Erythromycin

Medically Reviewed by Dr. Harshi Dhingra, M.D.

Last Reviewed: May 03, 2023

Warnings

Erythromycin Risks, Warnings, and Complications

Erythromycin can cause or worsen health problems in some people. Talk to your doctor or pharmacist about other treatments for bacterial infections if you are at an increased risk of adverse reactions or complications from erythromycin.

LIVER TOXICITY: Erythromycin can cause severe and even life-threatening liver damage. The risk is greater in people with a history of liver problems. Call your doctor immediately if you develop fatigue, stomach pain, nausea, vomiting, dark urine, pale stools, or yellowing of the skin or eyes while on erythromycin.
LONG QT SYNDROME: In a small number of people, erythromycin can cause a serious heart rhythm abnormality called QT prolongation, which can result in sudden cardiac death. People with a history of QT prolongation, irregular heart rhythm, slow heart rate, and low potassium or magnesium are at greater risk of this happening. Those taking other medications that can affect heart rhythm (for example, pimozide (Orap)) and elderly patients over 65 years of age are also at higher risk. Before starting erythromycin, tell your healthcare provider if you have any heart problems. Give your provider a complete list of your medications.
SYPHILIS IN PREGNANCY: In women who are treated for syphilis during pregnancy, not enough erythromycin crosses the placenta to reach the unborn baby. Consequently, the baby may be infected with syphilis at birth and may need to be treated with penicillin.
CLOSTRIDIUM DIFFICILE ASSOCIATED DIARRHEA: Erythromycin and other antibiotics can allow Clostridium difficile (C. diff) to grow out of control in the gut. This can increase the risk of developing C. diff associated diarrhea, which is a severe and potentially fatal type of diarrhea. This can happen even 2 months after finishing antibiotic treatment. Stop taking erythromycin and contact your healthcare provider without delay if you develop bloody or watery stools. The risk is higher if you are on multiple antibacterial agents, long-term treatment with antibiotics, are above 65 years of age, or have a weakened immune system.
DRUG INTERACTIONS: Serious adverse effects can occur if you take erythromycin with certain drugs, such as colchicine (Colcrys), which can lead to colchicine toxicity, pimozide (Orap) which can cause QT prolongation, statins (cholesterol-lowering drugs) like atorvastatin and simvastatin, which can cause rhabdomyolysis (muscle damage), and calcium channel blockers like diltiazem, amlodipine, verapamil which can cause low blood pressure. Give your doctor and pharmacist a complete list of your medications, including prescription drugs, nonprescription drugs, dietary supplements, and herbal products before starting erythromycin.
MYASTHENIA GRAVIS: Erythromycin can cause new or worsening symptoms of myasthenia gravis, including difficulty breathing and muscle weakness. Give your healthcare provider a complete medical history and discuss the pros and cons of taking erythromycin if you have myasthenia gravis.

Precautions Before Starting Erythromycin

Tell your doctor if you have ever had an allergic reaction to erythromycin, any of the active or inactive ingredients in erythromycin formulations, other antibiotics, or any other medications. Your pharmacy can give you a list of ingredients.

Give your doctor and pharmacist a complete list of your medications, including prescription medications, over-the-counter medicines, vitamins, supplements, and herbal products. This can help avoid possible drug interactions.

Give your doctor a complete medical history. Erythromycin may not be right for people with certain health conditions, such as low magnesium or potassium, prolonged QT interval, irregular heartbeat, liver disease, or myasthenia gravis.

Tell your health care professional if you are pregnant, could be pregnant, plan to get pregnant, or are breastfeeding.

Precautions During Use of Erythromycin

Keep all your healthcare appointments during erythromycin treatment. Your doctor may want to order medical tests to check if your infection has cleared.

Avoid eating large amounts of grapefruit or drinking large quantities of grapefruit juice while on erythromycin, as this can increase the drug’s blood levels.

Tell your doctor if you become pregnant while taking erythromycin.

Tell all your healthcare providers you are on erythromycin, especially before any procedure, including dental procedures.

Erythromycin Drug Interactions

Certain other drugs can affect how erythromycin works. Possible drug interactions with other medicines can increase the risk of severe adverse effects. The following medications can have interactions with erythromycin:

Pimozide (Orap)
Colchicine (Colcrys, Mitigare)
Calcium channel blockers such as amlodipine (Norvasc, in Caduet, in Lotrel), diltiazem (Cardizem, Cartia, Diltzac, Tiazac), and verapamil (Calan, Covera, in Tarka, Verelan)
Dihydroergotamine (DHE 45, Migranal) and ergotamine (Ergomar, in Cafergot, in Migergot)
Benzodiazepines such as alprazolam (Xanax), midazolam, and triazolam (Halcion)
Blood thinners or anticoagulants such as warfarin (Coumadin, Jantoven)
Bromocriptine (Cycloset)
Anticonvulsants such as carbamazepine (Carbatrol, Epitol, Equetro, Tegretol), phenytoin (Dilantin, Phenytek), and valproic acid (Depakene, Depakote)
Cilostazol (Pletal)
Cyclosporine (Neoral, Sandimmune)
Digoxin (Lanoxin)
Antiarrhythmics such as disopyramide (Norpace), dofetilide (Tikosyn), procainamide (Procanbid), quinidine, and sotalol (Betapace)
Statins such as lovastatin (Altoprev) and simvastatin (Zocor, in Vytorin)
Sildenafil (Revatio, Viagra)
Theophylline (Elixophyllin, Theochron, Theo-Dur)

Give your doctor or pharmacist a complete list of your medications, including prescription drugs, nonprescription drugs, dietary supplements, and herbal remedies. Also, tell your healthcare professional if you smoke, drink alcohol, or use recreational drugs because some of these substances can cause serious health complications when used with prescription medications.

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