Drug interactions
Dabigatran + Erythromycin
Severity: Major
Dabigatran and Erythromycin: major interaction.
Last updated
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
Erythromycin inhibits P-glycoprotein and may raise plasma levels of dabigatran etexilate, increasing anticoagulant effect and bleeding risk. The risk is greater in patients with renal impairment because dabigatran is mainly renally cleared.
What this interaction means in plain words
Dabigatran and Erythromycin 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.
Why it happens
P-glycoprotein inhibition by erythromycin increases absorption and reduces efflux of dabigatran etexilate.
What to do
Avoid the combination in patients with significant renal impairment (CrCl below 30 mL/min for atrial fibrillation, below 50 mL/min for VTE treatment). In others, monitor renal function and for bleeding, and consider an alternative antibiotic.
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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Other interactions of Erythromycin
- Conivaptan + Erythromycin Contraindicated
- Dihydroergotamine intranasal + Erythromycin Contraindicated
- Dihydroergotamine + Erythromycin Contraindicated
- Domperidone + Erythromycin Contraindicated
- Dronedarone + Erythromycin Contraindicated
- Droperidol + Erythromycin Contraindicated
Frequently asked questions
Can I take Dabigatran with Erythromycin?
MediHelp rates the interaction as major. Dabigatran and Erythromycin 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. Erythromycin inhibits P-glycoprotein and may raise plasma levels of dabigatran etexilate, increasing anticoagulant effect and bleeding risk. The risk is greater in patients with renal impairment because dabigatran is mainly renally cleared.
How serious is the interaction between Dabigatran and Erythromycin?
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 in patients with significant renal impairment (CrCl below 30 mL/min for atrial fibrillation, below 50 mL/min for VTE treatment). In others, monitor renal function and for bleeding, and consider an alternative antibiotic.
What other medicines interact with Erythromycin?
MediHelp also lists interactions of Erythromycin with, for example, Conivaptan, Dihydroergotamine intranasal, Dihydroergotamine. The full list is on the Erythromycin page.
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