INFECTOCIN ARYNOIN PLUS ERYTHROMYCIN TRETOCIN ECIN D MYCIN D MYCIN D MYCIN ERYTHROMYCIN ERYTHROMYCIN ERYTHROMYCIN ERITHRIN ERITHRIN ERITHRIN EPTHROCIN EPTHROCIN GEOERYTHCIN GEOERYTHCIN GEOERYTHCIN TROCIN TROCIN IRZACIN IRZACIN IRZACIN ERYTHROMYCIN ERYTHROMYCIN NOVOMYCIN NOVOMYCIN NOVOMYCIN NOVOMYCIN ERYCINA ERYCINA ERYTHROMYCIN ERYTHROMYCIN MUCONIL ACUMEN ACUMEN ACUMEN ERYTHROMYCIN ERYTHROMYCIN TRYCIN THROMYCIN ISOTREXIN STIEMYCIN-DS ERYTHRO ERYTHRO ERYTHRO ERYTHRO TETHROCIN ERYSIN AKNE BAN-T AKNE BAN-G WILMYCIN WILMYCIN WILMYCIN WILMYCIN WILMYCIN ERYWIL ERYWIL ERYMIN DELTACIN DELTACIN DELTACIN ERYTAB ERYTAB ERYTAB MB-THROCIN MB THROCIN EMYCIN EMYCIN EMYCIN EMYCIN MYCIN-E OCEMYCIN OCEMYCIN VISOREX RITOCIN MUZOMYCIN OLEX ERYTHROMYCIN RYTHOBACT RYTHOBACT ERYMOX ERYMOX ERYMOX ERYCIN-20% ERYMAC XEXAB XEXAB XEXAB MEDRITHRO MEDRITHRO ERUPCIN ERUPCIN ERYDERM PEDIAZOLE ERYBRON ERYBRON ERYTHROCIN ERYTHROCIN ERYTHROCIN ERYTHROCIN ERYTHROCIN ERYTHROCIN ERYTHROCIN TILORYTH TILORYTH XYROX-E XYROX XYROX ERYTHIN ERYTHIN ERYTHIN ERTHROMED ERTHROMED THROGIN LOLVAN ERYCARE ES ERYCARE EYTHRO EYTHRO ESOTEK ERYTHROSAF ERYTHROSAF ISOTRI ERYTHROMYCIN ERYTHROMYCIN ISOCANE

Dose: 0.5 to 1 g
Single Dose: 0.75 (0.75)
Frequency: 6 hourly
Route: IV
Instructions:

Dose: 7.812 to 15.625 mg/kg
Single Dose: 12 (11.7185)
Frequency: 6 hourly
Route: Oral
Instructions:

Dose: 18.75 mg/kg
Single Dose: 19 (18.75)
Frequency: 4 hourly
Route: Oral
Instructions:

Erythromycin (as Esotolate) is the derivative of Erythromycin. It is of Semi Synthetic origin. It belongs to Antibacterial (Proetin synthesis inhibitor) pharmacological group on the basis of mechanism of action and also classified in Antibiotics pharmacological group.The Molecular Weight of Erythromycin is 733.90. Its pKa is 8.8.

Erythromycin is contraindicated in conditions like Hepatic dysfunction,Hypersensitivity.

The severe or irreversible adverse effects of Erythromycin, which give rise to further complications include Tinnitus, Pseudomembranous colitis, Urticaria, Hepatitis, Pancreatitis, Stevens johnson syndrome, Jaundice, Jaundice, Stevens johnson syndrome, Eosinophilia, Thrombophlebitis, Eosinophilia, Interstitial nephritis, Psychosis, Porphyria.Erythromycin produces potentially life-threatening effects which include Hepatotoxicity, QT prolongation, Severe skin reactions, Torsades de pointes. which are responsible for the discontinuation of Erythromycin therapy.The signs and symptoms that are produced after the acute overdosage of Erythromycin include Nausea, Severe vomiting, Diarrhea, Torsades de pointes, Hearing loss.The symptomatic adverse reactions produced by Erythromycin are more or less tolerable and if they become severe, they can be treated symptomatically, these include Dizziness, Anorexia, Fever, Skin reactions, Abdominal pain, Sweating, Maculopapular rash, Rashes, Pruritus, GI symptoms, Cramps, Elevation of liver enzymes, Hypersensitivity, Cholestasis, Reaction at injection site, dizziness.

Erythromycin is primarily indicated in conditions like Acne vulgaris, Alternative to penicillin in hypersensitive patients, Bacterial infections, Bone and joint infection, Breast cancer, Bronchitis, Endocarditis, Erythrasma, Eye infections, GI infections, Gonorrhoea, Heart failure, Lower respiratory tract infections, Lymphogranuloma venereum, Ophthalmia neonatorum, Otitis media, Pharyngitis, Pneumonia, Prophylaxis of bacterial endocarditis, Rosacea, Sexually transmitted infections, Sinusitis, Skin infections, Soft tissue infections, Supraventricular arrhythmias (particularly atrial fibrillation), Surgical prophylaxis, Syphilis, Upper respiratory tract infections, and can also be given in adjunctive therapy as an alternative drug of choice in Diphtheria, Early lyme disease.

Erythromycin is known to interact with other drugs, the details of drug interactions is as follows:DrugDetailsSeverityOnsetManagementAcetazolamide (Na)Afatinibmay increase the level of afatinibuse alternative or reduced doseAlcoholCoadministration delay absorption and clinical effects of erythromycin due to slowed gastric emptying by ethanol.MinorPatients should avoid alcohol when taking erythromycin.AlprazolamErythromycin reduces the clearance of alprazolamAmiodarone (HCl)Amiodarone increase the risk of ventricular arrhythmia by prolongation of QT interval.Erythromycin is a strong CYP450 3A4 inhibitor and increased serum concentration and inhibit metabolism of amiiodarone.ModerateDelayed (Sequence important)Coadministration of these drugs require clinical monitoring.Amlodipine (Besylate)Erythromycin may decrease the metabolism, via CYP isoenzymes, of Amlodipine. ModerateMonitor for increased therapeutic effects of Amlodipine if Erythromycin is initiated/dose increased, or decreased effects if Erythromycin is discontinued/dose decreased. AmprenavirPlasma concentration of both drugs increased when Amprenavir given with Erythromycin.MajorArtemisininArtesunateConcurrent use may increase artesunate serum concentrations. Ascorbic AcidAstemizoleErytromycin potentiates effect of Astimizole by inhibiting its metabolismAstemizoleAtorvastatinErythromycin may decrease the metabolism, via CYP isoenzymes, of Atorvastatin. Possible increased risk of myopathy when atorvastatin given with erythromycin.ModerateWhen coadministration of a Macrolide antibiotic and an HMG-CoA reductase inhibitor is necessary, consider using a combination which appears to hold the lowest risk for the development of rhabdomyolysis. Azithromycin, Dirithromycin, and Spiramycin can probably be used safely (ie, no increased risk of side effects) with any HMG-CoA reductase inhibitor. Neither Fluvastatin, Pravastatin, nor Rosuvastatin would likely be affected by Macrolides.BamifyllineBiperiden (HCl)BromazepamBromocriptine (Mesylate)Plasma concentration of Bromocriptine increased by Erythromycin (increased risk of toxicity). Bromocriptine (Mesylate)Erythromycin reduces the hepatic metabolism of bromocriptine results in icreased plasma level of bromocriptine leads to toxicityModerateClosely monitor for signs of toxicity. Reduce the doseof bromocriptine.Buspirone (HCl)plasma concentration of Buspirone increased by Erythromycin.MajorReduce dose of Buspirone.CabergolinePlasma concentration of cabergoline increased by Erythromycin (increased risk of toxicity). CarbamazepineErythromycin may decrease the metabolism of Carbamazepineby increasing its serum levels through CYP450 3A4 inhibition.ModerateConsider selecting a noninteracting macrolide. Monitor for toxic effects of carbamazepine if Erythromycin is initiated or the dose is increased. The dose of carbamazepine will likely need to be altered.Cerivastatin SodiumCilostazoleCimetidine (HCl)Cimetidine inhibit CYP450 metabolism result in elevated plasma levels of erythromycin. ModerateNausea,vomiting,diarrhea or abdominal pain if occur consult physician.CisaprideCisaprideClozapineErythromycin decreases the hepatic clearence of clozapine thus increases the risk of toxicity.ModerateClosely monitor the patient whenever erythromycin added or withdraw from therapy. Azithromycin and dirithromycin is considered more safer alternative of erythromycin. ColchicineColistin (Sulphate & Sulphomethate Na)conjugated Estrogens/Bazedoxifenemay increase the exposure of conjugated estrogensmonitor closelyCyclosporin AErythromycin by interfering in hepatic and intestinal metabolism increases blood concentration of cyclosporine through CYP450 3A4 inhibition and may result in nephrotoxicity and neurotoxicity.ModerateGenerally avoid.Adjust dose and check cyclosporine blood levels and renal function.Dapoxetine HClConcomitant treatment with moderate CYP3A4 inhibitors may increased exposure of dapoxetine maximum dose of dapoxetine should be 30 mg DeflazacortDigoxinErythromycin may increase the serum concentration of Digoxin by about 40%-100%.ModerateMonitor serum concentrations of digoxin.Dihydroergotamine (Mesylate)Plasma concentration of dihydroergotamine is increased by erythromycin due to CYP450 3A4 inhibition responsible for clearance of ergotamines and may result in ergotism.MajorThis combination is contraindicated or azithromycin can be used in place of erythromycin as a better alternative.DisopyramideErythromycin increases the plasma level of Disopyramide.Erythromycin causes life threatening malignant arrhythmias and QT interval prolongation.MajorCoadministration should be avoided with disopyramide and level of Disopyramide must be monitored.DocetaxelEletriptanEplerenoneConcomitant use with moderate CYP3A4 Inhibitors (e.g. verapamil, erythromycin, saquinavir, fluconazole) may increase serum concentrations of Eplerenone ranging from 1.4-1.6 folds.ModerateIn patients with hypertension reduce the starting dose to 25mg once daily.Ergometrine (Maleate)Coadministration increases concentration of ergotamine in the plasma causing untoward peripheral vasoconstrictionModerateCoadministration is not recommended. If use then close clinical monitoring of response, tolerance and excessive vasoconstriction is recommended.Ergotamine (Tartrate)acute reactions ranging from minor ergotism to sever vasospasmMajorErgotamine (Tartrate)Erythromycin increases plasma concentration of ergotamine by inhibitiing CYP450 3A4 responsible for metabolic clearance of ergotamine.Ergotamine Toxicity occursMajorCoadministration of erythromycin and ergotamine is contraindicated.ErlotinibThis CYP3A4 inhibitor increases levels/toxicity of erlotinibFelodipineFexofenadineerythromycin increase plasma concentration of fexofenadineIndacaterolStrong inhibitors of CYP3A4 may increase levels of indacaterolmonitor closelyLercanidipine (HCl)Lincomycin (HCl)LoratadineErythromycin increases the plasma concentration of loratadine by inhibiting its hepatic metabolism thus increases its plasma level upto 40%MinorClosely monitor the patient for response and tolerance. Azithromycin and dirithromycin is considered as safer alternative.MethylprednisoloneMethylprednisoloneErythromycin by interfering in hepatic and intestinal metabolism increases blood concentration of cyclosporine through CYP450 3A4 inhibition and may result in nephrotoxicity and neurotoxicity.ModerateGenerally avoid.Adjust dose and check cyclosporine blood levels and renal function.NelfinavirNevirapineNitrendipineMay increase the levels/effects of nitrendipine.PitavastatinErythromycin significantly increased pitavastatin exposure.In patients taking erythromycin, a dose of pitavastatin 1 mg once daily should not be exceededProcyclidine (HCl)QuetiapineRepaglinideErythromycin may increase repaglinide concentrations by decreasing metabolism. RitonavirRitonavir increases plasma concentration of erythromycin by inhibiting CYP450 3A4 thus prolong QT interval which leads to ventricular arrhythmias.MajorErythromycin and ritonavir coadministration should be avoided.RoflumilastRoflumilast interacts with CYP34A Inhibitor like erythomycin, ketoconazole which results in the roflumilast 9% total inhibitory activity of PDE4.SibutramineSildenafilClearance of Sildenafil is decreased due to inhibition of CYP450Sodium BicarbonateSodium PicosulphateShould not be use concurrently without doctors prescription.Sodium ValproateSotalol (HCl)Sultamicillin erythromycin may interfere with the bactericidal effect of penicillins; Aviod concurrent therapyTacrolimusTamsulosin HydrochlorideTamsulosin Hydrochloride should be used with caution in combination with Erythromycin.Technetium Tc-99m DisofeninNonvisualization of gallbladder may occur due to erthromycin-induced hepatotoxicity.Technetium Tc-99m lidofeninNonvisualization of gallbladder may occur due to erthromycin-induced hepatotoxicity.TerfenadineErythromycin increases the plasma concentration of terfenadine by inhibiting CYP450 3A4-mediated first-pass metabolism result in high plasma level may be associated with prolongation of QT interval on the ECG, ventricular arrythmia, cardiac arrest and sudden death.MajorCoadministration is considered contraindicated. Loratadine, ctirizine, or fexofenadine is considered more safer than terfenadine and azithromycin and dirithromycin is consider more safer than erythromycin.TheophyllineSerum concentration of theophylline is icreased by erythromycin due to CYP450 3A4 inhibition result in seizures in pediatric patient. Clearance of theophylline is reduced 83% by oral erythromycinModeratePatient response and serum theophylline levels should be monitor if erythromycin given with theophylline.Tolterodine (Tartrate)TriazolamErythromycin inhibits metabolism of triazolam or midazolamVilazodoneErythromycin is moderate CYP3A4 inhibitor , it can increase vilazodone plasma concentration vilazodone dose should be reduced to 20mg for patients with intolerable adverse events.VORICONAZOLEVoriconazole may increase the serum concentration of erythromycin by decreasing its metabolism. Consider alternate therapy or monitor for QTc prolongation Warfarin (Na)Erythromycin may decrease the metabolism, via CYP isoenzymes, of Warfarin. Prothrombin time and bleeding increasesModerate (Sequence important)Monitor for increased therapeutic effects of Warfarin if Erythromycin is initiated/dose increased, or decreased effects if Erythromycin is discontinued/dose decreased.ZafirlukastZopiclone These interactions are sometimes beneficial and sometimes may pose threats to life. Always consult your physician for the change of dose regimen or an alternative drug of choice that may strictly be required.

Falsely elevated plasma conc. of Glutamic Oxaloacetic Transaminase in colorimetric assay.

Drug should not be given to Cardiac / Hypertensive Patients, and patients suffering from Liver Malfunction.If prescribing authority justifies the benefits of the drug against the possible damages he/she should reevaluate them and consult the reference material and previous studies.

Inj (reconstituted soln) Store in refrigerator. Use within 7 days if kept at room temperature. Oral Susp (reconstituted) Store in refrigerator. Do not Freeze. Use within 10-14 days if kept at room temperature. Skin Oint, Gel and Lotion, Eye Oint Store at room temperature. Do not Freeze. Protect from Sunlight and Heat. Tab, Caps Store in a well closed container, Below 40°C. Protect from Moisture.

Erythromycin should be used only if clearly needed during pregnancy or lactation. It should be used with caution (if contains tartrazine) in patients with aspirin hypersensitivity, because it may cause allergic reactions (including bronchial asthma). It should be used with caution in patients with any allergy, especially to antibiotics. Take appropriate measures if secondary infection occurs.