Drug interactions
Donepezil + Erythromycin ethylsuccinate
Severity: Major
Donepezil and Erythromycin ethylsuccinate: 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
Erythromycin prolongs the QT interval and can cause torsades de pointes. Donepezil adds QT liability, and erythromycin may also raise donepezil levels by inhibiting CYP3A4, compounding the risk.
What this interaction means in plain words
Donepezil and Erythromycin ethylsuccinate 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
Additive QT prolongation plus CYP3A4 inhibition by erythromycin that may increase donepezil exposure.
What to do
Choose a non-macrolide antibiotic with less QT effect where appropriate. If used, check ECG and electrolytes and monitor for bradycardia or syncope.
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
- Apozyl 10 mg Orodispersible Tablets - SmPC sections 4.3/4.5 (names the partner; "Certain antibiotics (e.g. clarithromycin, erythromycin, levofloxacin, moxifloxacin)") — electronic medicines compendium (UK SmPC)
Other interactions of Donepezil
- Donepezil + Dronedarone Contraindicated
- Donepezil + Pimozide Contraindicated
- Donepezil + Thioridazine Contraindicated
- Donepezil + Vandetanib Contraindicated
- Amiodarone + Donepezil Major
- Amisulpride + Donepezil Major
Frequently asked questions
Can I take Donepezil with Erythromycin ethylsuccinate?
MediHelp rates the interaction as major. Donepezil and Erythromycin ethylsuccinate 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 prolongs the QT interval and can cause torsades de pointes. Donepezil adds QT liability, and erythromycin may also raise donepezil levels by inhibiting CYP3A4, compounding the risk.
How serious is the interaction between Donepezil and Erythromycin ethylsuccinate?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Choose a non-macrolide antibiotic with less QT effect where appropriate. If used, check ECG and electrolytes and monitor for bradycardia or syncope.
What other medicines interact with Donepezil?
MediHelp also lists interactions of Donepezil with, for example, Dronedarone, Pimozide, Thioridazine. The full list is on the Donepezil page.
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