Drug interactions
Azithromycin + Levofloxacin
Severity: Major
Azithromycin and Levofloxacin: major interaction.
Last updated Sources: UK SmPC
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.
Summary
Both a macrolide and a fluoroquinolone can prolong the QT interval, and combining them can add to the risk of torsades de pointes. The risk is higher in older patients, women, and those with hypokalemia, bradycardia or structural heart disease.
What this interaction means in plain words
Azithromycin and Levofloxacin can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for.
Azithromycin belongs to Anti Bacterial; Levofloxacin belongs to Anti Bacterial.
Why it happens
Additive QTc prolongation via inhibition of the delayed rectifier potassium current.
What to do
Avoid the combination where an alternative regimen is available. If both are needed, obtain a baseline ECG, correct electrolytes and monitor the QTc.
What to ask your pharmacist
- Does the benefit of taking both outweigh the risk in my case?
- Do I need any blood test, ECG or other check while on both?
- What early warning signs should I watch for, and what should I do if they appear?
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References
- Azithromycin 200mg/5ml Powder for Oral Suspension - SmPC sections 4.3/4.5 (names the partner; "dofetilide, amiodarone and sotalol), antipsychotic agents (e.g. pimozide), antidepressants (e.g. citalopram), fluoroquinolones (e.g. moxifloxacin and levofloxac") — electronic medicines compendium (UK SmPC)
Other interactions of Azithromycin
- Azithromycin + Cisapride Contraindicated
- Azithromycin + Domperidone Contraindicated
- Azithromycin + Dronedarone Contraindicated
- Azithromycin + Pimozide Contraindicated
- Azithromycin + Piperaquine Contraindicated
- Azithromycin + Thioridazine Contraindicated
Other interactions of Levofloxacin
- Dronedarone + Levofloxacin Contraindicated
- Ibutilide + Levofloxacin Contraindicated
- Levofloxacin + Thioridazine Contraindicated
- Levofloxacin + Vandetanib Contraindicated
- Levofloxacin + Ziprasidone Contraindicated
- Adagrasib + Levofloxacin Major
Frequently asked questions
Can I take Azithromycin with Levofloxacin?
MediHelp rates the interaction as major. Azithromycin and Levofloxacin can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for. Both a macrolide and a fluoroquinolone can prolong the QT interval, and combining them can add to the risk of torsades de pointes. The risk is higher in older patients, women, and those with hypokalemia, bradycardia or structural heart disease.
How serious is the interaction between Azithromycin and Levofloxacin?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Avoid the combination where an alternative regimen is available. If both are needed, obtain a baseline ECG, correct electrolytes and monitor the QTc.
What other medicines interact with Azithromycin?
MediHelp also lists interactions of Azithromycin with, for example, Cisapride, Domperidone, Dronedarone. The full list is on the Azithromycin page.
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