Version July 2025
Note: Erythromycin use in neonates, particularly in the first 14 days of life, has been associated with infantile hypertrophic pyloric stenosis (IHPS) (Ref). Erythromycin is available as base and multiple salts; in neonates, the same dose is used for oral (base, ethylsuccinate) or IV (lactobionate).
General dosing, susceptible infection: Preterm and term neonates: IV, Oral: 10 mg/kg/dose every 6 hours (Ref).
Chlamydial conjunctivitis or chlamydial pneumonia: Neonates: Oral: Ethylsuccinate, base: 12.5 mg/kg/dose every 6 hours for 14 days; a repeat course may be necessary if first course does not result in cure (Ref).
Feeding intolerance, treatment; prokinetic agent for GI motility: Limited data available; multiple regimens reported; efficacy results variable.
Note: Most commonly reported salt form in studies was erythromycin ethylsuccinate (when reported).
Preterm neonates: PNA ≥14 days: Note: Treatment duration is typically 7 to 14 days (Ref).
Low-dose regimen: Oral: 1.5 to 2.5 mg/kg/dose every 6 hours or 1 mg/kg/dose every 8 hours (Ref). Note: Data from systematic reviews and a randomized trial indicate that low-dose regimens may not be effective (Ref).
Intermediate-dose regimen: Oral: 5 mg/kg/dose every 6 to 8 hours (Ref).
High-dose regimen: Oral: 10 to 12.5 mg/kg/dose every 6 to 8 hours; after 2 days, may decrease dose to 4 mg/kg/dose every 6 hours for 5 additional days (Ref). Note: High-dose regimens are not preferred due to risk of adverse effects and the possibility that therapeutic effects may be lost with higher doses (Ref).
Pertussis, treatment or postexposure prophylaxis (alternative agent): Note: Reserve for situations when azithromycin cannot be used (eg, shortages) (Ref). Most commonly reported salt forms in studies were erythromycin ethylsuccinate or base (when reported) (Ref).
Neonates: Oral: 10 to 12.5 mg/kg/dose every 6 hours for 14 days (Ref).
Note: Erythromycin is available in an IV formulation as the lactobionate salt, and orally as base, ethylsuccinate salt, or stearate salt. In adults, 400 mg erythromycin ethylsuccinate produces the same concentrations as 250 mg of erythromycin base or stearate; however, in pediatric patients, weight-based dosing is typically used interchangeably.
General dosing, susceptible infection:
Infants, Children, and Adolescents:
Oral: Base, ethylsuccinate, stearate: 40 to 50 mg/kg/day divided every 6 to 8 hours; maximum daily dose: 4,000 mg/day; the manufacturer's labeling also describes dividing the daily dose every 12 hours (Ref).
IV: Lactobionate: 15 to 20 mg/kg/day divided every 6 hours; maximum daily dose: 4,000 mg/day (Ref).
Acne vulgaris, moderate to severe, treatment (alternative agent):
Note: Use in combination with topical acne therapy. Reserve use for patients <8 years of age or with allergies who cannot receive tetracyclines; use limited by bacterial resistance and adverse effects (Ref).
Children and Adolescents: Oral: 250 to 500 mg 1 to 2 times daily; maximum daily dose: 50 mg/kg/day (Ref). Treatment should ideally be limited to 3 to 4 months to minimize development of resistance; some experts suggest discontinuation or tapering within 1 to 2 months once new lesions have stopped emerging; consistent follow-up and reevaluation is recommended for patients who require a longer course (Ref).
Bartonella spp. infection:
Treatment (bacillary angiomatosis, peliosis hepatitis):
Infants, Children, and Adolescents: Oral: Ethylsuccinate: 10 mg/kg/dose every 6 hours; maximum dose: 500 mg/dose (Ref). Note: In adolescent patients with HIV and multifocal disease or with clinical decompensation, give in combination with rifampin; IV therapy may be needed initially.
Duration of treatment:
Patients without HIV: For bacillary angiomatosis, treat for 3 months; for peliosis hepatitis, treat for 4 months (Ref). For cutaneous bacillary angiomatosis, IDSA skin and soft tissue infection guidelines recommend a duration of initial therapy of 2 weeks to 2 months, although treatment durations are not standardized (Ref).
Patients with HIV: Duration of therapy is ≥3 months; continuation of therapy depends on clinical condition and response to therapy (Ref).
Suppressive therapy for patients with HIV who experience a relapse after receiving a ≥3-month course of primary treatment:
Adolescents: Oral: 500 mg every 6 hours. Continue until patient has received at least 3 to 4 months of therapy and CD4 count is >200 cells/mm3 for ≥6 months; some experts discontinue therapy only if Bartonella titers have also decreased 4-fold (Ref).
Chancroid (Haemophilus ducreyi): Limited data available: Children ≥45 kg and Adolescents: Base: Oral: 500 mg every 8 hours for 7 days (Ref).
Chlamydia trachomatis infection:
Infants and Children weighing <45 kg: Oral: Base, ethylsuccinate: 12.5 mg/kg/dose every 6 hours for 14 days; maximum dose: 500 mg/dose. In infants with pneumonia, a second course may be necessary due to efficacy of ~80% (Ref).
Adolescents:
Lymphogranuloma venereum: Oral: Base: 500 mg 4 times daily for 21 days (Ref).
Exit-site or tunnel infection, peritoneal dialysis catheter: Infants, Children, and Adolescents: Oral: Base: 30 to 50 mg/kg/day divided every 6 to 8 hours; maximum dose: 500 mg/dose. Exit-site infection should be treated for ≥2 weeks and for at least 7 days after complete resolution, or for ≥3 weeks for Staphylococcus aureus; tunnel infection should be treated for 2 to 4 weeks (Ref).
Gastroparesis or prokinetic agent for GI motility: Limited data available:
Infants, Children, and Adolescents:
Response determination during gastric emptying study: IV: 2.8 mg/kg infused over 20 minutes; maximum dose: 250 mg/dose (Ref).
Treatment: Oral: 3 mg/kg/dose 4 times daily; may increase as needed to effect up to 10 mg/kg/dose; maximum dose: 250 mg/dose (Ref).
Impetigo (alternative agent): Infants, Children, and Adolescents: Oral: Base, ethylsuccinate: 40 mg/kg/day divided every 6 to 8 hours for 7 days; maximum dose (base): 250 mg/dose; maximum dose (ethylsuccinate): 400 mg/dose (Ref).
Lyme disease (Borrelia spp. infection), erythema migrans (alternative agent): Limited data available: Note: Current guidelines recommend macrolides (azithromycin) only when first-line agents cannot be used due to lower efficacy (Ref).
Infants, Children, and Adolescents: Oral: 12.5 mg/kg/dose every 6 hours for 14 to 21 days; maximum dose: 500 mg/dose (Ref).
Pertussis, treatment or postexposure prophylaxis:
Note: Most commonly reported salt forms in studies were erythromycin ethylsuccinate or base (when reported) (Ref).
Infants <6 months: Oral: 10 to 12.5 mg/kg/dose every 6 hours for 14 days; maximum dose: 500 mg/dose (Ref).
Infants ≥6 months and Children: Oral: 10 to 12.5 mg/kg/dose every 6 hours for 7 to 14 days; maximum dose: 500 mg/dose (Ref).
Adolescents: Oral: 500 mg every 6 hours for 7 to 14 days (Ref).
Pneumonia, community acquired; presumed or proven atypical infection (alternative agent):
Infants >3 months, Children, and Adolescents:
Mild infection or step-down therapy: Oral: 10 mg/kg/dose every 6 hours; maximum dose: 500 mg/dose (Ref).
Moderate to severe infection: IV: Lactobionate: 5 mg/kg/dose every 6 hours; maximum dose: 1,000 mg/dose (Ref).
Surgical prophylaxis, colorectal: Limited data available: Children and Adolescents: Oral: Base: 20 mg/kg/dose for 3 doses; administer at 1 PM, 2 PM, and 11 PM on the day before surgery, in combination with mechanical cleansing of the large intestine and oral neomycin; maximum dose: 1,000 mg/dose; perioperative IV antibiotics should also be administered on the day of surgery (Ref).
Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.
Infants, Children, and Adolescents: The following adjustments have been recommended (Ref). Note: Renally adjusted dose recommendations are based on oral doses of 30 to 50 mg/kg/day divided every 6 to 8 hours.
GFR ≥10 mL/minute/1.73 m2: No adjustment required.
GFR <10 mL/minute/1.73 m2: Intermittent hemodialysis, peritoneal dialysis: Not removed by peritoneal dialysis or hemodialysis: Oral: 10 to 17 mg/kg/dose every 8 hours.
There are no dosage adjustments provided in the manufacturer's labeling.
(For additional information see "Erythromycin (systemic): Drug information")
Note: PCE tablets have been discontinued in the United States for >1 year.
Note: Due to differences in absorption, 400 mg erythromycin ethylsuccinate produces the same serum levels as 250 mg erythromycin base or stearate.
Usual dosage range:
Oral:
Base or stearate: 250 to 500 mg every 6 to 12 hours; maximum: 4 g daily.
Ethylsuccinate: 400 to 800 mg every 6 to 12 hours; maximum: 4 g daily.
IV: Lactobionate: 15 to 20 mg/kg/day divided every 6 hours or 500 mg to 1 g every 6 hours; maximum: 4 g daily.
Acne vulgaris, inflammatory, moderate to severe (alternative agent) (off-label use):
Note: Use in combination with topical acne therapy. Reserve for patients who cannot use preferred agents; use may be limited by bacterial resistance (Ref).
Oral: 250 to 500 mg (base) twice daily (Ref). Treatment should ideally be limited to 3 to 4 months to minimize the risk of resistance (Ref).
Bartonella spp. infection (off-label use):
Patients with HIV:
Treatment: Note: Duration of therapy is ≥3 months; continuation of therapy depends on clinical condition and response to therapy (Ref).
Bacillary angiomatosis, cat scratch disease, peliosis hepatis, bacteremia, and osteomyelitis: Oral, IV: 500 mg every 6 hours (Ref).
Other severe infections (excluding CNS infections or endocarditis): Oral, IV: 500 mg every 6 hours in combination with rifampin; IV therapy may be needed initially (Ref).
Suppressive therapy: Note: For patients who experience a relapse after receiving a ≥3-month course of primary treatment. Oral: 500 mg every 6 hours. Continue until patient has received ≥3 months of therapy and CD4 count is >200 cells/mm3 for ≥6 months; some experts discontinue therapy only if Bartonella titers have also decreased 4-fold (Ref).
Patients without HIV:
Bacillary angiomatosis (BA), peliosis hepatitis (PH): Oral: 500 mg (base) 4 times daily for 3 months (BA) or 4 months (PH) (Ref). Note: IDSA skin and soft tissue infection guidelines recommend a duration of initial therapy of 2 weeks to 2 months for cutaneous BA, although treatment durations are not standardized (Ref).
Endoscopy/esophagogastroduodenoscopy, adjunctive prokinetic agent (off-label use): IV: 250 mg as a single dose infused over 20 to 30 minutes; perform endoscopy 20 to 90 minutes after infusion is complete (Ref).
Gastroparesis (off-label use):
IV: 3 mg/kg administered over 45 minutes every 8 hours (Ref).
Oral: Patients refractory/intolerant to other prokinetic agents (eg, metoclopramide, domperidone): 250 to 500 mg (base) 3 times daily before meals. Limit duration of therapy, tachyphylaxis may occur after 4 weeks (Ref).
Legionnaire disease:
IV: 1 to 4 g/day in divided doses.
Oral: 1.6 to 4 g (ethylsuccinate) daily or 1 to 4 g (base or stearate) daily in divided doses.
Pertussis: Oral: 500 mg (base) every 6 hours for 14 days (Ref).
Preterm prelabor rupture of membranes (ie, patients <34 weeks' gestation) (off-label use):
Note: IV erythromycin is used as part of a combination regimen with IV ampicillin followed by oral amoxicillin and oral erythromycin (Ref).
IV: 250 mg every 6 hours for 48 hours, then switch to oral dosing for 5 days (Ref).
Oral: 333 mg every 8 hours or 500 mg every 8 hours for 5 days following 48 hours of IV dosing (Ref).
Rheumatic fever, secondary prophylaxis (alternative agent): Oral: 250 mg (base or stearate) or 400 mg (ethylsuccinate) twice daily.
Sexually transmitted infections:
Chancroid (off-label use): Oral: 500 mg (base) 3 times daily for 7 days; Note: Isolates with intermediate resistance have been documented (Ref).
Granuloma inguinale (donovanosis) (alternative agent) (off-label use): Oral: 500 mg (base) 4 times daily for >3 weeks and until resolution of lesions. Note: If symptoms do not improve within the first few days of therapy, the addition of a second agent may be considered (Ref).
Lymphogranuloma venereum (alternative agent) (off-label use): Oral: 500 mg (base) 4 times daily for 21 days (Ref).
Surgical (preoperative) prophylaxis (colorectal) (off-label dose): Oral: 1 g erythromycin base per dose at 1 PM, 2 PM, and 11 PM on the day before 8 AM surgery combined with mechanical cleansing of the large intestine, oral neomycin. Perioperative IV antibiotics are also given on the day of surgery (Ref).
Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.
The renal dosing recommendations are based upon the best available evidence and clinical expertise. Senior Editorial Team: Bruce Mueller, PharmD, FCCP, FASN, FNKF; Jason A. Roberts, PhD, BPharm (Hons), B App Sc, FSHP, FISAC; Michael Heung, MD, MS.
Altered kidney function:
eGFR ≥15 mL/minute/1.73 m2: Oral, IV: No dosage adjustment likely to be necessary (Ref).
eGFR <15 mL/minute/1.73 m2: Oral, IV: Increased incidence of ototoxicity (a concentration-dependent adverse effect) in patients with severe kidney impairment has been reported. Consider limiting erythromycin dose to 2 g/day or using an alternative agent; monitor hearing acuity closely (Ref).
Hemodialysis, intermittent (thrice weekly):
Not significantly dialyzable (Ref):
Oral, IV : Increased incidence of ototoxicity (a concentration-dependent adverse effect) in patients with severe kidney impairment has been reported. Consider limiting erythromycin dose to 2 g/day or using an alternative agent; monitor hearing acuity closely (Ref).
Peritoneal dialysis: Not likely to be significantly dialyzed (Ref):
Oral, IV : Increased incidence of ototoxicity (a concentration-dependent adverse effect) in patients with severe kidney impairment has been reported. Consider limiting erythromycin dose to 2 g/day or using an alternative agent; monitor hearing acuity closely (Ref).
CRRT: Oral, IV: No dosage adjustment necessary (Ref).
PIRRT (eg, sustained, low-efficiency diafiltration): Oral, IV: No dosage adjustment necessary (Ref).
There are no dosage adjustments provided in the manufacturer's labeling; use with caution.
The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified.
Frequency not defined. Incidence may vary with formulation.
Cardiovascular: QTc prolongation, torsade de pointes, ventricular arrhythmia, ventricular tachycardia
Central nervous system: Seizure
Dermatologic: Erythema multiforme, pruritus, skin rash, Stevens-Johnson syndrome, toxic epidermal necrolysis, urticaria
Gastrointestinal: Abdominal pain, anorexia, diarrhea, nausea, oral candidiasis, pancreatitis, pseudomembranous colitis, pyloric stenosis (infantile hypertrophic), vomiting
Hepatic: Abnormal hepatic function tests, cholestatic jaundice (most common with estolate), hepatitis
Hypersensitivity: Anaphylaxis, hypersensitivity reaction
Local: Injection site phlebitis
Neuromuscular & skeletal: Weakness
Otic: Hearing loss
Renal: Interstitial nephritis
Postmarketing and/or case reports: Hepatotoxicity (idiosyncratic) (Chalasani 2014)
Hypersensitivity to erythromycin, any macrolide antibiotics, or any component of the formulation; concomitant use with astemizole, cisapride, dihydroergotamine, ergotamine, lovastatin, pimozide, simvastatin, or terfenadine.
Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.
Canadian labeling: Additional contraindications (not in the US labeling): Injection: History of QT prolongation (acquired or congenital); ventricular cardiac arrhythmia, including torsades de pointes; electrolyte imbalance (hypokalemia, hypomagnesemia); IV bolus/push.
Concerns related to adverse effects:
• Altered cardiac conduction: Macrolides have been associated with rare QTc prolongation and ventricular arrhythmias, including torsade de pointes; use with caution in patients at risk of prolonged cardiac repolarization; avoid use in patients with prolonged QT interval, uncorrected hypokalemia or hypomagnesemia, clinically significant bradycardia, or concurrent use of Class IA (eg, quinidine, procainamide) or Class III (eg, amiodarone, dofetilide, sotalol) antiarrhythmic agents.
• Superinfection: Prolonged use may result in fungal or bacterial superinfection, including C. difficile-associated diarrhea (CDAD) and pseudomembranous colitis; CDAD has been observed >2 months postantibiotic treatment.
Disease-related concerns:
• Hepatic impairment: Use with caution in patients with preexisting liver disease; hepatic impairment, including hepatocellular and/or cholestatic hepatitis, with or without jaundice, has been observed. Discontinue if symptoms of malaise, nausea, vomiting, abdominal colic, and fever.
• Myasthenia gravis: Exacerbation of and new onset of myasthenia gravis symptoms have been reported.
Concurrent drug therapy issues:
• Major inhibitor of CYP3A4: Use caution with any agents with substantial metabolism through the CYP3A4 pathway; high potential for drug interactions exists. Avoid concurrent use with strong CYP3A4 inhibitors; may increase the risk of sudden cardiac death (Ray 2004).
Special populations:
• Older adult: May be at increased risk of adverse events, including hearing loss and/or torsade de pointes, particularly if concurrent renal/hepatic impairment.
Dosage form specific issues:
• Benzyl alcohol and derivatives: Some dosage forms may contain benzyl alcohol; large amounts of benzyl alcohol (≥99 mg/kg/day) have been associated with a potentially fatal toxicity (“gasping syndrome”) in neonates; the “gasping syndrome” consists of metabolic acidosis, respiratory distress, gasping respirations, CNS dysfunction (including convulsions, intracranial hemorrhage), hypotension and cardiovascular collapse (AAP ["Inactive" 1997]; CDC 1982); some data suggests that benzoate displaces bilirubin from protein binding sites (Ahlfors 2001); avoid or use dosage forms containing benzyl alcohol with caution in neonates. See manufacturer's labeling.
Infantile hypertrophic pyloric stenosis (IHPS) has been associated with erythromycin use in the first 6 weeks of life, with the highest risk occurring in the first 2 weeks of life (Abdellatif 2019; Cooper 2002; Eberly 2015; Red Book [AAP 2021]). Absolute risk varies; in a large retrospective study using a health system database, <1% of neonates and infants <90 days of age who were prescribed erythromycin developed IHPS, though this reflected an ~4-fold increased risk as compared to patients who did not receive erythromycin. Neonates and infants <14 days of age at time of exposure were ~13 times more likely to experience IHPS (Eberly 2015). In a retrospective study in neonates receiving erythromycin prophylaxis for pertussis, risk of IHPS was 5.1% in neonates receiving <1 week of erythromycin and 10% in neonates who received >14 days of erythromycin (Honein 1999). Risk appears to be increased with use within the first 2 weeks of life, in patients born at term (vs preterm), with longer duration of therapy (>14 days), or with higher doses (~40 mg/kg/day) (Abdellatif 2019; Eberly 2015; Ericson 2015; Honein 1999; Hussain 2002; Maheshwai 2007). Pyloromyotomy for IHPS was undertaken a median of 13 days (range: 2 to 40 days; IQR: 8 to 25 days) after erythromycin exposure in a large database study (Eberly 2015). Carefully evaluate risks and benefits of treatment with erythromycin before use in neonates and young infants and monitor closely (Red Book [AAP 2021]; manufacturer's labeling).
PCE tablets have been discontinued in the US for more than 1 year.
Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product
Capsule Delayed Release Particles, Oral, as base:
Generic: 250 mg
Solution Reconstituted, Intravenous, as lactobionate [preservative free]:
Erythrocin Lactobionate: 500 mg (1 ea)
Generic: 500 mg (1 ea)
Suspension Reconstituted, Oral, as ethylsuccinate:
E.E.S. Granules: 200 mg/5 mL (100 mL, 200 mL) [cherry flavor]
EryPed 200: 200 mg/5 mL (100 mL [DSC]) [fruit flavor]
EryPed 400: 400 mg/5 mL (100 mL) [banana flavor]
Generic: 200 mg/5 mL (100 mL, 200 mL); 400 mg/5 mL (100 mL)
Suspension Reconstituted, Oral, as ethylsuccinate [preservative free]:
Generic: 200 mg/5 mL (100 mL [DSC])
Tablet, Oral, as base:
Generic: 250 mg, 500 mg
Tablet, Oral, as ethylsuccinate:
E.E.S. 400: 400 mg [contains corn starch, fd&c red #40 (allura red ac dye), quinoline yellow (d&c yellow #10)]
Generic: 400 mg [DSC]
Tablet, Oral, as stearate:
Erythrocin Stearate: 250 mg [DSC] [contains corn starch]
Tablet Delayed Release, Oral, as base:
Ery-Tab: 250 mg [DSC], 333 mg [DSC], 500 mg [DSC]
Generic: 250 mg, 333 mg, 500 mg
Yes
Capsule, enteric pellets (Erythromycin Base Oral)
250 mg (per each): $9.20
Solution (reconstituted) (Erythrocin Lactobionate Intravenous)
500 mg (per each): $101.45
Solution (reconstituted) (Erythromycin Lactobionate Intravenous)
500 mg (per each): $240.00
Suspension (reconstituted) (E.E.S. Granules Oral)
200 mg/5 mL (per mL): $4.51
Suspension (reconstituted) (EryPed 400 Oral)
400 mg/5 mL (per mL): $7.94
Suspension (reconstituted) (Erythromycin Ethylsuccinate Oral)
200 mg/5 mL (per mL): $3.91 - $4.05
400 mg/5 mL (per mL): $7.14
Tablet, EC (Erythromycin Base Oral)
250 mg (per each): $8.39
333 mg (per each): $10.56
500 mg (per each): $13.00
Tablets (E.E.S. 400 Oral)
400 mg (per each): $14.61
Tablets (Erythromycin Base Oral)
250 mg (per each): $12.46 - $13.23
500 mg (per each): $18.79 - $19.94
Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided when more than one manufacturer's AWP price is available and uses the low and high price reported by the manufacturers to determine the range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing data is updated monthly.
Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product
Capsule Delayed Release Particles, Oral:
Eryc: 333 mg [DSC]
Solution Reconstituted, Intravenous, as lactobionate:
Erythrocin: 500 mg (1 ea); 1000 mg (1 ea)
Tablet, Oral, as base:
Generic: 250 mg [DSC]
Tablet, Oral, as stearate:
Generic: 250 mg [DSC]
Oral: Administer base or stearate dosage forms on an empty stomach (at least 30 minutes and preferably 2 hours before a meal). Administer ethylsuccinate (EES) or delayed-release (ERY-TAB) without regards to meals; may consider administering after food to decrease GI discomfort. Swallow delayed-release capsule or enteric-coated tablets whole, do not chew or break. Shake reconstituted suspension well before use.
Parenteral: Administer by intermittent IV infusion over 20 to 60 minutes or as a continuous infusion. Intermittent IV infusion may be very irritating to the vein; per the manufacturer, continuous infusion is preferable due to slower infusion rate and lower concentration. For intermittent IV infusion, prolonging the infusion duration over 60 minutes or longer has been recommended to decrease the cardiotoxic effects of erythromycin (Ref).
Oral: Administer base, PCE, or stearate dosage forms on an empty stomach (2 hours before or after a meal); administer ethylsuccinate (EES) or delayed release (ERY-TAB) without regard to meals; may consider administering after food to decrease GI discomfort. Swallow delayed-release capsule or enteric-coated tablets whole; do not chew or break.
Bariatric surgery: Capsule and tablet, delayed release: Some institutions may have specific protocols that conflict with these recommendations; refer to institutional protocols as appropriate. Delayed-release capsule and tablet cannot be opened. Switch to IR tablet or oral suspension.
IV: Infuse 1 g over 20 to 60 minutes. For pre-endoscopy/esophagogastroduodenoscopy, infuse 250 mg over 20 to 30 minutes (Ref). IV infusion may be very irritating to the vein; infusion should be sufficiently slow to minimize pain along the vein; diluted infusions must be completed in ≤8 hours. Do not administer IV push or bolus.
Injection: Store unreconstituted vials at 20°C to 25°C (68°F to 77°F). Reconstituted solution (50 mg/mL) is stable for 2 weeks when refrigerated or for 24 hours at room temperature. Erythromycin IV infusion solution is stable at pH 6 to 8; stability of lactobionate is pH dependent; IV form has longest stability in NS. Parenteral admixture in NS is stable for 24 hours at 4°C. Admixtures in NS (including Add-Vantage containers) should be infused within 8 hours of preparation.
Oral suspension:
Granules: Prior to mixing, store at <30°C (<86°F). After mixing, store under refrigeration and use within 10 days.
Powder: Prior to mixing, store at <30°C (<86°F). After mixing, store at ≤25°C (≤77°F) and use within 35 days.
Tablet and capsule formulations: Store at 20°C to 25°C (68°F to 77°F).
Treatment of the following bacterial infections: mild to moderate upper respiratory tract infection caused by Haemophilus influenzae (when used in combination with a sulfonamide), Streptococcus pneumoniae, or Streptococcus pyogenes; mild to moderate lower respiratory tract infections caused by S. pneumoniae or S. pyogenes; respiratory tract infections caused by Mycoplasma pneumoniae; mild to moderate skin and soft tissue infections caused by S. pyogenes or Staphylococcus aureus; intestinal amebiasis caused by Entamoeba histolytica (oral formulations only); pelvic inflammatory syndrome caused by Neisseria gonorrhoeae; nongonococcal urethritis caused by Ureaplasma urealyticum; conjunctivitis of the newborn, pneumonia of infancy, and urogenital infections caused by Chlamydia trachomatis; listeriosis; pertussis; diphtheria; erythrasma; syphilis; Legionnaire disease; prophylaxis of acute rheumatic fever (All indications: FDA approved in all ages); has also been used for preoperative bowel decontamination in combination with neomycin, prophylaxis of pneumococcal infections in patients with sickle cell disease (SCD) and functional or anatomic asplenia in patients who are penicillin allergic, treatment of Lyme disease, treatment of exit-site or tunnel infection in patients with peritoneal dialysis catheters, and treatment of feeding intolerance or gastroparesis.
Note: Although FDA approved, routine use of erythromycin has been replaced by alternative antibiotics for many indications.
Erythromycin may be confused with azithromycin, clarithromycin
Eryc may be confused with Emcyt, Ery-Tab
KIDs List: Erythromycin (systemic), when used in neonates, is identified on the Key Potentially Inappropriate Drugs in Pediatrics (KIDs) list and should be avoided due to risk of hypertrophic pyloric stenosis unless treating Chlamydia trachomatis pneumonia (strong recommendation; high quality of evidence)(PPA [Meyers 2020]).
Substrate of CYP2B6 (Minor), CYP3A4 (Major with inhibitors), CYP3A4 (Minor with inducers), P-glycoprotein (Minor); Note: Assignment of Major/Minor substrate status based on clinically relevant drug interaction potential; Inhibits CYP3A4 (Moderate), P-glycoprotein;
Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the drug interactions program by clicking on the “Launch drug interactions program” link above.
Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the drug interactions program
Abemaciclib: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Abemaciclib. Management: Monitor for increased abemaciclib toxicities if combined with moderate CYP3A4 inhibitors. Consider reducing the abemaciclib dose in 50 mg decrements if necessary. Risk C: Monitor
Acalabrutinib: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Acalabrutinib. Management: Reduce acalabrutinib dose to 100 mg once daily with concurrent use of a moderate CYP3A4 inhibitor. Monitor patient closely for both acalabrutinib response and evidence of adverse effects with any concurrent use. Risk D: Consider Therapy Modification
Acrivastine: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Acrivastine. Risk C: Monitor
Afatinib: P-glycoprotein/ABCB1 Inhibitors may increase serum concentration of Afatinib. Management: If combined, administer the P-gp inhibitor simultaneously with, or after, the dose of afatinib. Monitor closely for signs and symptoms of afatinib toxicity and if the combination is not tolerated, reduce the afatinib dose by 10 mg. Risk D: Consider Therapy Modification
ALfentanil: CYP3A4 Inhibitors (Moderate) may increase serum concentration of ALfentanil. Management: If use of alfentanil and moderate CYP3A4 inhibitors is necessary, consider dosage reduction of alfentanil until stable drug effects are achieved. Frequently monitor patients for respiratory depression and sedation when these agents are combined. Risk D: Consider Therapy Modification
Alfuzosin: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Alfuzosin. Risk C: Monitor
Aliskiren: P-glycoprotein/ABCB1 Inhibitors may increase serum concentration of Aliskiren. Risk C: Monitor
Alitretinoin (Systemic): CYP3A4 Inhibitors (Moderate) may increase serum concentration of Alitretinoin (Systemic). Risk C: Monitor
ALPRAZolam: CYP3A4 Inhibitors (Moderate) may increase serum concentration of ALPRAZolam. Management: Consider alternatives to this combination when possible. If combined, consider an alprazolam dose reduction and monitor for increased alprazolam effects and toxicities (eg, sedation, lethargy). Risk D: Consider Therapy Modification
Amiodarone: May increase QTc-prolonging effects of Erythromycin (Systemic). Erythromycin (Systemic) may increase QTc-prolonging effects of Amiodarone. Erythromycin (Systemic) may increase serum concentration of Amiodarone. Risk X: Avoid
Amisulpride (Oral): May increase QTc-prolonging effects of QT-prolonging Agents (Moderate Risk). Risk C: Monitor
AmLODIPine: CYP3A4 Inhibitors (Moderate) may increase serum concentration of AmLODIPine. Risk C: Monitor
Apixaban: Inhibitors of CYP3A4 (Moderate) and P-glycoprotein may increase serum concentration of Apixaban. Risk C: Monitor
Aprepitant: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Aprepitant. Risk X: Avoid
ARIPiprazole Lauroxil: CYP3A4 Inhibitors (Moderate) may increase serum concentration of ARIPiprazole Lauroxil. Risk C: Monitor
ARIPiprazole: CYP3A4 Inhibitors (Moderate) may increase serum concentration of ARIPiprazole. Management: Monitor for increased aripiprazole pharmacologic effects. Aripiprazole dose adjustments may or may not be required based on concomitant therapy, indication, or dosage form. Consult full interaction monograph for specific recommendations. Risk C: Monitor
Atogepant: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Atogepant. Risk C: Monitor
Atorvastatin: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Atorvastatin. Risk C: Monitor
Avacopan: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Avacopan. Risk C: Monitor
Avanafil: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Avanafil. Management: The maximum avanafil dose is 50 mg per 24-hour period when used together with a moderate CYP3A4 inhibitor. Patients receiving such a combination should also be monitored more closely for evidence of adverse effects (eg, hypotension, syncope, priapism). Risk D: Consider Therapy Modification
Avapritinib: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Avapritinib. Management: Avoid use of moderate CYP3A4 inhibitors with avapritinib. If this combination cannot be avoided, reduce the avapritinib dose to 100 mg daily for the treatment of GIST or to 50 mg daily for the treatment of advanced systemic mastocytosis. Risk D: Consider Therapy Modification
Axitinib: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Axitinib. Risk C: Monitor
Bacillus clausii: Antibiotics may decrease therapeutic effects of Bacillus clausii. Management: Bacillus clausii should be taken in between antibiotic doses during concomitant therapy. Risk D: Consider Therapy Modification
Barnidipine: Erythromycin (Systemic) may increase serum concentration of Barnidipine. Risk X: Avoid
BCG (Intravesical): Antibiotics may decrease therapeutic effects of BCG (Intravesical). Risk X: Avoid
BCG Vaccine (Immunization): Antibiotics may decrease therapeutic effects of BCG Vaccine (Immunization). Risk C: Monitor
Benidipine: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Benidipine. Risk C: Monitor
Benzhydrocodone: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Benzhydrocodone. Specifically, the concentration of hydrocodone may be increased. Risk C: Monitor
Beta-Acetyldigoxin: P-glycoprotein/ABCB1 Inhibitors may increase serum concentration of Beta-Acetyldigoxin. Risk C: Monitor
Bilastine: P-glycoprotein/ABCB1 Inhibitors may increase serum concentration of Bilastine. Risk X: Avoid
Blonanserin: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Blonanserin. Risk C: Monitor
Bortezomib: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Bortezomib. Risk C: Monitor
Bosutinib: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Bosutinib. Risk X: Avoid
Brexpiprazole: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Brexpiprazole. Management: The brexpiprazole dose should be reduced to 25% of usual if used together with both a moderate CYP3A4 inhibitor and a strong or moderate CYP2D6 inhibitor, or if a moderate CYP3A4 inhibitor is used in a CYP2D6 poor metabolizer. Risk C: Monitor
Brigatinib: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Brigatinib. Management: Avoid concurrent use of brigatinib with moderate CYP3A4 inhibitors when possible. If such a combination cannot be avoided, reduce the dose of brigatinib by approximately 40% (ie, from 180 mg to 120 mg, from 120 mg to 90 mg, or from 90 mg to 60 mg). Risk D: Consider Therapy Modification
Bromocriptine: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Bromocriptine. Management: The bromocriptine dose should not exceed 1.6 mg daily with use of a moderate CYP3A4 inhibitor. The Cycloset brand specifically recommends this dose limitation, but other bromocriptine products do not make such specific recommendations. Risk D: Consider Therapy Modification
Budesonide (Oral Inhalation): CYP3A4 Inhibitors (Moderate) may increase serum concentration of Budesonide (Oral Inhalation). Risk C: Monitor
Budesonide (Systemic): CYP3A4 Inhibitors (Moderate) may increase serum concentration of Budesonide (Systemic). Management: Avoid the concomitant use of CYP3A4 inhibitors and oral budesonide. If patients receive both budesonide and CYP3A4 inhibitors, they should be closely monitored for signs and symptoms of corticosteroid excess. Risk D: Consider Therapy Modification
Budesonide (Topical): CYP3A4 Inhibitors (Moderate) may increase serum concentration of Budesonide (Topical). Risk X: Avoid
Buprenorphine: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Buprenorphine. Risk C: Monitor
BusPIRone: Erythromycin (Systemic) may increase serum concentration of BusPIRone. Management: Limit the buspirone dose to 2.5 mg twice daily and monitor for increased buspirone effects/toxicities if combined with erythromycin. Dose adjustments of buspirone or erythromycin should be based on clinical assessments. Risk D: Consider Therapy Modification
Cabozantinib: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Cabozantinib. Risk C: Monitor
Calcium Channel Blockers (Nondihydropyridine): Erythromycin (Systemic) may increase serum concentration of Calcium Channel Blockers (Nondihydropyridine). Calcium Channel Blockers (Nondihydropyridine) may increase serum concentration of Erythromycin (Systemic). Risk C: Monitor
Cannabis: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Cannabis. More specifically, tetrahydrocannabinol and cannabidiol serum concentrations may be increased. Risk C: Monitor
Capivasertib: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Capivasertib. Management: If capivasertib is combined with moderate CYP3A4 inhibitors, reduce the capivasertib dose to 320 mg twice daily for 4 days, followed by 3 days off. Monitor patients closely for adverse reactions. Risk D: Consider Therapy Modification
CarBAMazepine: CYP3A4 Inhibitors (Moderate) may increase serum concentration of CarBAMazepine. Risk C: Monitor
Cardiac Glycosides: Macrolide Antibiotics may increase serum concentration of Cardiac Glycosides. Risk C: Monitor
Cariprazine: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Cariprazine. CYP3A4 Inhibitors (Moderate) may increase active metabolite exposure of Cariprazine. Management: Cariprazine dose adjustments are recommended and depend upon whether a patient is initiating a moderate CYP3A4 inhibitor or cariprazine, as well as cariprazine indication. See full mono for details. Some non-US labels contraindicate this combination. Risk D: Consider Therapy Modification
Celiprolol: P-glycoprotein/ABCB1 Inhibitors may increase serum concentration of Celiprolol. Risk C: Monitor
Ceritinib: May increase QTc-prolonging effects of Erythromycin (Systemic). Ceritinib may increase serum concentration of Erythromycin (Systemic). Erythromycin (Systemic) may increase serum concentration of Ceritinib. Management: Consider alternatives to this drug combination. If combined, monitor for QTc interval prolongation and ventricular arrhythmias. Patients with additional risk factors for QTc prolongation may be at even higher risk. Risk D: Consider Therapy Modification
Chlorprothixene: May increase QTc-prolonging effects of Erythromycin (Systemic). Risk X: Avoid
Cholera Vaccine: Antibiotics may decrease therapeutic effects of Cholera Vaccine. Management: Avoid cholera vaccine in patients receiving systemic antibiotics, and within 14 days following the use of oral or parenteral antibiotics. Risk X: Avoid
Cilostazol: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Cilostazol. Management: Decrease the dose of cilostazol to 50 mg twice daily when combined with moderate CYP3A4 inhibitors. Risk D: Consider Therapy Modification
Cimetidine: May increase serum concentration of Erythromycin (Systemic). Risk C: Monitor
Cisapride: May increase QTc-prolonging effects of Erythromycin (Systemic). Erythromycin (Systemic) may increase QTc-prolonging effects of Cisapride. Erythromycin (Systemic) may increase serum concentration of Cisapride. Risk X: Avoid
Citalopram: May increase QTc-prolonging effects of QT-prolonging Moderate CYP3A4 Inhibitors (Moderate Risk). QT-prolonging Moderate CYP3A4 Inhibitors (Moderate Risk) may increase serum concentration of Citalopram. Risk C: Monitor
Clindamycin (Systemic): CYP3A4 Inhibitors (Moderate) may increase serum concentration of Clindamycin (Systemic). Risk C: Monitor
Clindamycin (Topical): Erythromycin (Systemic) may decrease therapeutic effects of Clindamycin (Topical). Management: Consider avoiding the concomitant use of systemic erythromycin and topical clindamycin when treating acne vulgaris. This recommendation does not appear to apply to intravaginal use of clindamycin for the treatment of bacterial vaginosis. Risk D: Consider Therapy Modification
Clofazimine: May increase serum concentration of CYP3A4 Substrates (High risk with Inhibitors). Risk C: Monitor
Clopidogrel: Erythromycin (Systemic) may decrease antiplatelet effects of Clopidogrel. Risk C: Monitor
Cobicistat: May increase serum concentration of Erythromycin (Systemic). Management: Consider alternatives to this combination when cobicistat is combined with atazanavir or darunavir. If combined, monitor for increased erythromycin and cobicistat effects/toxicities. Risk D: Consider Therapy Modification
Cobimetinib: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Cobimetinib. Management: Avoid this combination when possible. If concurrent short term (14 days or less) use cannot be avoided, reduce the cobimetinib dose from 60 mg to 20 mg daily. Avoid concomitant use in patients already receiving reduced cobimetinib doses. Risk D: Consider Therapy Modification
Codeine: CYP3A4 Inhibitors (Moderate) may increase active metabolite exposure of Codeine. Risk C: Monitor
Colchicine: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Colchicine. Management: Avoidance, dose reduction, or increased monitoring for colchicine toxicity may be needed and will depend on brand, indication for colchicine use, renal/hepatic function, and use of a P-gp inhibitor. See full monograph for details. Risk D: Consider Therapy Modification
Colchicine: P-glycoprotein/ABCB1 Inhibitors may increase serum concentration of Colchicine. Colchicine distribution into certain tissues (e.g., brain) may also be increased. Management: This combination is often contraindicated, but combined use may be permitted with dose adjustment and monitoring. Recommendations vary based on brand, indication, use of CYP3A4 inhibitors, and hepatic/renal function. See interaction monograph for details. Risk D: Consider Therapy Modification
Conivaptan: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Conivaptan. Risk C: Monitor
Copanlisib: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Copanlisib. Risk C: Monitor
Crizotinib: QT-prolonging Moderate CYP3A4 Inhibitors (Moderate Risk) may increase QTc-prolonging effects of Crizotinib. QT-prolonging Moderate CYP3A4 Inhibitors (Moderate Risk) may increase serum concentration of Crizotinib. Management: Monitor for QTc interval prolongation and ventricular arrhythmias when these agents are combined. Patients with additional risk factors for QTc prolongation may be at even higher risk. Risk C: Monitor
CycloSPORINE (Systemic): Erythromycin (Systemic) may increase serum concentration of CycloSPORINE (Systemic). Risk C: Monitor
CYP3A4 Inhibitors (Moderate): May increase serum concentration of Erythromycin (Systemic). Risk C: Monitor
CYP3A4 Inhibitors (Strong): May increase serum concentration of Erythromycin (Systemic). Management: Consider alternatives to this combination when possible. If combined, monitor for increased erythromycin effects and toxicities, including QTc interval prolongation. Risk D: Consider Therapy Modification
Dabigatran Etexilate: P-glycoprotein/ABCB1 Inhibitors may increase active metabolite exposure of Dabigatran Etexilate. Risk C: Monitor
Dabrafenib: QT-prolonging Moderate CYP3A4 Inhibitors (Moderate Risk) may increase QTc-prolonging effects of Dabrafenib. QT-prolonging Moderate CYP3A4 Inhibitors (Moderate Risk) may increase serum concentration of Dabrafenib. Management: Monitor for QTc interval prolongation, ventricular arrhythmias, and dabrafenib adverse effects when these agents are combined. Patients with additional risk factors for QTc prolongation may be at even higher risk. Risk C: Monitor
Dapoxetine: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Dapoxetine. Management: The dose of dapoxetine should be limited to 30 mg per day when used together with a moderate inhibitor of CYP3A4. Risk D: Consider Therapy Modification
Daridorexant: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Daridorexant. Management: Limit the daridorexant dose to 25 mg, no more than once per night, when combined with moderate CYP3A4 inhibitors. Risk D: Consider Therapy Modification
Darifenacin: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Darifenacin. Risk C: Monitor
Deflazacort: CYP3A4 Inhibitors (Moderate) may increase active metabolite exposure of Deflazacort. Management: Administer one third of the recommended deflazacort dose when used together with a strong or moderate CYP3A4 inhibitor. Risk D: Consider Therapy Modification
DexAMETHasone (Systemic): CYP3A4 Inhibitors (Moderate) may increase serum concentration of DexAMETHasone (Systemic). Risk C: Monitor
DiazePAM: CYP3A4 Inhibitors (Moderate) may increase serum concentration of DiazePAM. Risk C: Monitor
Diazoxide Choline: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Diazoxide Choline. Risk C: Monitor
Dienogest: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Dienogest. Risk C: Monitor
Digitoxin: P-glycoprotein/ABCB1 Inhibitors may increase serum concentration of Digitoxin. Risk C: Monitor
DOCEtaxel: CYP3A4 Inhibitors (Moderate) may increase serum concentration of DOCEtaxel. Risk C: Monitor
Domperidone: May increase QTc-prolonging effects of QT-prolonging Moderate CYP3A4 Inhibitors (Moderate Risk). QT-prolonging Moderate CYP3A4 Inhibitors (Moderate Risk) may increase serum concentration of Domperidone. Risk X: Avoid
Doxercalciferol: Erythromycin (Systemic) may increase serum concentration of Doxercalciferol. Risk C: Monitor
Doxofylline: Erythromycin (Systemic) may increase serum concentration of Doxofylline. Risk C: Monitor
DOXOrubicin (Conventional): P-glycoprotein/ABCB1 Inhibitors may increase serum concentration of DOXOrubicin (Conventional). Risk X: Avoid
DOXOrubicin (Liposomal): P-glycoprotein/ABCB1 Inhibitors may increase serum concentration of DOXOrubicin (Liposomal). Risk C: Monitor
DroNABinol: CYP3A4 Inhibitors (Moderate) may increase serum concentration of DroNABinol. Risk C: Monitor
Dronedarone: May increase QTc-prolonging effects of Erythromycin (Systemic). Erythromycin (Systemic) may increase serum concentration of Dronedarone. Risk X: Avoid
Ebastine: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Ebastine. Risk C: Monitor
Edoxaban: Erythromycin (Systemic) may increase serum concentration of Edoxaban. Management: In patients treated for DVT/PE, reduce the edoxaban dose to 30 mg daily when combined with erythromycin. No dose adjustment is recommended for patients treated for atrial fibrillation. Monitor for increased edoxaban toxicities (ie, bleeding) when combined Risk D: Consider Therapy Modification
Elacestrant: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Elacestrant. Risk X: Avoid
Elbasvir and Grazoprevir: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Elbasvir and Grazoprevir. Risk C: Monitor
Eletriptan: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Eletriptan. Risk X: Avoid
Elexacaftor, Tezacaftor, and Ivacaftor: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Elexacaftor, Tezacaftor, and Ivacaftor. Management: When combined with moderate CYP3A4 inhibitors, elexacaftor/tezacaftor/ivacaftor should be given in the morning, every other day. Ivacaftor alone should be given in the morning, every other day on alternate days. Risk D: Consider Therapy Modification
Eliglustat: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Eliglustat. Management: Reduce eliglustat dose to 84 mg daily in CYP2D6 EMs when used with moderate CYP3A4 inhibitors. Avoid use of moderate CYP3A4 inhibitors in CYP2D6 IMs or PMs. Use in CYP2D6 EMs or IMs also taking strong or moderate CYP2D6 inhibitors is contraindicated. Risk D: Consider Therapy Modification
Encorafenib: May increase QTc-prolonging effects of QT-prolonging Moderate CYP3A4 Inhibitors (Moderate Risk). QT-prolonging Moderate CYP3A4 Inhibitors (Moderate Risk) may increase serum concentration of Encorafenib. Management: Avoid use of encorafenib and moderate CYP3A4 inhibitors when possible. If combined, decrease encorafenib dose from 450 mg to 225 mg; 300 mg to 150 mg; and 225 mg or 150 mg to 75 mg. Monitor closely for QT interval prolongation. Risk D: Consider Therapy Modification
Ensartinib: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Ensartinib. Risk X: Avoid
Ensartinib: P-glycoprotein/ABCB1 Inhibitors may increase serum concentration of Ensartinib. Risk X: Avoid
Entrectinib: May increase QTc-prolonging effects of QT-prolonging Moderate CYP3A4 Inhibitors (Moderate Risk). QT-prolonging Moderate CYP3A4 Inhibitors (Moderate Risk) may increase serum concentration of Entrectinib. Risk X: Avoid
Eplerenone: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Eplerenone. Management: If coadministered with moderate CYP3A4 inhibitors, the max dose of eplerenone is 25 mg daily if used for heart failure; if used for hypertension initiate eplerenone 25 mg daily, titrate to max 25 mg twice daily. Risk D: Consider Therapy Modification
Ergot Derivatives (Vasoconstrictive CYP3A4 Substrates): Erythromycin (Systemic) may increase serum concentration of Ergot Derivatives (Vasoconstrictive CYP3A4 Substrates). Risk X: Avoid
Erlotinib: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Erlotinib. Risk C: Monitor
Escitalopram: May increase QTc-prolonging effects of QT-prolonging Moderate CYP3A4 Inhibitors (Moderate Risk). Risk C: Monitor
Eszopiclone: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Eszopiclone. Risk C: Monitor
Etoposide Phosphate: P-glycoprotein/ABCB1 Inhibitors may increase serum concentration of Etoposide Phosphate. Risk C: Monitor
Etoposide: P-glycoprotein/ABCB1 Inhibitors may increase serum concentration of Etoposide. Risk C: Monitor
Etravirine: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Etravirine. Risk C: Monitor
Everolimus: Inhibitors of CYP3A4 (Moderate) and P-glycoprotein may increase serum concentration of Everolimus. Management: Afinitor: For TSC-associated SEGA or TSC-associated seizures reduce everolimus dose 50%. For other Afinitor indications, reduce everolimus dose to 2.5 mg/day, increase to 5 mg/day if tolerated. Zortress: Monitor for increased everolimus concentrations. Risk D: Consider Therapy Modification
Fecal Microbiota (Live) (Oral): May decrease therapeutic effects of Antibiotics. Risk X: Avoid
Fecal Microbiota (Live) (Rectal): Antibiotics may decrease therapeutic effects of Fecal Microbiota (Live) (Rectal). Risk X: Avoid
Fedratinib: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Fedratinib. Risk C: Monitor
Felodipine: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Felodipine. Risk C: Monitor
FentaNYL: CYP3A4 Inhibitors (Moderate) may increase serum concentration of FentaNYL. Management: Consider fentanyl dose reductions when combined with a moderate CYP3A4 inhibitor. Monitor for respiratory depression and sedation. Upon discontinuation of a CYP3A4 inhibitor, consider a fentanyl dose increase; monitor for signs and symptoms of withdrawal. Risk D: Consider Therapy Modification
Fexinidazole: QT-prolonging Moderate CYP3A4 Inhibitors (Moderate Risk) may increase QTc-prolonging effects of Fexinidazole. Fexinidazole may decrease serum concentration of QT-prolonging Moderate CYP3A4 Inhibitors (Moderate Risk). Specifically, concentrations of crizotinib, nilotinib, and ribociclib may be decreased. QT-prolonging Moderate CYP3A4 Inhibitors (Moderate Risk) may decrease active metabolite exposure of Fexinidazole. Management: Consider alternatives to this combination. If combined, monitor for QT interval prolongation and ventricular arrhythmias. Also monitor for reduced efficacy of fexinidazole, crizotinib, nilotinib, and ribociclib. Risk D: Consider Therapy Modification
Finerenone: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Finerenone. Risk C: Monitor
Flibanserin: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Flibanserin. Management: Use of flibanserin with moderate CYP3A4 inhibitors is contraindicated. If starting flibanserin, start 2 weeks after the last dose of the CYP3A4 inhibitor. If starting a CYP3A4 inhibitor, start 2 days after the last dose of flibanserin. Risk X: Avoid
Fluconazole: May increase QTc-prolonging effects of Erythromycin (Systemic). Fluconazole may increase serum concentration of Erythromycin (Systemic). Risk X: Avoid
Fluorouracil Products: QT-prolonging Moderate CYP3A4 Inhibitors (Moderate Risk) may increase QTc-prolonging effects of Fluorouracil Products. Management: Monitor for QTc interval prolongation and ventricular arrhythmias when these agents are combined. Patients with additional risk factors for QTc prolongation may be at even higher risk. Risk C: Monitor
Fluticasone (Nasal): CYP3A4 Inhibitors (Moderate) may increase serum concentration of Fluticasone (Nasal). Risk C: Monitor
Fluticasone (Oral Inhalation): CYP3A4 Inhibitors (Moderate) may increase serum concentration of Fluticasone (Oral Inhalation). Risk C: Monitor
Fosamprenavir: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Fosamprenavir. Risk C: Monitor
Fosaprepitant: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Fosaprepitant. Risk X: Avoid
Fusidic Acid (Systemic): May increase serum concentration of CYP3A4 Substrates (High risk with Inhibitors). Management: Consider avoiding this combination if possible. If required, monitor patients closely for increased adverse effects of the CYP3A4 substrate. Risk D: Consider Therapy Modification
Futibatinib: Inhibitors of CYP3A4 (Moderate) and P-glycoprotein may increase serum concentration of Futibatinib. Risk C: Monitor
Gepirone: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Gepirone. Management: Reduce the gepirone dose by 50% if combined with moderate CYP3A4 inhibitors. Monitor for QTc interval prolongation with combined use. Risk D: Consider Therapy Modification
Gepotidacin: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Gepotidacin. Risk C: Monitor
Glasdegib: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Glasdegib. Risk C: Monitor
Glecaprevir and Pibrentasvir: P-glycoprotein/ABCB1 Inhibitors may increase serum concentration of Glecaprevir and Pibrentasvir. Risk C: Monitor
Grapefruit Juice: May increase serum concentration of Erythromycin (Systemic). Risk C: Monitor
GuanFACINE: CYP3A4 Inhibitors (Moderate) may increase serum concentration of GuanFACINE. Management: Reduce the extended-release guanfacine dose 50% when combined with a moderate CYP3A4 inhibitor. Monitor for increased guanfacine toxicities when these agents are combined. Risk D: Consider Therapy Modification
Haloperidol: QT-prolonging Moderate CYP3A4 Inhibitors (Moderate Risk) may increase QTc-prolonging effects of Haloperidol. Management: Monitor for QTc interval prolongation and ventricular arrhythmias when these agents are combined. Patients with additional risk factors for QTc prolongation may be at even higher risk. Risk C: Monitor
HYDROcodone: CYP3A4 Inhibitors (Moderate) may increase serum concentration of HYDROcodone. Risk C: Monitor
Ibrutinib: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Ibrutinib. Management: When treating B-cell malignancies, decrease ibrutinib to 280 mg daily when combined with moderate CYP3A4 inhibitors. When treating graft versus host disease, monitor patients closely and reduce the ibrutinib dose as needed based on adverse reactions. Risk D: Consider Therapy Modification
Ifosfamide: CYP3A4 Inhibitors (Moderate) may increase adverse/toxic effects of Ifosfamide. CYP3A4 Inhibitors (Moderate) may decrease active metabolite exposure of Ifosfamide. Risk C: Monitor
Iloperidone: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Iloperidone. Risk C: Monitor
Immune Checkpoint Inhibitors (Anti-PD-1, -PD-L1, and -CTLA4 Therapies): Antibiotics may decrease therapeutic effects of Immune Checkpoint Inhibitors (Anti-PD-1, -PD-L1, and -CTLA4 Therapies). Risk C: Monitor
Irinotecan Products: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Irinotecan Products. CYP3A4 Inhibitors (Moderate) may increase active metabolite exposure of Irinotecan Products. Specifically, the serum concentration of SN-38 may be increased. Risk C: Monitor
Isavuconazonium Sulfate: CYP3A4 Inhibitors (Moderate) may increase active metabolite exposure of Isavuconazonium Sulfate. Specifically, CYP3A4 Inhibitors (Moderate) may increase isavuconazole serum concentrations. Risk C: Monitor
Isradipine: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Isradipine. Risk C: Monitor
Ivabradine: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Ivabradine. Risk X: Avoid
Ivacaftor: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Ivacaftor. Management: Ivacaftor dose reductions may be required; consult full drug interaction monograph content for age- and weight-specific dosage recommendations. Risk D: Consider Therapy Modification
Ivosidenib: May increase QTc-prolonging effects of QT-prolonging Moderate CYP3A4 Inhibitors (Moderate Risk). QT-prolonging Moderate CYP3A4 Inhibitors (Moderate Risk) may increase serum concentration of Ivosidenib. Management: Consider alternatives to this drug combination. If combined, monitor for QTc interval prolongation and ventricular arrhythmias. Patients with additional risk factors for QTc prolongation may be at even higher risk. Risk D: Consider Therapy Modification
Ixabepilone: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Ixabepilone. Risk C: Monitor
Lactobacillus and Estriol: Antibiotics may decrease therapeutic effects of Lactobacillus and Estriol. Risk C: Monitor
Lapatinib: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Lapatinib. Risk C: Monitor
Larotrectinib: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Larotrectinib. Risk C: Monitor
Lefamulin: May increase QTc-prolonging effects of QT-prolonging CYP3A4 Substrates. Management: Do not use lefamulin tablets with QT-prolonging CYP3A4 substrates. Lefamulin prescribing information lists this combination as contraindicated. Risk X: Avoid
Lemborexant: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Lemborexant. Risk X: Avoid
Leniolisib: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Leniolisib. Risk C: Monitor
Lercanidipine: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Lercanidipine. Risk C: Monitor
Levamlodipine: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Levamlodipine. Risk C: Monitor
Levoketoconazole: QT-prolonging CYP3A4 Substrates may increase QTc-prolonging effects of Levoketoconazole. Levoketoconazole may increase serum concentration of QT-prolonging CYP3A4 Substrates. Risk X: Avoid
Levomethadone: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Levomethadone. Risk C: Monitor
Levomilnacipran: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Levomilnacipran. Risk C: Monitor
Lidocaine (Systemic): CYP3A4 Inhibitors (Moderate) may increase serum concentration of Lidocaine (Systemic). CYP3A4 Inhibitors (Moderate) may increase active metabolite exposure of Lidocaine (Systemic). Specifically, concentrations of monoethylglycinexylidide (MEGX) may be increased. Risk C: Monitor
Lincomycin: Erythromycin (Systemic) may decrease therapeutic effects of Lincomycin. Risk X: Avoid
Lomitapide: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Lomitapide. Risk X: Avoid
Lovastatin: Erythromycin (Systemic) may increase serum concentration of Lovastatin. Risk X: Avoid
Lumacaftor and Ivacaftor: May decrease serum concentration of Erythromycin (Systemic). Risk X: Avoid
Lumateperone: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Lumateperone. Management: Limit the lumateperone dose to 21 mg once daily when used with a moderate CYP3A4 inhibitor. Risk D: Consider Therapy Modification
Lurasidone: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Lurasidone. Management: Reduce the lurasidone dose by half when initiating therapy with a moderate CYP3A4 inhibitor. If initiating lurasidone in a patient already receiving a moderate CYP3A4 inhibitor, start lurasidone at 20 mg/day with a max dose of 80 mg/day. Risk D: Consider Therapy Modification
Lurbinectedin: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Lurbinectedin. Management: Avoid concomitant use of lurbinectedin and moderate CYP3A4 inhibitors when possible. If combined, reduce the lurbinectedin dose by 50%. Risk D: Consider Therapy Modification
Macitentan: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Macitentan. Risk C: Monitor
Manidipine: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Manidipine. Risk C: Monitor
Maraviroc: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Maraviroc. Risk C: Monitor
Mavacamten: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Mavacamten. Management: Start mavacamten at 5 mg/day if stable on a moderate CYP3A4 inhibitor, and reduce the mavacamten dose by one dose level if initiating a moderate CYP3A4 inhibitor. Avoid initiating moderate CYP3A4 inhibitors in patients on mavacamten 2.5 mg/day. Risk D: Consider Therapy Modification
Mavorixafor: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Mavorixafor. Risk C: Monitor
Meperidine: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Meperidine. Risk C: Monitor
Metergoline: Erythromycin (Systemic) may increase serum concentration of Metergoline. Risk X: Avoid
Methadone: May increase QTc-prolonging effects of QT-prolonging Moderate CYP3A4 Inhibitors (Moderate Risk). QT-prolonging Moderate CYP3A4 Inhibitors (Moderate Risk) may increase serum concentration of Methadone. Management: Consider alternatives to this drug combination. If combined, monitor for increased methadone toxicities (eg, respiratory depression, QTc interval prolongation). Patients with additional risk factors for QTc prolongation may be at even higher risk. Risk D: Consider Therapy Modification
MethylPREDNISolone: CYP3A4 Inhibitors (Moderate) may increase serum concentration of MethylPREDNISolone. Risk C: Monitor
Methysergide: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Methysergide. Risk X: Avoid
Midazolam: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Midazolam. Management: Avoid concomitant use of nasal midazolam and moderate CYP3A4 inhibitors. Consider alternatives to use with oral midazolam whenever possible and consider using lower midazolam doses. Monitor patients for sedation and respiratory depression if combined. Risk D: Consider Therapy Modification
Mirodenafil: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Mirodenafil. Risk C: Monitor
Mitapivat: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Mitapivat. Management: When coadministered with moderate CYP3A4 inhibitors, doses of mitapivat should not exceed 20 mg twice daily. Additionally, patients should be monitored for changes in hemoglobin response and increased mitapivat adverse effects. Risk D: Consider Therapy Modification
Mizolastine: Macrolide Antibiotics may increase serum concentration of Mizolastine. Risk X: Avoid
Mobocertinib: QT-prolonging Moderate CYP3A4 Inhibitors (Moderate Risk) may increase QTc-prolonging effects of Mobocertinib. QT-prolonging Moderate CYP3A4 Inhibitors (Moderate Risk) may increase serum concentration of Mobocertinib. QT-prolonging Moderate CYP3A4 Inhibitors (Moderate Risk) may increase active metabolite exposure of Mobocertinib. Management: Avoid use of QT prolonging moderate CYP3A4 inhibitors with mobocertinib when possible. If combined, the mobocertinib dose should be reduced by approximately 50% (ie, from 160 mg to 80 mg, 120 mg to 40 mg, or 80 mg to 40 mg). Monitor QTc interval closely. Risk D: Consider Therapy Modification
Morphine (Systemic): P-glycoprotein/ABCB1 Inhibitors may increase serum concentration of Morphine (Systemic). Risk C: Monitor
Mycophenolate: Antibiotics may decrease active metabolite exposure of Mycophenolate. Specifically, concentrations of mycophenolic acid (MPA) may be reduced. Risk C: Monitor
Nadolol: P-glycoprotein/ABCB1 Inhibitors may increase serum concentration of Nadolol. Risk C: Monitor
Naldemedine: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Naldemedine. Risk C: Monitor
Nalfurafine: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Nalfurafine. Risk C: Monitor
Naloxegol: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Naloxegol. Management: The use of naloxegol and moderate CYP3A4 inhibitors should be avoided. If concurrent use is unavoidable, reduce naloxegol dose to 12.5 mg once daily and monitor for signs of opiate withdrawal (eg, hyperhidrosis, chills, diarrhea, anxiety, irritability). Risk D: Consider Therapy Modification
Neratinib: Inhibitors of CYP3A4 (Moderate) and P-glycoprotein may increase serum concentration of Neratinib. Risk X: Avoid
NIFEdipine (Topical): CYP3A4 Inhibitors (Moderate) may increase serum concentration of NIFEdipine (Topical). Risk C: Monitor
NIFEdipine: CYP3A4 Inhibitors (Moderate) may increase serum concentration of NIFEdipine. Risk C: Monitor
NiMODipine: CYP3A4 Inhibitors (Moderate) may increase serum concentration of NiMODipine. Risk C: Monitor
Nintedanib: Inhibitors of CYP3A4 (Moderate) and P-glycoprotein may increase serum concentration of Nintedanib. Risk C: Monitor
Nirogacestat: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Nirogacestat. Risk X: Avoid
Nisoldipine: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Nisoldipine. Risk X: Avoid
Nitrendipine: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Nitrendipine. Risk C: Monitor
Olaparib: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Olaparib. Management: Avoid use of moderate CYP3A4 inhibitors with olaparib, if possible. If such concurrent use cannot be avoided, the dose of olaparib tablets should be reduced to 150 mg twice daily and the dose of olaparib capsules should be reduced to 200 mg twice daily. Risk D: Consider Therapy Modification
Oliceridine: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Oliceridine. Risk C: Monitor
Olmutinib: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Olmutinib. Risk C: Monitor
Omaveloxolone: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Omaveloxolone. Management: Avoid this combination if possible. If coadministration is required, decrease the omaveloxolone dose to 100 mg daily and monitor closely for adverse reactions. If adverse reactions occur, decrease omaveloxolone to 50 mg daily. Risk D: Consider Therapy Modification
Ondansetron: May increase QTc-prolonging effects of QT-prolonging Moderate CYP3A4 Inhibitors (Moderate Risk). Management: Monitor for QTc interval prolongation and ventricular arrhythmias when these agents are combined. Patients with additional risk factors for QTc prolongation may be at even higher risk. Risk C: Monitor
OxyBUTYnin: Erythromycin (Systemic) may increase serum concentration of OxyBUTYnin. Risk C: Monitor
OxyCODONE: CYP3A4 Inhibitors (Moderate) may increase serum concentration of OxyCODONE. Serum concentrations of the active metabolite Oxymorphone may also be increased. Risk C: Monitor
PACLitaxel (Conventional): CYP3A4 Inhibitors (Moderate) may increase serum concentration of PACLitaxel (Conventional). Risk C: Monitor
PACLitaxel (Protein Bound): CYP3A4 Inhibitors (Moderate) may increase serum concentration of PACLitaxel (Protein Bound). Risk C: Monitor
Pacritinib: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Pacritinib. Risk C: Monitor
Palbociclib: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Palbociclib. Risk C: Monitor
Palovarotene: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Palovarotene. Management: Avoid concomitant use of palovarotene and moderate CYP3A4 inhibitors when possible. If combined, decrease palovarotene dose by 50% as described in the full interaction monograph. Monitor for palovarotene toxicities when combined. Risk D: Consider Therapy Modification
Panobinostat: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Panobinostat. Risk C: Monitor
PAZOPanib: Erythromycin (Systemic) may increase QTc-prolonging effects of PAZOPanib. Erythromycin (Systemic) may increase serum concentration of PAZOPanib. Risk X: Avoid
Pemigatinib: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Pemigatinib. Management: If combined use cannot be avoided, reduce the pemigatinib dose from 13.5 mg daily to 9 mg daily, or from 9 mg daily to 4.5 mg daily. Resume prior pemigatinib dose after stopping the moderate inhibitor once 3 half-lives of the inhibitor has passed. Risk D: Consider Therapy Modification
Pentamidine (Systemic): May increase QTc-prolonging effects of QT-prolonging Moderate CYP3A4 Inhibitors (Moderate Risk). Management: Monitor for QTc interval prolongation and ventricular arrhythmias when these agents are combined. Patients with additional risk factors for QTc prolongation may be at even higher risk. Risk C: Monitor
Pexidartinib: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Pexidartinib. Management: If combined use cannot be avoided, pexidartinib dose should be reduced as follows: reduce pexidartinib doses of 500 mg or 375 mg daily to 125 mg twice daily; reduce pexidartinib 250 mg daily to 125 mg once daily. Risk D: Consider Therapy Modification
Pimavanserin: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Pimavanserin. Risk C: Monitor
Pimecrolimus: CYP3A4 Inhibitors (Moderate) may decrease metabolism of Pimecrolimus. Risk C: Monitor
Pimozide: May increase QTc-prolonging effects of QT-prolonging Agents (Moderate Risk). Risk X: Avoid
Piperaquine: QT-prolonging Agents (Moderate Risk) may increase QTc-prolonging effects of Piperaquine. Risk X: Avoid
Pirtobrutinib: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Pirtobrutinib. Risk C: Monitor
Pitavastatin: Erythromycin (Systemic) may increase serum concentration of Pitavastatin. Management: Limit pitavastatin to a maximum of 1 mg/day when used in combination with erythromycin. If this combination is used, monitor patients more closely for evidence of pitavastatin toxicity. Risk D: Consider Therapy Modification
Pivmecillinam: Erythromycin (Systemic) may decrease therapeutic effects of Pivmecillinam. Risk C: Monitor
PONATinib: CYP3A4 Inhibitors (Moderate) may increase serum concentration of PONATinib. Risk C: Monitor
Posaconazole: May increase serum concentration of QT-prolonging CYP3A4 Substrates. Such increases may lead to a greater risk for proarrhythmic effects and other similar toxicities. Risk X: Avoid
Pralsetinib: Inhibitors of CYP3A4 (Moderate) and P-glycoprotein may increase serum concentration of Pralsetinib. Management: If this combo cannot be avoided, decrease pralsetinib dose from 400 mg daily to 300 mg daily; from 300 mg daily to 200 mg daily; and from 200 mg daily to 100 mg daily. Risk D: Consider Therapy Modification
Pravastatin: Erythromycin (Systemic) may increase serum concentration of Pravastatin. Management: Limit pravastatin dose to a maximum of 40 mg/day when used in combination with erythromycin. If this combination is used, monitor patients more closely for evidence of pravastatin toxicity. Risk D: Consider Therapy Modification
Prazepam: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Prazepam. Risk C: Monitor
Praziquantel: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Praziquantel. Risk C: Monitor
QT-prolonging Antidepressants (Moderate Risk): May increase QTc-prolonging effects of QT-prolonging Moderate CYP3A4 Inhibitors (Moderate Risk). Risk C: Monitor
QT-prolonging Antipsychotics (Moderate Risk): QT-prolonging Moderate CYP3A4 Inhibitors (Moderate Risk) may increase QTc-prolonging effects of QT-prolonging Antipsychotics (Moderate Risk). Management: Monitor for QTc interval prolongation and ventricular arrhythmias when these agents are combined. Patients with additional risk factors for QTc prolongation may be at even higher risk. Risk C: Monitor
QT-prolonging Class IA Antiarrhythmics (Highest Risk): May increase QTc-prolonging effects of Erythromycin (Systemic). Erythromycin (Systemic) may increase QTc-prolonging effects of QT-prolonging Class IA Antiarrhythmics (Highest Risk). Erythromycin (Systemic) may increase serum concentration of QT-prolonging Class IA Antiarrhythmics (Highest Risk). Management: Consider alternatives to this drug combination. If combined, monitor for QTc interval prolongation and ventricular arrhythmias. Patients with additional risk factors for QTc prolongation may be at even higher risk. Risk D: Consider Therapy Modification
QT-prolonging Class IC Antiarrhythmics (Moderate Risk): May increase QTc-prolonging effects of QT-prolonging Moderate CYP3A4 Inhibitors (Moderate Risk). Management: Monitor for QTc interval prolongation and ventricular arrhythmias when these agents are combined. Patients with additional risk factors for QTc prolongation may be at even higher risk. Risk C: Monitor
QT-prolonging Class III Antiarrhythmics (Highest Risk): May increase QTc-prolonging effects of Erythromycin (Systemic). Erythromycin (Systemic) may increase QTc-prolonging effects of QT-prolonging Class III Antiarrhythmics (Highest Risk). Management: Avoid concomitant use of erythromycin and class III antiarrhythmic agents. Use of erythromycin with dronedarone is specifically contraindicated. Risk X: Avoid
QT-Prolonging Inhalational Anesthetics (Moderate Risk): May increase QTc-prolonging effects of QT-prolonging Moderate CYP3A4 Inhibitors (Moderate Risk). Management: Monitor for QTc interval prolongation and ventricular arrhythmias when these agents are combined. Patients with additional risk factors for QTc prolongation may be at even higher risk. Risk C: Monitor
QT-prolonging Kinase Inhibitors (Highest Risk): May increase QTc-prolonging effects of QT-prolonging Moderate CYP3A4 Inhibitors (Moderate Risk). QT-prolonging Moderate CYP3A4 Inhibitors (Moderate Risk) may increase serum concentration of QT-prolonging Kinase Inhibitors (Highest Risk). Management: Consider alternatives to this drug combination. If combined, monitor for QTc interval prolongation and ventricular arrhythmias. Patients with additional risk factors for QTc prolongation may be at even higher risk. Risk D: Consider Therapy Modification
QT-prolonging Kinase Inhibitors (Moderate Risk): QT-prolonging Moderate CYP3A4 Inhibitors (Moderate Risk) may increase QTc-prolonging effects of QT-prolonging Kinase Inhibitors (Moderate Risk). QT-prolonging Moderate CYP3A4 Inhibitors (Moderate Risk) may increase serum concentration of QT-prolonging Kinase Inhibitors (Moderate Risk). Risk C: Monitor
QT-prolonging Miscellaneous Agents (Highest Risk): QT-prolonging Moderate CYP3A4 Inhibitors (Moderate Risk) may increase QTc-prolonging effects of QT-prolonging Miscellaneous Agents (Highest Risk). Management: Consider alternatives to this drug combination. If combined, monitor for QTc interval prolongation and ventricular arrhythmias. Patients with additional risk factors for QTc prolongation may be at even higher risk. Risk D: Consider Therapy Modification
QT-prolonging Miscellaneous Agents (Moderate Risk): QT-prolonging Moderate CYP3A4 Inhibitors (Moderate Risk) may increase QTc-prolonging effects of QT-prolonging Miscellaneous Agents (Moderate Risk). QT-prolonging Moderate CYP3A4 Inhibitors (Moderate Risk) may increase serum concentration of QT-prolonging Miscellaneous Agents (Moderate Risk). Management: Monitor for QTc interval prolongation and ventricular arrhythmias when these agents are combined. Patients with additional risk factors for QTc prolongation may be at even higher risk. Risk C: Monitor
QT-prolonging Moderate CYP3A4 Inhibitors (Moderate Risk): Erythromycin (Systemic) may increase QTc-prolonging effects of QT-prolonging Moderate CYP3A4 Inhibitors (Moderate Risk). QT-prolonging Moderate CYP3A4 Inhibitors (Moderate Risk) may increase serum concentration of Erythromycin (Systemic). Management: Monitor for QTc interval prolongation and ventricular arrhythmias when these agents are combined. Patients with additional risk factors for QTc prolongation may be at even higher risk. Risk C: Monitor
QT-prolonging Quinolone Antibiotics (Moderate Risk): May increase QTc-prolonging effects of QT-prolonging Moderate CYP3A4 Inhibitors (Moderate Risk). Management: Monitor for QTc interval prolongation and ventricular arrhythmias when these agents are combined. Patients with additional risk factors for QTc prolongation may be at even higher risk. Risk C: Monitor
QT-prolonging Strong CYP3A4 Inhibitors (Highest Risk): May increase QTc-prolonging effects of Erythromycin (Systemic). QT-prolonging Strong CYP3A4 Inhibitors (Highest Risk) may increase serum concentration of Erythromycin (Systemic). Management: Consider alternatives to this combination. If combined, monitor for increased erythromycin toxicities, including QTc interval prolongation and ventricular arrhythmias. Patients with additional risk factors for QTc prolongation may be at even higher risk. Risk D: Consider Therapy Modification
QT-prolonging Strong CYP3A4 Inhibitors (Moderate Risk): Erythromycin (Systemic) may increase QTc-prolonging effects of QT-prolonging Strong CYP3A4 Inhibitors (Moderate Risk). QT-prolonging Strong CYP3A4 Inhibitors (Moderate Risk) may increase serum concentration of Erythromycin (Systemic). Management: Consider alternatives to this drug combination. If combined, monitor for QTc interval prolongation and ventricular arrhythmias. Patients with additional risk factors for QTc prolongation may be at even higher risk. Risk D: Consider Therapy Modification
QUEtiapine: QT-prolonging Moderate CYP3A4 Inhibitors (Moderate Risk) may increase QTc-prolonging effects of QUEtiapine. QT-prolonging Moderate CYP3A4 Inhibitors (Moderate Risk) may increase serum concentration of QUEtiapine. Management: Consider alternatives to this combination. If combined, monitor for QTc interval prolongation, ventricular arrhythmias, and other quetiapine toxicities. Patients with additional risk factors for QTc prolongation may be at even higher risk. Risk D: Consider Therapy Modification
Quinidine (Non-Therapeutic): CYP3A4 Inhibitors (Moderate) may increase serum concentration of Quinidine (Non-Therapeutic). Risk C: Monitor
QuiNIDine: Erythromycin (Systemic) may increase QTc-prolonging effects of QuiNIDine. Erythromycin (Systemic) may increase serum concentration of QuiNIDine. Risk X: Avoid
Ranolazine: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Ranolazine. Management: Limit the ranolazine dose to a maximum of 500 mg twice daily in patients concurrently receiving moderate CYP3A4 inhibitors. Monitor for increased ranolazine effects and toxicities during concomitant use. Risk D: Consider Therapy Modification
Red Yeast Rice: Erythromycin (Systemic) may increase serum concentration of Red Yeast Rice. Risk X: Avoid
Regorafenib: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Regorafenib. CYP3A4 Inhibitors (Moderate) may decrease active metabolite exposure of Regorafenib. Risk C: Monitor
Relugolix, Estradiol, and Norethindrone: P-glycoprotein/ABCB1 Inhibitors may increase serum concentration of Relugolix, Estradiol, and Norethindrone. Management: Avoid use of relugolix/estradiol/norethindrone with P-glycoprotein (P-gp) inhibitors. If concomitant use is unavoidable, relugolix/estradiol/norethindrone should be administered at least 6 hours before the P-gp inhibitor. Risk D: Consider Therapy Modification
Relugolix: P-glycoprotein/ABCB1 Inhibitors may increase serum concentration of Relugolix. Management: Avoid coadministration of relugolix with oral P-gp inhibitors whenever possible. If combined, take relugolix at least 6 hours prior to the P-gp inhibitor and monitor patients more frequently for adverse reactions. Risk D: Consider Therapy Modification
Repaglinide: Erythromycin (Systemic) may increase serum concentration of Repaglinide. Risk C: Monitor
Repotrectinib: P-glycoprotein/ABCB1 Inhibitors may increase serum concentration of Repotrectinib. Risk X: Avoid
Revumenib: QT-prolonging Moderate CYP3A4 Inhibitors (Moderate Risk) may increase QTc-prolonging effects of Revumenib. QT-prolonging Moderate CYP3A4 Inhibitors (Moderate Risk) may increase serum concentration of Revumenib. Management: Consider alternatives to this drug combination. If combined, monitor for QTc interval prolongation and ventricular arrhythmias. Patients with additional risk factors for QTc prolongation may be at even higher risk. Risk D: Consider Therapy Modification
Rifabutin: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Rifabutin. Risk C: Monitor
RifAXIMin: P-glycoprotein/ABCB1 Inhibitors may increase serum concentration of RifAXIMin. Risk C: Monitor
Rilpivirine: Macrolide Antibiotics may increase serum concentration of Rilpivirine. Management: Consider the use of azithromycin or another non-macrolide alternative when appropriate to avoid this potential interaction. Risk D: Consider Therapy Modification
Rimegepant: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Rimegepant. Management: If taking rimegepant for the acute treatment of migraine, avoid a second dose of rimegepant within 48 hours when used concomitantly with moderate CYP3A4 inhibitors. No dose adjustment needed if using rimegepant for prevention of episodic migraine. Risk D: Consider Therapy Modification
Rimegepant: P-glycoprotein/ABCB1 Inhibitors may increase serum concentration of Rimegepant. Management: Avoid administration of another dose of rimegepant within 48 hours if given concomitantly with a P-glycoprotein (P-gp) inhibitor. Risk D: Consider Therapy Modification
Riociguat: Inhibitors of CYP3A4 (Moderate) and P-glycoprotein may increase serum concentration of Riociguat. Risk C: Monitor
RisperiDONE: May increase QTc-prolonging effects of Erythromycin (Systemic). Erythromycin (Systemic) may increase serum concentration of RisperiDONE. Management: Monitor for increased risperidone toxicities, including QTc interval prolongation and ventricular arrhythmias when these agents are combined. Patients with additional risk factors for QTc prolongation may be at even higher risk. Risk C: Monitor
Rivaroxaban: Inhibitors of CYP3A4 (Moderate) and P-glycoprotein may increase serum concentration of Rivaroxaban. Management: No action is needed in patients with normal renal function. Do not use this combination in patients with estimated creatinine clearance 15 to 80 mL/min unless prospective benefits outweigh the risks. Risk D: Consider Therapy Modification
Roflumilast-Containing Products: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Roflumilast-Containing Products. Risk C: Monitor
RomiDEPsin: P-glycoprotein/ABCB1 Inhibitors may increase serum concentration of RomiDEPsin. Risk C: Monitor
Rupatadine: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Rupatadine. Risk C: Monitor
Ruxolitinib (Systemic): CYP3A4 Inhibitors (Moderate) may increase serum concentration of Ruxolitinib (Systemic). Risk C: Monitor
Salmeterol: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Salmeterol. Risk C: Monitor
Saquinavir: Erythromycin (Systemic) may increase QTc-prolonging effects of Saquinavir. Erythromycin (Systemic) may increase serum concentration of Saquinavir. Risk X: Avoid
SAXagliptin: CYP3A4 Inhibitors (Moderate) may increase serum concentration of SAXagliptin. Risk C: Monitor
Selpercatinib: QT-prolonging Moderate CYP3A4 Inhibitors (Moderate Risk) may increase QTc-prolonging effects of Selpercatinib. QT-prolonging Moderate CYP3A4 Inhibitors (Moderate Risk) may increase serum concentration of Selpercatinib. Management: Avoid combination if possible. If use is necessary, reduce selpercatinib dose as follows: from 120mg twice/day to 80mg twice/day, or from 160mg twice/day to 120mg twice/day. Monitor QT interval more closely for QTc interval prolongation and arrhythmias. Risk D: Consider Therapy Modification
Selumetinib: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Selumetinib. Management: Avoid concomitant use when possible. If combined, selumetinib dose reductions are recommended and vary based on body surface area and selumetinib dose. For details, see the full drug interaction monograph or selumetinib prescribing information. Risk D: Consider Therapy Modification
Sertindole: QT-prolonging Moderate CYP3A4 Inhibitors (Moderate Risk) may increase QTc-prolonging effects of Sertindole. QT-prolonging Moderate CYP3A4 Inhibitors (Moderate Risk) may increase serum concentration of Sertindole. Risk X: Avoid
Sertraline: Erythromycin (Systemic) may increase adverse/toxic effects of Sertraline. Risk C: Monitor
Sildenafil: Erythromycin (Systemic) may increase serum concentration of Sildenafil. Management: For pulmonary arterial hypertension, no dose adjustment required. For erectile dysfunction, consider using a lower starting dose of 25 mg in patients who are also taking erythromycin. Monitor patients for sildenafil toxicities when combined. Risk D: Consider Therapy Modification
Silodosin: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Silodosin. Risk C: Monitor
Simeprevir: Erythromycin (Systemic) may increase serum concentration of Simeprevir. Simeprevir may increase serum concentration of Erythromycin (Systemic). Risk X: Avoid
Simvastatin: Erythromycin (Systemic) may increase active metabolite exposure of Simvastatin. Erythromycin (Systemic) may increase serum concentration of Simvastatin. Risk X: Avoid
Sincalide: Drugs that Affect Gallbladder Function may decrease therapeutic effects of Sincalide. Management: Consider discontinuing drugs that may affect gallbladder motility prior to the use of sincalide to stimulate gallbladder contraction. Risk D: Consider Therapy Modification
Sirolimus (Conventional): Erythromycin (Systemic) may increase serum concentration of Sirolimus (Conventional). Sirolimus (Conventional) may increase serum concentration of Erythromycin (Systemic). Management: Monitor for increased serum concentrations of sirolimus if combined with erythromycin. Lower initial sirolimus doses or sirolimus dose reductions will likely be required. Risk D: Consider Therapy Modification
Sirolimus (Protein Bound): P-glycoprotein/ABCB1 Inhibitors may increase serum concentration of Sirolimus (Protein Bound). Risk X: Avoid
Sodium Picosulfate: Antibiotics may decrease therapeutic effects of Sodium Picosulfate. Management: Consider using an alternative product for bowel cleansing prior to a colonoscopy in patients who have recently used or are concurrently using an antibiotic. Risk D: Consider Therapy Modification
Solifenacin: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Solifenacin. Risk C: Monitor
Sonidegib: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Sonidegib. Management: Avoid concomitant use of sonidegib and moderate CYP3A4 inhibitors when possible. When concomitant use cannot be avoided, limit CYP3A4 inhibitor use to less than 14 days and monitor for sonidegib toxicity (particularly musculoskeletal adverse reactions). Risk D: Consider Therapy Modification
Sparsentan: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Sparsentan. Risk C: Monitor
SUFentanil: CYP3A4 Inhibitors (Moderate) may increase serum concentration of SUFentanil. Risk C: Monitor
SUNItinib: QT-prolonging Moderate CYP3A4 Inhibitors (Moderate Risk) may increase QTc-prolonging effects of SUNItinib. QT-prolonging Moderate CYP3A4 Inhibitors (Moderate Risk) may increase serum concentration of SUNItinib. Management: Monitor for QTc interval prolongation and ventricular arrhythmias when these agents are combined. Patients with additional risk factors for QTc prolongation may be at even higher risk. Risk C: Monitor
Suvorexant: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Suvorexant. Management: The recommended dose of suvorexant is 5 mg daily in patients receiving a moderate CYP3A4 inhibitor. The dose can be increased to 10 mg daily (maximum dose) if necessary for efficacy. Risk D: Consider Therapy Modification
Suzetrigine: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Suzetrigine. Management: Reduce suzetrigine dose as follows: initiate with 100 mg for 1 dose; then 12 hours after first dose, give 50 mg every 12 hours for doses 2, 3, and 4; then 50 mg every 24 hours for dose 5 and thereafter. Risk D: Consider Therapy Modification
Tacrolimus (Systemic): Erythromycin (Systemic) may increase serum concentration of Tacrolimus (Systemic). Risk C: Monitor
Tacrolimus (Topical): CYP3A4 Inhibitors (Moderate) may increase serum concentration of Tacrolimus (Topical). Risk C: Monitor
Tadalafil: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Tadalafil. Risk C: Monitor
Talazoparib: P-glycoprotein/ABCB1 Inhibitors may increase serum concentration of Talazoparib. Risk C: Monitor
Tamsulosin: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Tamsulosin. Risk C: Monitor
Tazemetostat: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Tazemetostat. Management: Avoid when possible. If combined, reduce tazemetostat dose from 800 mg twice daily to 400 mg twice daily, from 600 mg twice daily to 400 mg in AM and 200 mg in PM, or from 400 mg twice daily to 200 mg twice daily. Risk D: Consider Therapy Modification
Temsirolimus: CYP3A4 Inhibitors (Moderate) may increase active metabolite exposure of Temsirolimus. Specifically, concentrations of sirolimus may be increased. Risk C: Monitor
Teniposide: P-glycoprotein/ABCB1 Inhibitors may increase serum concentration of Teniposide. Risk C: Monitor
Tenofovir Disoproxil Fumarate: P-glycoprotein/ABCB1 Inhibitors may increase serum concentration of Tenofovir Disoproxil Fumarate. Risk C: Monitor
Tetrahydrocannabinol and Cannabidiol: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Tetrahydrocannabinol and Cannabidiol. Risk C: Monitor
Tetrahydrocannabinol: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Tetrahydrocannabinol. Risk C: Monitor
Tezacaftor and Ivacaftor: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Tezacaftor and Ivacaftor. Management: If combined with moderate CYP3A4 inhibitors, give tezacaftor/ivacaftor in the morning, every other day; give ivacaftor in the morning, every other day on alternate days. Tezacaftor/ivacaftor dose depends on age and weight; see full Lexi-Interact monograph Risk D: Consider Therapy Modification
Theophylline Derivatives: Erythromycin (Systemic) may increase serum concentration of Theophylline Derivatives. Theophylline Derivatives may decrease serum concentration of Erythromycin (Systemic). Management: Consider alternatives to this combination. If combined, monitor for increased serum concentrations/toxic effects of theophylline derivatives.Theophylline derivative dose reductions may be needed. Also monitor for reduced erythromycin efficacy. Risk D: Consider Therapy Modification
Thioridazine: QT-prolonging Agents (Moderate Risk) may increase QTc-prolonging effects of Thioridazine. Risk X: Avoid
Thiotepa: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Thiotepa. CYP3A4 Inhibitors (Moderate) may decrease active metabolite exposure of Thiotepa. Risk C: Monitor
Ticagrelor: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Ticagrelor. CYP3A4 Inhibitors (Moderate) may decrease active metabolite exposure of Ticagrelor. Risk C: Monitor
Tilidine: CYP3A4 Inhibitors (Moderate) may increase active metabolite exposure of Tilidine. CYP3A4 Inhibitors (Moderate) may increase serum concentration of Tilidine. Risk C: Monitor
Tofacitinib: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Tofacitinib. Risk C: Monitor
Tolterodine: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Tolterodine. Risk C: Monitor
Tolvaptan: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Tolvaptan. Management: Avoid this combination with Samsca brand of tolvaptan. Reduce dose for Jynarque brand: 90 mg AM and 30 mg PM, reduce to 45 mg AM and 15 mg PM; 60 mg AM and 30 mg PM, reduce to 30 mg AM and 15 mg PM; 45 mg AM and 15 mg PM, reduce to 15 mg AM and PM. Risk D: Consider Therapy Modification
Topotecan: P-glycoprotein/ABCB1 Inhibitors may increase serum concentration of Topotecan. Risk X: Avoid
Trabectedin: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Trabectedin. Risk C: Monitor
TraMADol: CYP3A4 Inhibitors (Moderate) may increase serum concentration of TraMADol. CYP3A4 Inhibitors (Moderate) may increase active metabolite exposure of TraMADol. Risk C: Monitor
TraZODone: CYP3A4 Inhibitors (Moderate) may increase serum concentration of TraZODone. Risk C: Monitor
Tretinoin (Systemic): CYP3A4 Inhibitors (Moderate) may increase serum concentration of Tretinoin (Systemic). Risk C: Monitor
Triamcinolone (Systemic): CYP3A4 Inhibitors (Moderate) may increase serum concentration of Triamcinolone (Systemic). Risk C: Monitor
Triazolam: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Triazolam. Management: Consider triazolam dose reduction in patients receiving concomitant moderate CYP3A4 inhibitors. Risk D: Consider Therapy Modification
Typhoid Vaccine: Antibiotics may decrease therapeutic effects of Typhoid Vaccine. Only the live attenuated Ty21a strain is affected. Management: Avoid use of live attenuated typhoid vaccine (Ty21a) in patients being treated with systemic antibacterial agents. Postpone vaccination until 3 days after cessation of antibiotics and avoid starting antibiotics within 3 days of last vaccine dose. Risk D: Consider Therapy Modification
Ubrogepant: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Ubrogepant. Management: Use an initial ubrogepant dose of 50 mg and avoid a second dose for 24 hours when used with moderate CYP3A4 inhibitors. Risk D: Consider Therapy Modification
Udenafil: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Udenafil. Risk C: Monitor
Valbenazine: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Valbenazine. CYP3A4 Inhibitors (Moderate) may increase active metabolite exposure of Valbenazine. Risk C: Monitor
Vamorolone: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Vamorolone. Risk C: Monitor
Vanzacaftor, Tezacaftor, and Deutivacaftor: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Vanzacaftor, Tezacaftor, and Deutivacaftor. Management: Age- and weight-specific dose reductions of vanzacaftor, tezacaftor, and deutivacaftor are recommended. Please see full Interact monograph or labeling for details. Risk D: Consider Therapy Modification
Vardenafil: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Vardenafil. Management: Limit Levitra (vardenafil) dose to a single 5 mg dose within a 24-hour period if combined with moderate CYP3A4 inhibitors. Avoid concomitant use of Staxyn (vardenafil) and moderate CYP3A4 inhibitors. Combined use is contraindicated outside of the US. Risk D: Consider Therapy Modification
Venetoclax: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Venetoclax. Management: Reduce the venetoclax dose by at least 50% in patients requiring concomitant treatment with moderate CYP3A4 inhibitors. Resume the previous venetoclax dose 2 to 3 days after discontinuation of moderate CYP3A4 inhibitors. Risk D: Consider Therapy Modification
Vilazodone: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Vilazodone. Risk C: Monitor
VinBLAStine: CYP3A4 Inhibitors (Moderate) may increase serum concentration of VinBLAStine. Risk C: Monitor
VinCRIStine: P-glycoprotein/ABCB1 Inhibitors may increase serum concentration of VinCRIStine. Risk X: Avoid
Vindesine: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Vindesine. Risk C: Monitor
Vinflunine: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Vinflunine. CYP3A4 Inhibitors (Moderate) may increase active metabolite exposure of Vinflunine. Risk C: Monitor
Vitamin K Antagonists: Macrolide Antibiotics may increase anticoagulant effects of Vitamin K Antagonists. Risk C: Monitor
Voclosporin: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Voclosporin. Management: Decrease the voclosporin dose to 15.8 mg in the morning and 7.9 mg in the evening when combined with moderate CYP3A4 inhibitors. Risk D: Consider Therapy Modification
Vorapaxar: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Vorapaxar. Risk C: Monitor
Zafirlukast: Erythromycin (Systemic) may decrease serum concentration of Zafirlukast. Risk C: Monitor
Zanubrutinib: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Zanubrutinib. Management: Decrease the zanubrutinib dose to 80 mg twice daily during coadministration with a moderate CYP3A4 inhibitor. Further dose adjustments may be required for zanubrutinib toxicities, refer to prescribing information for details. Risk D: Consider Therapy Modification
Zopiclone: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Zopiclone. Risk C: Monitor
Zuranolone: CYP3A4 Inhibitors (Moderate) may increase serum concentration of Zuranolone. Risk C: Monitor
Food: Erythromycin serum levels may be altered if taken with food (formulation-dependent). GI upset, including diarrhea, is common. Management: May be taken with food to decrease GI upset, otherwise take around-the-clock with a full glass of water. Do not give with milk or acidic beverages (eg, soda, juice).
Some products may contain sodium.
Base, PCE or stearate dosage forms should be taken on an empty stomach (2 hours before or after a meal).
Ethylsuccinate (EES) or delayed-release (ERY-TAB) dosage forms may be administered without regards to meals.
May consider administering after food to decrease GI discomfort.
Erythromycin crosses the placenta.
Cardiovascular anomalies following exposure in early pregnancy have been reported in some observational studies.
Serum concentrations of erythromycin may be variable in pregnant patients (Kiefer 1955; Philipson 1976).
Erythromycin is the antibiotic of choice for the treatment of lymphogranuloma venereum in pregnancy, and the treatment of or long-term suppression of Bartonella infection in HIV-infected pregnant patients. Erythromycin is one of the antibiotics that may be used for the treatment of chancroid or granuloma inguinale during pregnancy (consult current guidelines) (CDC [Workowski 2021]; HHS [OI adult] 2022). Erythromycin is recommended as part of a combination regimen in the management of preterm prelabor rupture of membranes; regimens include erythromycin in combination with IV ampicillin followed by oral amoxicillin (ACOG 2020). Agents other than systemic erythromycin are preferred for the treatment of acne during pregnancy (AAD [Zaenglein 2016]).
Changes in frequency of bowel movements. Liver and renal function (with prolonged use). Blood pressure and heart rate (with IV use or as clinically appropriate). Signs of hypertrophic pyloric stenosis (eg, feeding intolerance, emesis) in neonates and young infants.
Antibiotic: Inhibits RNA-dependent protein synthesis at the chain elongation step; binds to the 50S ribosomal subunit resulting in blockage of transpeptidation.
Gastric motility: Agonizes motilin receptors, possibly regulating phase III of the migrating motor complex (MMC), resulting in antral and duodenal peristalsis (Curry 2001; Febo-Rodriguez 2019; Tillman 2016).
Absorption: Oral: Variable but better with salt forms than with base form; 18% to 45%; ethylsuccinate may be better absorbed with food (Coyne 1978; Eriksson 1981; Thompson 1980).
Distribution:
Vd:
Preterm neonates (GA: 23 to 29 weeks; PNA: 2 to 15 days): Lactobionate (IV): Mean range: 1.9 to 2.4 L/kg (Waites 1994).
Adults: 0.64 L/kg.
Relative diffusion from blood into CSF: Minimal even with inflammation.
CSF:blood level ratio: Normal meninges: 2% to 13%; Inflamed meninges: 7% to 25%.
Protein binding: Base: 73% to 81%.
Metabolism: Demethylation primarily via hepatic CYP3A4.
Half-life elimination:
Preterm neonates (GA: 23 to 29 weeks; PNA: 2 to 15 days): Lactobionate (IV): Mean range: 1.9 to 2.1 hours (Waites 1994).
Neonates and Infants <4 months: Ethylsuccinate (oral): 2.42 ± 0.31 hours (Patamasucon 1981).
Infants ≥2 months and Children <4 years: Ethylsuccinate (oral): Mean range: 1.4 to 1.7 hours (McCracken 1978).
Adults: Peak: 1.5 to 2 hours; End-stage renal disease: 5 to 6 hours.
Time to peak, serum: Note: Delayed with food due to differences in absorption.
Neonates and Infants <4 months: Ethylsuccinate (oral): Initial dose: 1.8 ± 0.48 hours; Steady state: 0.8 ± 0.11 hours (Patamasucon 1981).
Infants ≥6 months and Children ≤5 years: Ethylsuccinate (oral): 0.5 to 1.5 hours (Coyne 1978).
Adults: Base: 4 hours; Ethylsuccinate: 0.5 to 2.5 hours; Stearate: 3 hours (Steigbigel 2000).
Excretion: Primarily feces; urine (2% to 15% as unchanged drug).
