Drug interactions
Erythromycin lactobionate + Verapamil
Severity: Major
Erythromycin lactobionate and Verapamil: major interaction.
Last updated Sources: US FDA label
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 inhibits CYP3A4 and raises verapamil levels, and verapamil may modestly raise erythromycin levels. This can cause marked hypotension, bradycardia, AV block and, rarely, QT prolongation or arrhythmia. Cases of severe hypotension and shock have been reported.
What this interaction means in plain words
Erythromycin lactobionate and Verapamil 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 lactobionate belongs to Anti Bacterial; Verapamil belongs to Cardiovascular.
Why it happens
Mutual CYP3A4 inhibition, chiefly erythromycin reducing verapamil clearance, with additive effects on cardiac conduction.
What to do
Prefer a non-interacting antibiotic such as azithromycin or a different class. If combined, monitor blood pressure, heart rate and ECG, and consider lowering the verapamil dose.
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
Other interactions of Verapamil
- Dofetilide + Verapamil Contraindicated
- Flibanserin + Verapamil Contraindicated
- Lomitapide + Verapamil Contraindicated
- Lonafarnib + Verapamil Contraindicated
- Pimozide + Verapamil Contraindicated
- Acebutolol + Verapamil 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 Erythromycin lactobionate with Verapamil?
MediHelp rates the interaction as major. Erythromycin lactobionate and Verapamil 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 inhibits CYP3A4 and raises verapamil levels, and verapamil may modestly raise erythromycin levels. This can cause marked hypotension, bradycardia, AV block and, rarely, QT prolongation or arrhythmia. Cases of severe hypotension and shock have been reported.
How serious is the interaction between Erythromycin lactobionate and Verapamil?
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-interacting antibiotic such as azithromycin or a different class. If combined, monitor blood pressure, heart rate and ECG, and consider lowering the verapamil dose.
What other medicines interact with Verapamil?
MediHelp also lists interactions of Verapamil with, for example, Dofetilide, Flibanserin, Lomitapide. The full list is on the Verapamil page.
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