azithromycin

AKA

Zithromax®, Zithromax Z-Pak®, Zmax SR®, AG-Azithromycin®, Apo-Azithromycin®, Auro-Azithromycin®, JAMP-Azithromycin®, M-Azithromycin®, MAR-Azithromycin, NRA-Azithromycin®, PMS-Azithromycin®, PRO-Azithromycin®, Riva-Azithromycin®, Sandoz-Azithromycin®, Teva-Azithromycin® and others

Purpose [+] Antibiotic, Anti-Infective

HIDE ALL

SHOW ALL

Alcohol

Booze, ethyl or ethanol, adult beverage, brew, brewski, liquor, drink, shot, sauce, rot gut, hooch, giggle juice, moonshine, jello shots, wobbly pop

Learn more about this substance »

Interaction
No information currently available.

Think First

Mixing azithromycin with alcohol doesn't seem to change the risk of drinking alcohol. This means, your usual dose of azithromycin and 1 or 2 drinks.

Think First

Remember, 1 drink = 1 beer, 1 glass of wine or 1 shot of liquor.

Tobacco

smokes, butts, cigs, cigars, darts, stogies, cancer sticks, chew, dip

Learn more about this substance »

Interaction
No information currently available.

Unknown Dangers

Unknown dangers.

Caffeine

coffee, java, joe, soda, pop, tea, energy drinks (Red Bull®, Monster®, Rock Star®, Amp®, NOS®, Full Throttle®, 5-hour Energy Drink®, Beaver Buzz®), chocolate, cocoa

Learn more about this substance »

Interaction
No information currently available.

Unknown Dangers

Unknown dangers.

Cannabis/ Hash

Marijuana, mary jane, BC bud, blunt, chronic, J, jay, joint, hemp, pot, grass, herb, 420, dope, THC, weed, reefer, ganja, gangster, skunk, hydro, hash oil, weed oil, hash brownies, grease, boom, honey oil, K2, spice, poppers, shatter, budder

Learn more about this substance »

Interaction
No information currently available.

Unknown Dangers

Unknown dangers.

Cocaine/ Crack

coke, snow, flake, nose candy, blow, lady white, stardust, rock, crystal, bazooka, moon rock, tar

Learn more about this substance »

Interaction
QTc interval prolongation has been observed with azithromycin. Concomitant use with cocaine may result in an arrhythmia with the potential to develop Torsades de Pointes.

Mechanism
Both azithromycin and cocaine can cause QTc interval prolongation. When used together, these effects may be additive.

Significance
Due to increased risk of QTc interval prolongation, it is recommended to avoid concomitant use of cocaine and azithromycin.

Serious Risk for Harm

Both cocaine and azithromycin can cause abnormal heart rhythm. Mixing these two medications could make the chance of having a deadly abnormal heart beat more likely, so this cocktail should be avoided.

Opioids

codeine, Tylenol #3®, cody, meperidine, Demerol®, DXM, dextromethorphan, robo, skittles, morphine, morph, monkey, methadone, bupe, sub, or dollies, oxycodone, Oxycontin®, hillbilly heroin, OxyNeo®, OC, oxy, roxy, percs, fentanyl, Sublimaze®, Duragesic®, china white, hydrocodone, Hycodan®, Vicodin®, suboxone®, buprenorphine, vike, heroin, H, horse, junk, smack, brown sugar, black tar, down, china white, purple drank, W18, carfentanil, elephant tranquilizer, loperamide, lope, lean

Learn more about this substance »

Interaction

LOPERAMIDE: QTc prolongation has been observed with azithromycin. Concomitant use with high-dose loperamide (>100 mg/day) may result in an arrhythmia with the potential to develop Torsades de Pointes.

METHADONE: QTc prolongation has been observed with azithromycin. Concomitant use with methadone may result in an arrhythmia with the potential to develop Torsades de Pointes.

A 47 year old male on methadone maintenance therapy (10 mg TID) was three days into a course of azithromycin therapy when he experienced symptoms of nausea and palpitations, followed by cyanosis and unconsciousness. ECG revealed sinus tachycardia and a QTc interval of 490 msec.

MORPHINE: Azithromycin may theoretically increase blood levels of morphine.

Mechanism

LOPERAMIDE: Both azithromycin and high dose loperamide can cause QTc interval prolongation. When used together, these effects may be additive.

METHADONE: Both azithromycin and methadone can cause QTc interval prolongation. When used together, these effects may be additive.

MORPHINE: Azithromycin is a p-glycoprotein inhibitor. This may reduce the efflux of morphine (a p-glycoprotein substrate) and could lead to increased levels of morphine.

Significance

LOPERAMIDE: Due to increased risk of QTc interval prolongation, it is recommended to avoid concomitant use of high-dose loperamide (>100 mg/day) and azithromycin.

METHADONE: Due to increased risk of QTc interval prolongation, it is recommended to avoid concomitant use of methadone and azithromycin.

MORPHINE: Concomitant use of azithromycin and morphine may enhance the adverse/toxic effects of morphine. If concomitant use is necessary, monitor patients for sedation and respiratory depression.

Serious Risk for Harm

METHADONE: Both azithromycin and methadone can cause abnormal heart rhythm. Mixing these two medications could make the chance of having a deadly abnormal heart beat more likely, so this cocktail should be avoided.

LOPERAMIDE: Use of both azithromycin and very high doses of loperamide (more than 100 mg in one day) can cause abnormal heart rhythm. Mixing these two medications could make the chance of having a deadly abnormal heart beat more likely, so this cocktail should be avoided.

Serious Risk for Harm

MORPHINE: Taking azithromycin and morphine together may make the effects of morphine stronger than expected. This would be like taking too much morphine and could cause drowsiness or dangerously slowed breathing.

Unknown Dangers

OTHER OPIOIDS: Unknown dangers.

Amphetamines/ Stimulants

uppers, ecstasy, E, X, Molly, mesc, XTC, love drug, MDA, MDE, Eve, MDMA, adam, disco biscuit, bennies, black beauties, Dexedrine®, Adderall®, dexies, Ritalin®, speed, crystal, meth, ice, glass, crank, tweak, cat, qat, kat, khat, bath salts, Ivory Wave, Vanilla Sky, Cloud 9

Learn more about this substance »

Interaction
No information currently available.

Unknown Dangers

Unknown dangers.

Phencyclidine/ Ketamine

PCP, angel dust, PeaCe Pill, rocket fuel, love boat, embalming fluid, elephant tranquilizer, hog, illy, wet, wet stick, dipper, toe tag, cadillac, snorts, or surfer, Special K, vitamin K, CVR, cat tranquilizer, cat valium, jet, kit kat, Ketalar®

Learn more about this substance »

Interaction
No information currently available.

Unknown Dangers

Unknown dangers.

LSD/ Hallucinogens

acid, blotter, cartoon acid, hit, purple haze, trip, white lightning, raggedy ann, sunshine, window-pane, microdot, boomers, buttons, mesc, peyote, salvia, morning glory seeds, flying saucers, licorice drops, pearly gates, magic mushrooms, shrooms

Learn more about this substance »

Interaction
No information currently available.

Unknown Dangers

Unknown dangers.

Benzodiazepines

benzos, downers, tranquilizers, tranks, Ativan®, Halcion®, Klonopin®, Rivotril®, Restoril®, Serax®, Valium®, Xanax®, Rohypnol® (roofies, rope, the forget or date rape pill)

Learn more about this substance »

Interaction
MIDAZOLAM: Azithromycin 750 mg had no effect on the metabolism of 10 or 15 mg doses of orally administered midazolam and did not affect the performance on psychomotor tests in 64 healthy subjects. Another study also found no interaction between azithromycin and midazolam.

OTHER BENZODIAZEPINES: Unknown dangers.

Mechanism
MIDAZOLAM: Unlike other macrolides, azithromycin does not inhibit CYP3A4 to a significant degree.

Significance
Azithromycin may be a preferred choice when a macrolide is prescribed for a patient receiving benzodiazepines.

Think First

MIDAZOLAM: Mixing azithromycin with midazolam doesn't seem to change the risk of taking midazolam.

Unknown Dangers

OTHER BENZODIAZEPINES: Unknown dangers.

References

[+]

Baxter K, ed. Stockley's Drug Interactions [online]. London: Pharmaceutical Press. 2021; Aug 23, 2021.

Lexi-Comp ONLINE, Lexi-Comp ONLINE Interaction Analysis, Hudson, Ohio: Lexi-Comp, Inc.; 2021; Aug 23, 2021.

Magnano AR, Talathoti NB, Hallur R et al. Effect of acute cocaine administration on the QTc interval of habitual users. Am J Cardiol 2006; 15: 1244-6.

Mattila MJ, Vanakoski J, Idanpaan-Heikkila JJ. Azithromycin Does Not Alter the Effect of Oral Midazolam on Human Performance. Eur J Clin Pharmacol 1994; 47: 49-52.

Upadhyay A, Bodar V, Malekzadegan M et al. Loperamide Induced Life Threatening Ventricular Arrhythmia. Case Rep Cardiol 2016; 2016: 5040176.

Wills S. Drugs of Abuse, 2nd edition. Great Britain: Pharmaceutical Press 2005.

Winton JC, Twilla JD et al. Sudden cardiac arrest in a patient on chronic methadone after the addition of azithromycin. Am J Med Sci 2013; 345: 160-2.

Yeates RA, Laufen H, Zimmermann T. Interaction Between Midazolam and Clarithromycin: Comparison With Azithromycin. Int J Clin Pharmacol Ther 1996; 34: 400-5.

The Drug Cocktails website – “Facts for Youth about mixing Medicine, Booze and Street Drugs” (the “Site”) has been developed as a resource for youth and staff within Children’s & Women’s Health Centre of British Columbia Branch (C&W) for Provincial Health Services Authority and its branch agencies (PHSA)(C&W and PHSA together the “Societies”). There are support systems at the Societies which may not exist in other clinical settings and therefore adoption or use of this manual is not the responsibility of the Societies. Agencies other than the Societies should use Cocktails as a guideline for reference purposes only. The contents of this website were current at the time of development in July 2013. The Societies are not responsible for information that has changed after that time, whether incorporated into the Site or not.

The Site contains best practice knowledge, but practice standards may change as more knowledge is gained. Decision making in a specific context remains the responsibility of attending professionals. Nothing on the Site should in any way be construed as being either official or unofficial policy of the Societies.

Contact information and links to websites contained on the Site are provided for convenience only. The Societies cannot guarantee that the information, links or content from these links remain current. Providing a contact or link does not mean that the Societies endorse the views, products or services that may be offered via the link. The Societies assume no responsibility or liability arising from any error in, or omission of, information or from the use of any information, link, contact, opinion, advice or similar, provided on the Site.

Copyright © 2024. All rights reserved. Children’s & Women's Health Centre of British Columbia. Materials on this website may be copied and used for personal non-commercial purposes.

azithromycin

References

Which version would you like to print?