Drug interactions
Donepezil + Erythromycin lactobionate
Severity: Major
Donepezil and Erythromycin lactobionate: 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
Intravenous erythromycin has a notable risk of QT prolongation and torsades, particularly with rapid infusion. Donepezil adds to the effect, and CYP3A4 inhibition by erythromycin may increase donepezil exposure.
What this interaction means in plain words
Donepezil and Erythromycin lactobionate 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.
Donepezil belongs to Central Nervous System; Erythromycin lactobionate belongs to Anti Bacterial.
Why it happens
Additive QT prolongation plus CYP3A4 inhibition by erythromycin that may increase donepezil exposure.
What to do
Prefer a non-macrolide alternative. If IV erythromycin is needed, infuse slowly, check ECG and electrolytes and monitor for arrhythmia.
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
Other interactions of Erythromycin lactobionate
- Cisapride + Erythromycin lactobionate Contraindicated
- Dihydroergotamine + Erythromycin lactobionate Contraindicated
- Dronedarone + Erythromycin lactobionate Contraindicated
- Eletriptan + Erythromycin lactobionate Contraindicated
- Ergotamine + Erythromycin lactobionate Contraindicated
- Erythromycin lactobionate + Flibanserin Contraindicated
Frequently asked questions
Can I take Donepezil with Erythromycin lactobionate?
MediHelp rates the interaction as major. Donepezil and Erythromycin lactobionate 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. Intravenous erythromycin has a notable risk of QT prolongation and torsades, particularly with rapid infusion. Donepezil adds to the effect, and CYP3A4 inhibition by erythromycin may increase donepezil exposure.
How serious is the interaction between Donepezil and Erythromycin lactobionate?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Prefer a non-macrolide alternative. If IV erythromycin is needed, infuse slowly, check ECG and electrolytes and monitor for arrhythmia.
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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