Drug interactions
Azithromycin + Domperidone
For healthcare professionals — reference only. This page is a brief summary, not medical advice and not a substitute for official labeling or clinical judgement. Always verify before prescribing or dispensing.
Overview
Additive QT prolongation with increased risk of torsades de pointes and sudden cardiac death; domperidone is contraindicated with QT‑prolonging drugs. Azithromycin also has known QT risk and may modestly increase domperidone exposure.
Mechanism of action
Pharmacodynamic: additive QT interval prolongation. Pharmacokinetic: domperidone is a CYP3A4 substrate; azithromycin is a weak CYP3A4/P‑gp inhibitor, so PK contribution is likely limited but possible.
Clinical management
Avoid coadministration. Use an alternative antibiotic without QT effects (e.g., beta‑lactam such as amoxicillin when appropriate) or an antiemetic without QT risk. If no alternative is feasible, obtain baseline and follow‑up ECGs, correct K+/Mg2+, minimize domperidone dose/duration, and monitor for arrhythmia; discontinue if QTc >500 ms or increases >60 ms or if symptomatic.
Drug reference
References
- Motilium (domperidone) Summary of Product Characteristics – Section 4.3 Contraindications and 4.5 Interaction — EMA
- Zithromax (azithromycin) Prescribing Information – Warnings and Precautions: QT Prolongation — FDA Label
- Azithromycin – Known Risk of Torsades de Pointes (QTdrugs List) — CredibleMeds
- Domperidone: risk of cardiac side effects—new contraindications, reduced dose and duration — MHRA Drug Safety Update
- Drug Interactions: Domperidone and Azithromycin — Lexicomp
Frequently asked questions
Can I take Azithromycin with Domperidone?
The interaction is rated: Contraindicated. Additive QT prolongation with increased risk of torsades de pointes and sudden cardiac death; domperidone is contraindicated with QT‑prolonging drugs. Azithromycin also has known QT risk and may modestly increase domperidone exposure.
How serious is the interaction between Azithromycin and Domperidone?
The interaction is rated: Contraindicated. Evidence level: High.
How is the interaction between Azithromycin and Domperidone managed?
Avoid coadministration. Use an alternative antibiotic without QT effects (e.g., beta‑lactam such as amoxicillin when appropriate) or an antiemetic without QT risk. If no alternative is feasible, obtain baseline and follow‑up ECGs, correct K+/Mg2+, minimize domperidone dose/duration, and monitor for arrhythmia; discontinue if QTc >500 ms or increases >60 ms or if symptomatic.
Why do Azithromycin and Domperidone interact?
Pharmacodynamic: additive QT interval prolongation. Pharmacokinetic: domperidone is a CYP3A4 substrate; azithromycin is a weak CYP3A4/P‑gp inhibitor, so PK contribution is likely limited but possible.
Full monographs, dosing and an interaction checker in the MediHelp app
Open the complete reference, check multi-drug interactions and use dosing tools in the MediHelp app.