Erythromycin 250mg DR Tablets

Erythromycin binds to the 50S ribosomal subunit of susceptible bacteria, thereby inhibiting 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 medical attention immediately:

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, trouble breathing, swallowing, or talking, unusual hoarseness, or swelling of the mouth, face, lips, tongue, or throat.
Signs of liver problems: dark urine, tiredness, 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): this rare but potentially life-threatening condition has been associated with this medication. If you experience an irregular heartbeat, seek medical help immediately. Taking other medications with this drug may increase the risk of this side effect.

Additional Important Side Effects

Diarrhea is a common side effect of antibiotics. In rare cases, a severe form of diarrhea called C. diff-associated diarrhea (CDAD) may occur, which can lead to life-threatening bowel problems. If you experience stomach pain, cramps, or loose, watery, or bloody stools, contact your doctor immediately. Do not treat diarrhea without consulting your doctor first.
Hearing loss has been reported in people taking this medication, usually resolving on its own. However, the risk may be higher if you have kidney problems or take high doses of this drug. If you experience hearing problems, such as hearing loss, contact your doctor right away.

Other Possible Side Effects

Most people do not experience significant side effects, but some may occur. If you notice any of the following side effects or any other symptoms that bother you or do not go away, contact your doctor:

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

Reporting Side Effects

If you have questions or concerns about side effects, contact 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 and its symptoms.
Certain health conditions, including:
+ Abnormal heart rhythms, such as a prolonged QTc interval on an electrocardiogram (ECG)
+ Other irregular heartbeats
+ Slow heartbeat (bradycardia)
+ Low potassium or magnesium levels

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

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

This is crucial because some medications, such as those used to treat mood disorders, irregular heartbeats, 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. Therefore, it is vital to discuss all your medications and health problems with your doctor and pharmacist to ensure safe treatment.

Do not start, stop, or change the dose of any medication without first consulting your doctor to confirm it is safe to do so with this medication.

Important Warnings and Cautions for Patients Taking This Medication

If you are taking this medication, it is essential to inform all of your healthcare providers, including doctors, nurses, pharmacists, and dentists, about your treatment. Long-term use of this drug requires regular blood work checks; consult with your doctor to discuss the necessary monitoring.

This medication may interfere with certain laboratory tests, so it is crucial to notify all healthcare providers and laboratory personnel that you are taking this drug. Do not exceed the recommended duration of treatment, as this may increase the risk of a second infection.

If you are following a low-sodium or sodium-free diet, consult with your doctor, as some formulations of this medication may contain sodium. Additionally, if you have myasthenia gravis, discuss your treatment with your doctor, and seek medical attention immediately if your symptoms worsen. 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 (e.g., blurred vision or double vision), can also occur in individuals without a prior diagnosis; report any of these symptoms to your doctor promptly.

Older adults (65 years and older) should exercise caution when taking this medication, as they may be more susceptible to side effects. If you are pregnant, planning to become pregnant, or breastfeeding, consult with your doctor to weigh the benefits and risks of treatment to both you and your baby.

Special Considerations for Newborns

Newborns taking this medication are at risk of developing a severe stomach problem. If your child experiences vomiting or becomes irritable during feeding, seek medical attention immediately.

• Colchicine (in patients with renal or hepatic impairment)
• Ergotamine, Dihydroergotamine (risk of acute ergot toxicity)
• Lurasidone, Pimozide (risk of QT prolongation and cardiac arrhythmias)
• Lovastatin, Simvastatin (risk of rhabdomyolysis)
• Ticagrelor (increased ticagrelor exposure)

• Amiodarone, Disopyramide, Dofetilide, Procainamide, Quinidine, Sotalol (increased risk of QT prolongation and Torsades de Pointes)
• Cisapride (increased risk of QT prolongation and arrhythmias)
• Warfarin (increased anticoagulant effect, bleeding risk)
• Digoxin (increased digoxin levels)
• Theophylline (increased theophylline levels, toxicity)
• Carbamazepine, Phenytoin, Valproic acid (increased anticonvulsant levels, toxicity)
• Cyclosporine, Tacrolimus (increased immunosuppressant levels, nephrotoxicity)
• Statins (e.g., Atorvastatin, Rosuvastatin - increased risk of myopathy/rhabdomyolysis, except for pravastatin and fluvastatin)
• Benzodiazepines (e.g., Midazolam, Triazolam - increased sedation)
• Calcium channel blockers (e.g., Verapamil, Diltiazem, Amlodipine - increased CCB levels, hypotension, bradycardia)
• Corticosteroids (e.g., Methylprednisolone - increased corticosteroid levels)
• Sildenafil, Tadalafil (increased PDE5 inhibitor levels, adverse effects)
• Quetiapine (increased quetiapine levels, toxicity)
• Rifampin (decreased erythromycin levels)
• Clindamycin, Lincomycin (antagonistic effect)

• Oral contraceptives (potential for reduced efficacy, though evidence is mixed)
• Zidovudine (decreased zidovudine levels)
• Cimetidine (increased erythromycin levels)
• Grapefruit juice (increased erythromycin levels)
• Other drugs that prolong QT interval (e.g., some antipsychotics, antidepressants, fluoroquinolones)

• Antacids (may reduce absorption of some erythromycin salts, but less relevant for DR forms)

• Nausea
• Vomiting
• Abdominal pain/cramping
• Diarrhea (especially severe or bloody, indicative of C. difficile)
• Hearing loss
• Tinnitus
• Dizziness
• Palpitations
• Yellowing of skin/eyes (jaundice)
• Dark urine
• Unusual fatigue
• Muscle pain/weakness (if on statins)

Erythromycin is generally considered safe for use during pregnancy when clearly needed. It is classified as Pregnancy Category B.

Erythromycin is excreted into breast milk in small amounts. It is generally considered compatible with breastfeeding, but monitor the infant for gastrointestinal disturbances (e.g., diarrhea, candidiasis) or allergic reactions.

Erythromycin is widely used in pediatric patients for various infections. Dosage is typically weight-based. Caution is advised in neonates due to potential for infantile hypertrophic pyloric stenosis (IHPS), especially with erythromycin ethylsuccinate, though the risk with other salts or delayed-release forms is lower but still present. Monitor for GI side effects.

No specific dose adjustment is generally required based on age alone. However, elderly patients may be more susceptible to adverse effects such as hearing loss, QT prolongation, and drug interactions due to polypharmacy, reduced renal/hepatic function, and underlying comorbidities. Monitor closely for these effects.

• Erythromycin is a potent CYP3A4 inhibitor, leading to numerous significant drug interactions. Always review concomitant medications.
• Commonly causes gastrointestinal upset (nausea, vomiting, abdominal cramps, diarrhea) due to its prokinetic effect. Delayed-release formulations aim to mitigate this.
• Can prolong the QT interval and carries a risk of Torsades de Pointes, especially in patients with pre-existing cardiac conditions, electrolyte imbalances, or on other QT-prolonging drugs.
• Ototoxicity (reversible hearing loss, tinnitus) can occur, particularly with high doses, renal/hepatic impairment, or in the elderly.
• Erythromycin is an alternative for penicillin-allergic patients for susceptible infections.
• Resistance to macrolides is increasing, so susceptibility testing is important when possible.

• Azithromycin (another macrolide, longer half-life, less frequent dosing, fewer CYP interactions)
• Clarithromycin (another macrolide, similar spectrum, more potent CYP inhibitor)
• Penicillins (e.g., Amoxicillin, Penicillin V - if susceptible and no allergy)
• Cephalosporins (e.g., Cephalexin, Cefuroxime - if susceptible and no allergy)
• Tetracyclines (e.g., Doxycycline - for certain atypical infections)
• Fluoroquinolones (e.g., Levofloxacin, Moxifloxacin - for specific indications, broader spectrum, different side effect profile)

If your symptoms or health issues persist or worsen, it's 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 be sure to check with your pharmacist for more information. If you have any questions or concerns about your medication, don't hesitate to reach out to 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 details about the medication taken, the amount, and the time it happened.