E.E.S. 200mg/5ml 100ml Granules

Erythromycin binds to the 50S ribosomal subunit of susceptible microorganisms, thereby inhibiting bacterial protein synthesis without affecting nucleic acid synthesis. It is generally considered bacteriostatic but may be bactericidal at high concentrations or against highly susceptible organisms.

Urgent Side Effects: Seek Medical Help Right Away

Although rare, some people may experience severe and potentially life-threatening side effects while taking this medication. If you notice any of the following symptoms, contact your doctor or seek immediate medical attention:

Signs of an allergic reaction: rash, hives, itching, red, swollen, blistered, or peeling skin (with or without fever), wheezing, tightness in the chest or throat, difficulty breathing, swallowing, or talking, unusual hoarseness, or swelling of the mouth, face, lips, tongue, or throat.
Signs of liver problems: dark urine, fatigue, decreased appetite, upset stomach or stomach pain, light-colored stools, vomiting, or yellow skin or eyes.
Signs of a severe skin reaction (Stevens-Johnson syndrome/toxic epidermal necrolysis): red, swollen, blistered, or peeling skin (with or without fever), red or irritated eyes, or sores in the mouth, throat, nose, or eyes.
Urination problems: inability to pass urine or changes in urine output.
Severe dizziness or fainting.
Rapid heartbeat.
Abnormal heartbeat (long QT on ECG), which can be life-threatening. This risk may increase when taking other medications with this drug. Seek medical help immediately if you experience an irregular heartbeat.
Diarrhea, particularly a severe form called C. diff-associated diarrhea (CDAD), which can lead to life-threatening bowel problems. If you experience stomach pain, cramps, or loose, watery, or bloody stools, contact your doctor right away. Before treating diarrhea, consult your doctor.
Hearing loss, which is rare but may be more likely if you have kidney problems or take high doses of this medication. If you experience hearing problems, such as hearing loss, contact your doctor immediately.

Other Possible Side Effects

Most medications can cause side effects, but many people experience none or only mild symptoms. If you encounter any of the following side effects or any other unusual symptoms, contact your doctor or seek medical attention if they bother you or persist:

Diarrhea, stomach pain, upset stomach, vomiting, or decreased appetite.

This is not an exhaustive list of potential side effects. If you have questions or concerns, consult your doctor. You can also report side effects to the FDA at 1-800-332-1088 or online at https://www.fda.gov/medwatch.

Before Taking This Medication: Important Information to Share with Your Doctor

It is essential to inform your doctor about the following:

Any allergies you have, including allergies to this medication, its components, or other substances, such as foods or drugs. Be sure to describe the allergic reaction you experienced, including any symptoms that occurred.
Certain health conditions, including:
+ Abnormal heart rhythms, such as a prolonged QTc interval on an electrocardiogram (ECG)
+ Other irregular heartbeats
+ Slow heartbeat
+ Low levels of potassium or magnesium in your blood

Additionally, tell your doctor about all the medications you are taking, including:

Prescription and over-the-counter (OTC) drugs
Natural products
Vitamins

This is crucial because some medications, such as those used to treat mood disorders, abnormal heart rhythms, or migraine headaches, may interact with this medication and should not be taken together. It is not possible to list all the medications and health conditions that may interact with this drug, so it is vital to disclose all your medications and health problems to your doctor and pharmacist.

To ensure your safety, always check with your doctor before:
Starting any new medication
Stopping any medication
Changing the dose of any medication

This will help you avoid potential interactions and ensure that it is safe to take this medication with all your other medications and health conditions.

Important Information for Patients Taking This Medication

It is crucial that you inform all your healthcare providers, including doctors, nurses, pharmacists, and dentists, that you are taking this medication. If you are taking this drug long-term, your doctor may recommend regular blood tests to monitor your condition.

Please note that this medication may interfere with certain laboratory tests. Be sure to notify all your healthcare providers and laboratory personnel that you are taking this medication.

Duration of Use and Potential Risks

Do not take this medication for longer than prescribed by your doctor. Prolonged use may increase the risk of a second infection.

Dietary Considerations and Interactions

If you are following a low-sodium or sodium-free diet, consult with your doctor before taking this medication, as some products may contain sodium.

Special Precautions for Certain Medical Conditions

If you have myasthenia gravis, discuss your treatment plan with your doctor. Monitor your condition closely, and contact your doctor immediately if your symptoms worsen. Additionally, be aware that this medication may cause signs of myasthenia gravis in people who do not have the condition. Seek medical attention right away if you experience new or worsening muscle weakness, difficulty chewing or swallowing, breathing problems, droopy eyelids, or changes in vision, such as blurred vision or double vision.

Age-Related Considerations

If you are 65 years or older, use this medication with caution, as you may be more susceptible to side effects.

Pregnancy and Breastfeeding

If you are pregnant, plan to become pregnant, or are breastfeeding, consult with your doctor to discuss the potential benefits and risks of this medication to you and your baby.

Special Considerations for Newborns

In rare cases, newborns taking this medication may develop a severe stomach problem. If your child vomits or becomes irritable during feeding, contact your doctor immediately.

• Cisapride
• Pimozide
• Ergotamine
• Dihydroergotamine
• Colchicine (in patients with renal/hepatic impairment)
• Lurasidone
• Lovastatin
• Simvastatin

• Amiodarone
• Disopyramide
• Dofetilide
• Procainamide
• Quinidine
• Sotalol (risk of QT prolongation/Torsades de Pointes)
• Warfarin (increased anticoagulant effect)
• Digoxin (increased digoxin levels)
• Theophylline (increased theophylline levels)
• Carbamazepine (increased carbamazepine levels)
• Cyclosporine (increased cyclosporine levels)
• Tacrolimus (increased tacrolimus levels)
• Phenytoin (increased phenytoin levels)
• Alfentanil
• Bromocriptine
• Cilostazol
• Clarithromycin (additive QT prolongation)
• Clozapine
• Dabrafenib
• Darunavir
• Eplerenone
• Fentanyl
• Flibanserin
• Ivabradine
• Midazolam (oral)
• Quetiapine
• Ranolazine
• Rifabutin
• Rifampin (decreased erythromycin levels)
• Ritonavir
• Rivaroxaban
• Sildenafil
• Tadalafil
• Tolterodine
• Vardenafil
• Verapamil
• Vinblastine
• Zopiclone

• Oral contraceptives (decreased efficacy)
• Atorvastatin
• Rosuvastatin (increased risk of myopathy/rhabdomyolysis)
• Corticosteroids (increased corticosteroid levels)
• Valproic acid (increased valproic acid levels)
• Zidovudine (decreased zidovudine levels)
• Antacids (decreased erythromycin absorption if taken concurrently)
• Cimetidine (increased erythromycin levels)
• Fluconazole
• Itraconazole
• Ketoconazole (increased erythromycin levels)
• Nelfinavir
• Saquinavir (increased erythromycin levels)
• Omeprazole (increased erythromycin levels)
• Esomeprazole
• Lansoprazole
• Pantoprazole
• Rabeprazole (potential for increased erythromycin levels)

• Food (for erythromycin base, not E.E.S.)

• Diarrhea (especially severe or bloody, indicative of C. difficile-associated diarrhea)
• Nausea
• Vomiting
• Abdominal pain/cramping
• Rash or hives
• Itching
• Jaundice (yellowing of skin or eyes)
• Dark urine
• Pale stools
• Unusual tiredness or weakness
• Hearing loss or tinnitus (ringing in ears)
• Dizziness or lightheadedness
• Palpitations or irregular heartbeat
• Signs of superinfection (e.g., oral thrush, vaginal yeast infection)

Erythromycin is generally considered safe for use during pregnancy (Pregnancy Category B). Studies in animals have not shown harm to the fetus, and adequate, well-controlled studies in pregnant women have not demonstrated a risk to the fetus in the first trimester.

Erythromycin is excreted into breast milk in small amounts. It is generally considered compatible with breastfeeding (Lactation Risk L2 - probably compatible). Monitor breastfed infants for potential gastrointestinal disturbances (e.g., diarrhea, candidiasis) or allergic reactions.

Erythromycin is commonly used in pediatric patients. Dosing is weight-based. Caution is advised in neonates due to potential for infantile hypertrophic pyloric stenosis (IHPS), especially with erythromycin base. Erythromycin ethylsuccinate (E.E.S.) has a lower reported association with IHPS compared to the base, but vigilance is still warranted.

No specific dose adjustment is required based on age alone. However, elderly patients may be more susceptible to hearing loss (ototoxicity) and QT prolongation, especially if they have pre-existing renal or hepatic impairment, cardiac conditions, or are on concomitant QT-prolonging medications. Monitor closely for these adverse effects.

• Erythromycin ethylsuccinate (E.E.S.) is an ester form of erythromycin that is better absorbed when taken with food, unlike erythromycin base which should be taken on an empty stomach.
• Erythromycin is a potent CYP3A4 inhibitor, leading to numerous significant drug interactions. Always review concomitant medications.
• Common side effects include GI upset (nausea, vomiting, abdominal pain, diarrhea), which can be severe and lead to non-compliance. Taking with food (for E.E.S.) can help mitigate this.
• Rare but serious side effects include QT prolongation, Torsades de Pointes, hepatotoxicity (cholestatic hepatitis), and reversible ototoxicity (hearing loss, tinnitus), especially with high doses or in patients with renal/hepatic impairment.
• Erythromycin is a common cause of infantile hypertrophic pyloric stenosis (IHPS) when given to neonates, particularly in the first few weeks of life. Use in this population should be carefully considered.
• Despite its broad spectrum, resistance to erythromycin is common, especially among S. pneumoniae and S. aureus.
• It is an alternative for penicillin-allergic patients for certain infections.

• Azithromycin (another macrolide, longer half-life, less frequent dosing, fewer CYP3A4 interactions)
• Clarithromycin (another macrolide, similar spectrum, also CYP3A4 inhibitor)
• Doxycycline (tetracycline, for atypical pathogens)
• Amoxicillin (penicillin, for susceptible bacterial infections)
• Cephalexin (cephalosporin, for susceptible bacterial infections)
• Clindamycin (lincosamide, for anaerobic infections, skin/soft tissue infections)

If your symptoms or health issues persist or worsen, it is essential to contact your doctor for further guidance. To ensure your safety, never share your medication with others or take someone else's medication. Some medications may come with an additional patient information leaflet, so it's a good idea to check with your pharmacist. If you have any questions or concerns about this medication, don't hesitate to discuss them with your doctor, nurse, pharmacist, or other healthcare provider. In the event of a suspected overdose, immediately call your local poison control center or seek medical attention. When reporting the incident, be prepared to provide details about the medication taken, the amount, and the time it occurred.