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The increase in QTc is approximately 10 milliseconds at doses of mg twice daily the FDA-approved dose and up to 25 milliseconds at doses of mg twice daily. Although there are no studies examining the effects of dronedarone in patients receiving other QT prolonging drugs, coadministration of such drugs may result in additive QT prolongation. Droperidol: Major Droperidol should not be used in combination with any drug known to have potential to prolong the QT interval, such as azithromycin.

Droperidol administration is associated with an established risk for QT prolongation and torsade de pointes TdP.

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Some cases have occurred in patients with no known risk factors for QT prolongation and some cases have been fatal. If coadministration cannot be avoided, use extreme caution; initiate droperidol at a low dose and increase the dose as needed to achieve the desired effect. Drospirenone: Moderate It would be prudent to recommend alternative or additional contraception when oral contraceptives OCs are used in conjunction with antibiotics.

Drospirenone; Estradiol: Moderate It would be prudent to recommend alternative or additional contraception when oral contraceptives OCs are used in conjunction with antibiotics. Drospirenone; Ethinyl Estradiol: Moderate It would be prudent to recommend alternative or additional contraception when oral contraceptives OCs are used in conjunction with antibiotics. Drospirenone; Ethinyl Estradiol; Levomefolate: Moderate It would be prudent to recommend alternative or additional contraception when oral contraceptives OCs are used in conjunction with antibiotics.

Efavirenz: Moderate Consider alternatives to efavirenz when coadministering with azithromycin; coadministration may increase the risk for QT prolongation and torsade de pointes TdP. QTc prolongation has been observed with the use of efavirenz. Efavirenz; Emtricitabine; Tenofovir: Moderate Consider alternatives to efavirenz when coadministering with azithromycin; coadministration may increase the risk for QT prolongation and torsade de pointes TdP.

Efavirenz; Lamivudine; Tenofovir Disoproxil Fumarate: Moderate Consider alternatives to efavirenz when coadministering with azithromycin; coadministration may increase the risk for QT prolongation and torsade de pointes TdP. Eliglustat: Moderate Consider the risk of QT prolongation which can be fatal when administering azithromycin to patients on other QT prolonging agents such as eliglustat.

Emtricitabine; Rilpivirine; Tenofovir alafenamide: Moderate Use caution when coadministering rilpivirine with azithromycin. Emtricitabine; Rilpivirine; Tenofovir disoproxil fumarate: Moderate Use caution when coadministering rilpivirine with azithromycin. Encorafenib: Major Avoid coadministration of encorafenib and azithromycin due to QT prolongation.

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If concurrent use cannot be avoided, monitor ECGs for QT prolongation and monitor electrolytes; correct hypokalemia and hypomagnesemia prior to treatment. Encorafenib is associated with dose-dependent prolongation of the QT interval. Enflurane: Major Halogenated Anesthetics should be used cautiously and with close monitoring with azithromycin. Entrectinib: Major Avoid coadministration of entrectinib with aripiprazole due to the risk of QT prolongation.

Entrectinib has been associated with QT prolongation. Ergotamine: Minor The manufacturer of azithromycin recommends caution and careful monitoring of patients who receive azithromycin and ergotamine, because simultaneous use of ergotamine with other macrolides may produce ergot toxicity. Eribulin: Major Concurrent use of eribulin and azithromycin should be avoided due to an increased risk for QT prolongation and torsade de pointes TdP. If these drugs must be coadministered, ECG monitoring is recommended; closely monitor the patient for QT interval prolongation.

Eribulin has been associated with QT prolongation, and cases of QT prolongation and TdP have been reported with the use of azithromycin during the post-marketing period. Erythromycin: Major Avoid use of azithromycin and erythromycin together as this would be considered duplicate therapy. Cross-resistance with gram-positive organisms would be expected. Additionally, the risk for QT prolongation and torsade de pointes TdP increases if these drugs are administered together. Erythromycin has been associated with QT prolongation and TdP, and cases of QT prolongation and TdP have been reported during post-marketing use of azithromycin.

Erythromycin; Sulfisoxazole: Major Avoid use of azithromycin and erythromycin together as this would be considered duplicate therapy. Escitalopram: Moderate Use escitalopram with caution in combination with azithromycin as concurrent use may increase the risk of QT prolongation. There have been case reports of QT prolongation and torsade de pointes TdP with the use of azithromycin in postmarketing reports. Escitalopram has been associated with a risk of QT prolongation and TdP. Estradiol; Levonorgestrel: Moderate It would be prudent to recommend alternative or additional contraception when oral contraceptives OCs are used in conjunction with antibiotics.



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Estradiol; Norethindrone: Moderate It would be prudent to recommend alternative or additional contraception when oral contraceptives OCs are used in conjunction with antibiotics. Estradiol; Norgestimate: Moderate It would be prudent to recommend alternative or additional contraception when oral contraceptives OCs are used in conjunction with antibiotics. Ethinyl Estradiol: Moderate It would be prudent to recommend alternative or additional contraception when oral contraceptives OCs are used in conjunction with antibiotics. Ethinyl Estradiol; Desogestrel: Moderate It would be prudent to recommend alternative or additional contraception when oral contraceptives OCs are used in conjunction with antibiotics.



Ethinyl Estradiol; Ethynodiol Diacetate: Moderate It would be prudent to recommend alternative or additional contraception when oral contraceptives OCs are used in conjunction with antibiotics. Ethinyl Estradiol; Etonogestrel: Moderate It would be prudent to recommend alternative or additional contraception when oral contraceptives OCs are used in conjunction with antibiotics.

Ethinyl Estradiol; Levonorgestrel: Moderate It would be prudent to recommend alternative or additional contraception when oral contraceptives OCs are used in conjunction with antibiotics. Ethinyl Estradiol; Levonorgestrel; Ferrous bisglycinate: Moderate It would be prudent to recommend alternative or additional contraception when oral contraceptives OCs are used in conjunction with antibiotics.

Ethinyl Estradiol; Levonorgestrel; Folic Acid; Levomefolate: Moderate It would be prudent to recommend alternative or additional contraception when oral contraceptives OCs are used in conjunction with antibiotics. Ethinyl Estradiol; Norelgestromin: Moderate It would be prudent to recommend alternative or additional contraception when oral contraceptives OCs are used in conjunction with antibiotics. Ethinyl Estradiol; Norethindrone Acetate: Moderate It would be prudent to recommend alternative or additional contraception when oral contraceptives OCs are used in conjunction with antibiotics.

Ethinyl Estradiol; Norethindrone Acetate; Ferrous fumarate: Moderate It would be prudent to recommend alternative or additional contraception when oral contraceptives OCs are used in conjunction with antibiotics. Ethinyl Estradiol; Norethindrone: Moderate It would be prudent to recommend alternative or additional contraception when oral contraceptives OCs are used in conjunction with antibiotics.

Ethinyl Estradiol; Norethindrone; Ferrous fumarate: Moderate It would be prudent to recommend alternative or additional contraception when oral contraceptives OCs are used in conjunction with antibiotics. Ethinyl Estradiol; Norgestimate: Moderate It would be prudent to recommend alternative or additional contraception when oral contraceptives OCs are used in conjunction with antibiotics. Ethinyl Estradiol; Norgestrel: Moderate It would be prudent to recommend alternative or additional contraception when oral contraceptives OCs are used in conjunction with antibiotics.

Ezogabine: Moderate Consider the risk of QT prolongation which can be fatal when administering azithromycin to patients on other QT prolonging agents such as ezogabine. Ezogabine has been associated with QT prolongation. Fingolimod: Moderate Cautious use of fingolimod with azithromycin is advised, as azithromycin has been associated with post-marketing reports of QT prolongation and torsade de pointes TdP. Fingolimod initiation results in decreased heart rate and may prolong the QT interval.

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After the first fingolimod dose, overnight monitoring with continuous ECG in a medical facility is advised for patients taking QT prolonging drugs with a known risk of TdP. Fingolimod has not been studied in patients treated with drugs that prolong the QT interval, but drugs that prolong the QT interval have been associated with cases of TdP in patients with bradycardia. Flecainide: Moderate Cautious use of flecainide with azithromycin is advised, as azithromycin has been associated with post-marketing reports of QT prolongation and torsade de pointes TdP.

Although causality for TdP has not been established for flecainide, patients receiving concurrent drugs which have the potential for QT prolongation, such as azithromycin, may have an increased risk of developing proarrhythmias. Fluconazole: Moderate Due to an increased risk for QT prolongation and torsade de pointes TdP , caution is advised when administering fluconazole with azithromycin. Fluconazole has been associated with QT prolongation and rare cases of TdP.

An open-label, randomized, three-way crossover study evaluated mg fluconazole and a single mg oral dose of azithromycin. There was no significant pharmacokinetic interaction between the two agents. Fluoxetine: Moderate Use fluoxetine with caution in combination with azithromycin. Coadministration may increase the risk for QT prolongation and torsade de pointes TdP.

QT prolongation and TdP have been reported in patients treated with fluoxetine. Azithromycin has also been associated with postmarketing reports of QT prolongation and TdP. Fluoxetine; Olanzapine: Moderate Due to an increased risk for QT prolongation and torsade de pointes TdP , caution is advised when administering olanzapine with azithromycin.

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Limited data, including some case reports, suggest that olanzapine may be associated with a significant prolongation of the QTc interval. During postmarketing use, azithromycin has also been associated with case reports of QT prolongation and TdP. Moderate Use fluoxetine with caution in combination with azithromycin. Fluphenazine: Minor Due to a possible risk for QT prolongation and torsade de pointes TdP , azithromycin and fluphenazine should be used together cautiously.

Fluphenazine is associated with a possible risk for QT prolongation. Theoretically, fluphenazine may increase the risk of QT prolongation if coadministered with other drugs that have a risk of QT prolongation. Fluticasone; Salmeterol: Moderate Due to a possible risk for QT prolongation and torsade de pointes TdP , azithromycin and long-acting beta-agonists should be used together cautiously. Fluticasone; Umeclidinium; Vilanterol: Moderate Due to a possible risk for QT prolongation and torsade de pointes TdP , azithromycin and long-acting beta-agonists should be used together cautiously.

Fluticasone; Vilanterol: Moderate Due to a possible risk for QT prolongation and torsade de pointes TdP , azithromycin and long-acting beta-agonists should be used together cautiously. Fluvoxamine: Moderate Use fluvoxamine with caution in combination with azithromycin. QT prolongation and torsade de pointes TdP have been reported during post-marketing use in both azithromycin and fluvoxamine. Food: Moderate The effect of food on the oral bioavailability of azithromycin is variable depending on the specific azithromycin dosage form. Therefore, azithromycin capsules should be administered 1 hour before or 2 hours after meals.

Therefore, azithromycin tablets can be taken with or without food. Because peak azithromycin serum concentrations are increased substantially when the suspension is taken with food, the suspension should be taken on an empty stomach. Formoterol: Moderate Due to a possible risk for QT prolongation and torsade de pointes TdP , azithromycin and long-acting beta-agonists should be used together cautiously.