive deliveries e. Digoxin: Moderate Monitor digoxin concentrations before and during concomitant use of azithromycin and reduce the digoxin dose if necessary. Elevated digoxin concentrations have been observed when azithromycin has been coadministered with digoxin.

Dihydroergotamine: Minor Until more data are available, the manufacturer of azithromycin recommends caution and careful monitoring of patients who receive azithromycin and either ergotamine or dihydroergotamine concurrently. The simultaneous use of certain ergot alkaloids with certain macrolides may produce ergot toxicity. Disopyramide: Major Due to an increased risk for QT prolongation and torsade de pointes TdP , caution is advised when administering disopyramide with azithromycin.

Disopyramide is associated with QT prolongation and TdP, and cases of QT prolongation and TdP have been reported during the post-marketing use of azithromycin. Dofetilide: Major Coadministration of dofetilide and azithromycin is not recommended as concurrent use may increase the risk of QT prolongation. Dolasetron: Moderate Administer dolasetron with caution in combination with azithromycin; concurrent use may increase the risk for QT prolongation.

Additionally, QT prolongation and torsade de pointes TdP have been spontaneously reported during azithromycin postmarketing surveillance.

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Dolutegravir; Rilpivirine: Moderate Use caution when coadministering rilpivirine with azithromycin. Donepezil: Moderate Use donepezil with caution in combination with azithromycin; concurrent use increases the risk for QT prolongation and torsade de pointes TdP. Case reports indicate that QT prolongation and torsade de pointes TdP can occur during donepezil therapy.

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Donepezil; Memantine: Moderate Use donepezil with caution in combination with azithromycin; concurrent use increases the risk for QT prolongation and torsade de pointes TdP. Doxepin: Minor Due to a possible risk for QT prolongation and torsade de pointes TdP , azithromycin and tricyclic antidepressants TCAs should be used together cautiously.

Dronedarone: Severe Coadministration of dronedarone and azithromycin is contraindicated due to the potential for QT prolongation and torsade de pointes TdP. There have been case reports of QT prolongation and TdP with the use of azithromycin in post-marketing reports. Dronedarone administration is associated with a dose-related increase in the QTc interval. The increase in QTc is approximately 10 milliseconds at doses of mg twice daily the FDA-approved dose and up to 25 milliseconds at doses of mg twice daily.

Although there are no studies examining the effects of dronedarone in patients receiving other QT prolonging drugs, coadministration of such drugs may result in additive QT prolongation.

Azithromycin

Droperidol: Major Droperidol should not be used in combination with any drug known to have potential to prolong the QT interval, such as azithromycin. Droperidol administration is associated with an established risk for QT prolongation and torsade de pointes TdP. Some cases have occurred in patients with no known risk factors for QT prolongation and some cases have been fatal. If coadministration cannot be avoided, use extreme caution; initiate droperidol at a low dose and increase the dose as needed to achieve the desired effect. Drospirenone: Moderate It would be prudent to recommend alternative or additional contraception when oral contraceptives OCs are used in conjunction with antibiotics.

Drospirenone; Estradiol: Moderate It would be prudent to recommend alternative or additional contraception when oral contraceptives OCs are used in conjunction with antibiotics. Drospirenone; Ethinyl Estradiol: Moderate It would be prudent to recommend alternative or additional contraception when oral contraceptives OCs are used in conjunction with antibiotics. Drospirenone; Ethinyl Estradiol; Levomefolate: Moderate It would be prudent to recommend alternative or additional contraception when oral contraceptives OCs are used in conjunction with antibiotics.

Efavirenz: Moderate Consider alternatives to efavirenz when coadministering with azithromycin; coadministration may increase the risk for QT prolongation and torsade de pointes TdP. QTc prolongation has been observed with the use of efavirenz. Efavirenz; Emtricitabine; Tenofovir: Moderate Consider alternatives to efavirenz when coadministering with azithromycin; coadministration may increase the risk for QT prolongation and torsade de pointes TdP.

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Efavirenz; Lamivudine; Tenofovir Disoproxil Fumarate: Moderate Consider alternatives to efavirenz when coadministering with azithromycin; coadministration may increase the risk for QT prolongation and torsade de pointes TdP. Eliglustat: Moderate Consider the risk of QT prolongation which can be fatal when administering azithromycin to patients on other QT prolonging agents such as eliglustat.

Emtricitabine; Rilpivirine; Tenofovir alafenamide: Moderate Use caution when coadministering rilpivirine with azithromycin. Emtricitabine; Rilpivirine; Tenofovir disoproxil fumarate: Moderate Use caution when coadministering rilpivirine with azithromycin. Encorafenib: Major Avoid coadministration of encorafenib and azithromycin due to QT prolongation. If concurrent use cannot be avoided, monitor ECGs for QT prolongation and monitor electrolytes; correct hypokalemia and hypomagnesemia prior to treatment.

Encorafenib is associated with dose-dependent prolongation of the QT interval. Enflurane: Major Halogenated Anesthetics should be used cautiously and with close monitoring with azithromycin. Entrectinib: Major Avoid coadministration of entrectinib with aripiprazole due to the risk of QT prolongation. Entrectinib has been associated with QT prolongation. Ergotamine: Minor The manufacturer of azithromycin recommends caution and careful monitoring of patients who receive azithromycin and ergotamine, because simultaneous use of ergotamine with other macrolides may produce ergot toxicity.

Eribulin: Major Concurrent use of eribulin and azithromycin should be avoided due to an increased risk for QT prolongation and torsade de pointes TdP. If these drugs must be coadministered, ECG monitoring is recommended; closely monitor the patient for QT interval prolongation. Eribulin has been associated with QT prolongation, and cases of QT prolongation and TdP have been reported with the use of azithromycin during the post-marketing period. Erythromycin: Major Avoid use of azithromycin and erythromycin together as this would be considered duplicate therapy.

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Cross-resistance with gram-positive organisms would be expected. Additionally, the risk for QT prolongation and torsade de pointes TdP increases if these drugs are administered together. Erythromycin has been associated with QT prolongation and TdP, and cases of QT prolongation and TdP have been reported during post-marketing use of azithromycin. Erythromycin; Sulfisoxazole: Major Avoid use of azithromycin and erythromycin together as this would be considered duplicate therapy. Escitalopram: Moderate Use escitalopram with caution in combination with azithromycin as concurrent use may increase the risk of QT prolongation.

There have been case reports of QT prolongation and torsade de pointes TdP with the use of azithromycin in postmarketing reports. Escitalopram has been associated with a risk of QT prolongation and TdP.

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Estradiol; Levonorgestrel: Moderate It would be prudent to recommend alternative or additional contraception when oral contraceptives OCs are used in conjunction with antibiotics. Estradiol; Norethindrone: Moderate It would be prudent to recommend alternative or additional contraception when oral contraceptives OCs are used in conjunction with antibiotics. Estradiol; Norgestimate: Moderate It would be prudent to recommend alternative or additional contraception when oral contraceptives OCs are used in conjunction with antibiotics.

Ethinyl Estradiol: Moderate It would be prudent to recommend alternative or additional contraception when oral contraceptives OCs are used in conjunction with antibiotics. Ethinyl Estradiol; Desogestrel: Moderate It would be prudent to recommend alternative or additional contraception when oral contraceptives OCs are used in conjunction with antibiotics.


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Ethinyl Estradiol; Ethynodiol Diacetate: Moderate It would be prudent to recommend alternative or additional contraception when oral contraceptives OCs are used in conjunction with antibiotics. Ethinyl Estradiol; Etonogestrel: Moderate It would be prudent to recommend alternative or additional contraception when oral contraceptives OCs are used in conjunction with antibiotics. Ethinyl Estradiol; Levonorgestrel: Moderate It would be prudent to recommend alternative or additional contraception when oral contraceptives OCs are used in conjunction with antibiotics.

Ethinyl Estradiol; Levonorgestrel; Ferrous bisglycinate: Moderate It would be prudent to recommend alternative or additional contraception when oral contraceptives OCs are used in conjunction with antibiotics. Ethinyl Estradiol; Levonorgestrel; Folic Acid; Levomefolate: Moderate It would be prudent to recommend alternative or additional contraception when oral contraceptives OCs are used in conjunction with antibiotics.