E.E.S. 200mg/5ml 200ml 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, such as:
+ Rash or hives
+ Itching or red, swollen, blistered, or peeling skin (with or without fever)
+ Wheezing or 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, including:
+ Dark urine
+ Fatigue
+ Decreased appetite
+ Upset stomach or stomach pain
+ Light-colored stools
+ Vomiting
+ Yellow skin or eyes
Signs of a severe skin reaction (Stevens-Johnson syndrome/toxic epidermal necrolysis), such as:
+ Red, swollen, blistered, or peeling skin (with or without fever)
+ Red or irritated eyes
+ Sores in the mouth, throat, nose, or eyes
Difficulty urinating 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 be increased when taking other medications with this drug. Seek medical help immediately if you experience an irregular heartbeat.
Diarrhea, particularly if it is severe, bloody, or watery. Although diarrhea is common with antibiotics, a rare but potentially life-threatening condition called C. diff-associated diarrhea (CDAD) may occur. If you experience stomach pain, cramps, or severe diarrhea, contact your doctor promptly.
Hearing loss, which may be temporary but can be more likely to occur if you have kidney problems or take high doses of this medication. If you experience hearing problems, contact your doctor right away.

Other Possible Side Effects

Most people taking this medication do not experience significant side effects, but some may occur. If you notice any of the following symptoms or if they persist or bother you, contact your doctor:

Diarrhea
Stomach pain
Upset stomach
Vomiting
Decreased appetite

This is not an exhaustive list of possible side effects. If you have questions or concerns about side effects, 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. Be sure to describe the allergic reaction and its symptoms.
Certain health conditions, such as:
+ Abnormal heartbeat patterns, including a prolonged QTc interval on an electrocardiogram (ECG)
+ Slow heartbeat
+ Low potassium or magnesium levels

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

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

Some medications, particularly those used to treat mood disorders, abnormal heart rhythms, or migraine headaches, may interact with this medication and should not be taken concurrently. This is not an exhaustive list, and it is crucial to discuss all your medications and health conditions with your doctor.

To ensure your safety, consult with your doctor and pharmacist about all your medications and health problems before taking this medication. Do not start, stop, or change the dose of any medication without first consulting your doctor to confirm that it is safe to do so.

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 medication long-term, your doctor may recommend regular blood tests to monitor your condition. Be sure to discuss this with your doctor.

This medication may interfere with certain laboratory tests. Therefore, it is essential to notify all your healthcare providers and laboratory personnel that you are taking this medication.

Do not take this medication for longer than prescribed, as this may increase the risk of a second infection.

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

If you have myasthenia gravis, discuss your condition with your doctor. If your symptoms worsen, contact your doctor immediately. Additionally, be aware that myasthenia gravis symptoms, such as new or worsening muscle weakness, difficulty chewing or swallowing, breathing problems, droopy eyelids, or changes in vision (including blurred vision or double vision), can occur in people without a history of the condition. If you experience any of these symptoms, seek medical attention right away.

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

If you are pregnant, planning to become pregnant, or breastfeeding, consult your doctor to discuss the potential benefits and risks to you and your baby.

Special Considerations for Newborns

In newborns taking this medication, a severe stomach problem can occur. If your child vomits or becomes irritable during feeding, contact your doctor immediately.

• Colchicine (in patients with renal or hepatic impairment)
• Lurasidone
• Pimozide
• Ergotamine, Dihydroergotamine
• Lovastatin, Simvastatin (due to increased risk of rhabdomyolysis)
• Eliglustat (in patients who are CYP2D6 poor metabolizers or taking strong/moderate CYP2D6 inhibitors)

• Amiodarone, Disopyramide, Dofetilide, Dronedarone, Ibutilide, Quinidine, Sotalol (increased risk of QT prolongation/Torsades de Pointes)
• Warfarin (increased anticoagulant effect)
• Carbamazepine, Phenytoin, Valproic acid (increased levels of anticonvulsants)
• Theophylline (increased theophylline levels)
• Cyclosporine, Tacrolimus (increased immunosuppressant levels)
• Cisapride (increased risk of QT prolongation)
• Statins (e.g., Atorvastatin, Rosuvastatin - increased risk of myopathy/rhabdomyolysis)
• Oral contraceptives (potential decreased efficacy)
• Sildenafil, Tadalafil, Vardenafil (increased PDE5 inhibitor levels)
• Alprazolam, Midazolam, Triazolam (increased benzodiazepine levels)
• Digoxin (increased digoxin levels in some patients)
• Quetiapine (increased quetiapine levels)
• Ranolazine (increased ranolazine levels)
• Verapamil, Diltiazem (increased risk of hypotension, bradycardia, lactic acidosis)

• Corticosteroids (e.g., Methylprednisolone - increased corticosteroid levels)
• Cimetidine (may increase erythromycin levels)
• Fluconazole, Itraconazole, Ketoconazole (may increase erythromycin levels)
• Rifampin (may decrease erythromycin levels)
• Clindamycin, Lincomycin (antagonistic effect)
• Chloramphenicol (antagonistic effect)
• Zidovudine (decreased zidovudine levels)
• Omeprazole (increased omeprazole levels)
• Tolterodine (increased tolterodine levels in CYP2D6 poor metabolizers)

• Antacids (may decrease absorption if taken concurrently, separate by 2 hours)
• Food (Erythromycin base absorption is decreased by food, but ethylsuccinate is not significantly affected)

• Diarrhea (especially severe or persistent, may indicate C. difficile-associated diarrhea)
• Nausea, vomiting, abdominal pain (common GI side effects)
• Yellowing of skin or eyes, dark urine, pale stools (signs of hepatotoxicity)
• Unusual fatigue, muscle weakness, dark urine (signs of rhabdomyolysis, especially with statin co-administration)
• Palpitations, dizziness, syncope (signs of QT prolongation/arrhythmias)
• Hearing loss or tinnitus (rare, usually reversible ototoxicity)

Erythromycin is generally considered safe for use during pregnancy (Pregnancy Category B). It is often used as an alternative for penicillin-allergic pregnant women.

Erythromycin is excreted into breast milk in small amounts. It is generally considered compatible with breastfeeding (Lactation Risk L2 - safer drug). Monitor breastfed infant for gastrointestinal disturbances (e.g., diarrhea, candidiasis) or rash.

Widely used in pediatric patients. Dosing is weight-based. Caution in neonates due to potential for infantile hypertrophic pyloric stenosis (IHPS), especially with erythromycin base or estolate forms; ethylsuccinate has a lower but still present risk. Monitor for feeding intolerance and vomiting.

No specific dose adjustment is typically required based on age alone. However, geriatric patients may be more susceptible to QT prolongation, hearing loss, and drug interactions due to polypharmacy, renal/hepatic impairment, and underlying comorbidities. Monitor closely for adverse effects and drug interactions.

• Erythromycin ethylsuccinate (E.E.S.) is generally better tolerated gastrointestinally than erythromycin base and can be taken with or without food.
• It is a potent CYP3A4 inhibitor, leading to numerous significant drug interactions. Always review concomitant medications.
• Risk of QT prolongation and Torsades de Pointes, especially with pre-existing cardiac conditions, electrolyte imbalances, or co-administration of other QT-prolonging drugs.
• Can cause reversible hearing loss, particularly with high doses or in patients with renal impairment.
• Cholestatic hepatitis is a rare but serious adverse effect, more common with the estolate salt but can occur with others.
• Erythromycin is an effective prokinetic agent and is sometimes used off-label for gastroparesis, though this is not its primary indication.
• Infantile hypertrophic pyloric stenosis (IHPS) is a rare but serious concern in neonates and young infants treated with erythromycin, particularly the base or estolate forms. Parents should be advised to monitor for persistent vomiting.

• Penicillins (e.g., Amoxicillin, Penicillin V - if not allergic)
• Cephalosporins (e.g., Cephalexin)
• Tetracyclines (e.g., Doxycycline)
• Fluoroquinolones (e.g., Levofloxacin, Moxifloxacin)
• Clindamycin

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 seeking help, be prepared to provide information about what was taken, the amount, and the time it happened.