ALEMBIC CHEMICAL WORKS Co.LTD
ALEMBIC CHEMICAL WORKS Co.LTD
Prime Corporate Park 2nd Floor Behind ITC Grand Maratha Hotel Sahar Road Andheri West, Mumbai 400 099
Erythromycin estolate 250mg,
List of Related Indications:
- Amoebic dysentry
- Acute bacterial pharyngitis
- Cough Whoopng
List Of Drugs:
- Erythromycin ( *** ) @ - Macrolide- (FDC- List )
Indication Type Description:
Dosages/ Overdosage Etc
Interaction with Food
Pregnancy and lactation
Macrolide antibiotics include- Azithromycibn. clarithromycin, dirithromycin, erythromycin and troleandomycin
Interacting drugs - summary
alfentanil clearance decreased and its elimination half-life increased
anticoagulant effect of warfarin or anisindione increased.
The risk of bleeding is increased.
astemazole and terfenadine plasma levels increased, which lead to serious
cardivascular advere effects
serum bromocriptine levels increased, resulting in an increase in
pharmacologic and toxic effects.
carbamazepine toxicity sufficient to require hospitalisation result.
increased Cyclosporine concentrations with renal toxicity occur
increased serum Digoxin level occur in a small population of
patients(about 10%) toxic effects occur
increased disopyramide plasma level occur. Arrhythmias and
increased QTC have occurred
acute ergotism manifested as peripheral ischemia has occurred
under some conditions , coadministration antagonistic
Macrolide Antibiotics + Methyl prednisolone
methylprednisolone clearance decreased
In vitro tests and clinical studies demonstrated both
antagonism and synergism with coadministration.
increased Theophyline serum levels with toxicity are possible.
Decreased erythromycin levels occur
Triazolam bioavailability increased, resulting in CNS depression
severe myopathy or rhabdomyolysis occur with concurrent administration
in vitro indicate that troleandomycin, erythromycin and clarithromycin
markedly inhibit cytochrome p450 IIIA,mainly responsible for
metabolism of cisapride.
Concurrent use is contraindicated
cause toxicity of vinblastine. Severe myalgia, neutripenia and
these agents increase tacrolimus blood levels
Respiratory tract infections
Macrolide antibiotics include- Azithromycin. clarithromycin, dirithromycin, erythromycin and
Patients who are prescribed erythromycin concurrently with certain commonly used
medicines are at an increased risk of sudden death from cardiac diseases.
Such a risk does not exist with other antibiotics such as amoxycilin.
Prescribers should avoid administration of erythromycin with the following commonly
Amitriptyline, Chloroquin, Chlorpromazine, Cisapride, Doxepin, Haloperidol, Impipramine,
Pimozide, Quinidine, Quinine, Salatol, Sparfloxacin, Spiramycin, Thioridazine (MIMS)
Local- venous irritation and phlebitis have occured with parentral administration, but the risk of
administration may be reduced if the infusion is given slowly.
Special senses- isolated reports of reversible hearing loss occuring in patients with renal or heaptic
insufficiency in elderly (> 50 years old) and in those receiving high doses ( > 4g.day).
Hypersensitivity- serious allergic reactions including anaphylaxis have occured. Mild reactions include
rashes with or without pruritus, bullous fixed eruptions and eczema.
GI- most frequent dose-related side effects following oral use include abdominal cramping and
discomfort with erythromycin therapy has occurred
Hepatic- Hepatotoxicity is most commonly associated with erythromycin estlolate
Cardiovascular- rarely, production of arrhythmias, including ventricular tachycardia, and torse de pointes in individuals with prolonged QT intervals
Hypersens to erythromycin.History of jaundice.
Cholestatic hepatitis & reversible abnormalities in LFT may be associated with prolonged or
repeated therapy. History of hepatic disorders. Pregnancy, lactation.
Superinfection- use of antibiotics (especially prolonged or repeated therapy) may result in bacterial
overgrowth of nonsusceptible organisms. Take appropiate measures if superinfection occurs.
Pseudomembranous colitis- has occured with virtually all broad spectrum antibiotics. Consider its
diagnosis in patients who develop diarrhea in association with antibiotic use.
Hepatotoxicity- erythromycin administration has been associated with the frequent occurrence of
Symptoms may include malaise, nausea,vomiting, abdominalcramps and fever.Although initial
symptoms have developed after a few days of treatment, they genearlly have followed 1 or 2 weeks
of continuous therapy.
Symptoms reappear promptly, usually within 48 hours after the drug is administerd to sensitive persons.
Hypersensitivity- seriousallergic reactions including anphylaxis have occurred
Hepatic function impairment- exercise caution in administering to patients with impaired hepatic
function. There have reports of hepatic dysfunction with or without jaundice.
Pregnancy- safety for use use during pregnancy has not been established
Lactation- Erythromycin is considered compatible with breast feeding by the American Academy of
Dosages/ Overdosage Etc:
Usual dosage- Adults - 250mg(or 400mg ethyl succinate) every 6 hours or 500mg
every 12 hours or 333mg every 8 hours. May increase upto more than 4g/day, according
to severity of infection. If twice a day is required,the recommended dose 500mg every 12 hours.
30 to 50mg/kg/day(15 to 25mg/lb/day/) in divided doses. For more severe infections,
dosages may be doubled. Proper dosage is determined by age, weight and severity of infection.
Nausea, vomting, epigastric distress,and diarrhea .Severity is dose related.
1. Induce prompt elimination of unabsorbed drug
2. However, unless 5 times the normal single dose has been ingested , GI decontamination should not
3. Hemodialysis and peritoneal dialysis are not particularly effective.
1. If you miss a dose of this medicine, take it as soon as possible.
2. However, if it is almost time for next dose, skip the missed dose and go back to your regular dosing
3. Do not double doses.
Eosinophilia - ( 290 )
Many diseases are encountered where blood or tissue eosinophillia are increased. Eosinophils develop in the bone
marrow similar to neutrophils. Their characterstic red-staining ganules contain a unique perioxidase
Drugs causing adverse reactions- ( 585 )
1. Erythromycin estolate
4. p-aminosalicylic acid
1. Take preferably on an empty stomach at least 1 hour before or 3\2 hours after meals.
2. If GI upset occurs, may be taken with food. Erythromycin estolate, ethylsuccinate and certain
brands of erythromycin base enteric coated tablets may be taken without regards to meals.
2. Complete full course of therapy; take until finished.
3. Take at evenly spaced intervals during the day, preferably round the clock
4. Notify physician if nausea, vomiting, darrhoea, or stomach cramps, severe abdominal pain,
yellow discoluration of skin or eyes, darkened urine, pale stools, or unusual tiredness occurs.
5. Allergies- Tell your doctor if you have ever had any unusual or allergic reactions to eryhthromycin
or other related medicines such as azithromycin or clarithromycin. Also tell your doctor if your are
allergic to any other substances such as foods, preservatives or dyes.
6. Pregnancy- none of the erythromycins has been shown to cause birth fefects or other problems in
7. Breast feeding- erythromycins have not not been shown to cause problems in nursing babies
8. Children- has not been shown to cause different side effects or problems in children than it does in
9. Elderly- older adults maybe at at increased risk of hearing loss especially if they are taking high
doses of erythromycin and or have kidney or liver disease
10. Other medicines- tell your doctor if you are taking any of the following-
Anabolic steroids or
Antithyroid agents for overactive thyroid or
Estrogen female hormones or
Gold salts or
Oral contraceptives or
Other anti-infectives by mouth or by injection or
Valproic acid -use of these medicines with erythromycin especially erythromycin estolate may
increase the chance of liver problems
Theophylline - use of these medicines with erythromycin may increase the chance of side effects
from aminophylline , caffeine , oxtriphylline or theophylline
Tefandine - use of astemizole or terfenadine with eryhtromycin may cause heart problems such as
irregular heart beats , these medicines should not be used together
Cabamazepne - use of carbamazepine with reythromycin may increae the side effectsor increase
the chance liver problems
Lincomycin - use of these medicines with erythromycin may decrease the effectiveness of other
Warfarin - use of any of these medicines with erythromycin may increase the side effects of these
11. Other medical problems- presence of other medical problems may afect the use of erythromycin-
Heart disease - high dose of erythromycin may increase the chance of side effects in patients with
a history of irregular heart beat.
Liver disease- erythromycin especially estolate may increase the chance of side effects involving
Loss of hearing- high dose of eryhthromycin may on rare occassions cause hearing loss,
especially if you have kidney or liver disease.
13. Missed dose-
If you miss a dose of this medicine take it as soon as possible. However if it is almost time for your
next dose go back to your regular dosing schedule.
Do not double doses.
14. Avoid administration of erythromycin with the following used drugs-
Amitriptyline, Chloroquine, Chlopromazine, Cisapride, Doxepin, Haloperidol,
Imipramine, Pimozide, Quinidine, Quinine, Solatol, Sparfloxacin, Thioridazine
Interaction with Food:
Absorption affected to various extent for different esters.
Pregnancy and lactation:
Safety for use during has not been established. Use only when clearly needed.
Erythromycin is excreted in breast milk. It is considered as compatible by the American Academy