Drug interactions
azithromycin + piperaquine
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 QTc prolongation with increased risk of torsades de pointes; piperaquine labeling contraindicates concomitant QT‑prolonging drugs (includes macrolides).
Mechanism of action
Additive pharmacodynamic QT prolongation via cardiac IKr (hERG) blockade; piperaquine causes dose‑dependent QTc increase and azithromycin has known TdP risk.
Clinical management
Avoid combination. If no alternative, obtain baseline and follow‑up ECGs, correct K/Mg, avoid other QT‑prolonging agents, and monitor for palpitations/syncope; consider alternative antibiotic or antimalarial.
Drug reference
References
- Eurartesim (dihydroartemisinin/piperaquine) Summary of Product Characteristics — EMA
- Zithromax (azithromycin) Prescribing Information — FDA Label
- CredibleMeds QTDrugs List: Azithromycin (Known Risk of Torsades de Pointes) — CredibleMeds
Frequently asked questions
Can I take azithromycin with piperaquine?
The interaction is rated: Contraindicated. Additive QTc prolongation with increased risk of torsades de pointes; piperaquine labeling contraindicates concomitant QT‑prolonging drugs (includes macrolides).
How serious is the interaction between azithromycin and piperaquine?
The interaction is rated: Contraindicated. Evidence level: High.
How is the interaction between azithromycin and piperaquine managed?
Avoid combination. If no alternative, obtain baseline and follow‑up ECGs, correct K/Mg, avoid other QT‑prolonging agents, and monitor for palpitations/syncope; consider alternative antibiotic or antimalarial.
Why do azithromycin and piperaquine interact?
Additive pharmacodynamic QT prolongation via cardiac IKr (hERG) blockade; piperaquine causes dose‑dependent QTc increase and azithromycin has known TdP risk.
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