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Aminophylline Intravenous and Zithromax (Azithromycin Oral Suspension)

Determining the interaction of Aminophylline Intravenous and Zithromax (Azithromycin Oral Suspension) and the possibility of their joint administration.

Check result:
Aminophylline Intravenous <> Zithromax (Azithromycin Oral Suspension)
Relevance: 24.09.2022 Reviewer: Shkutko P.M., M.D., in

In the database of official manuals used in the service creation an interaction registered by statistical results of studies was found, which can either lead to negative consequences for the patient health or strengthen a mutual positive effect. A doctor should be consulted to address the issue of joint drug administration.

Consumer:

Using azithromycin together with aminophylline may increase the effects of aminophylline. You should contact your doctor if you experience nausea, vomiting, diarrhea, headache, restlessness, insomnia, seizures, or an irregular heartbeat. You may need a dose adjustment or special test to safely use both medications. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Professional:

MONITOR: Coadministration with certain macrolide antibiotics may increase the serum concentrations of theophylline, which may result in toxicity. In one case report, a pediatric patient developed seizures in association with theophylline toxicity shortly after the addition of erythromycin. The proposed mechanism is macrolide inhibition of CYP450 3A4, the isoenzyme partially responsible for the metabolic clearance of theophylline. Data from pharmacokinetic studies suggest that the magnitude of the interaction is generally greatest with troleandomycin, followed by erythromycin. The interaction with clarithromycin appears to be mild and inconsistent. Azithromycin and dirithromycin are generally believed to have little, if any, effect on CYP450 3A4, and most studies have not found a significant effect on the pharmacokinetics of theophylline. However, a case report describes an unusual interaction with azithromycin in an elderly patient whereby reduced serum theophylline levels were repeatedly observed after the discontinuation of azithromycin. The changes were transient and did not require an adjustment in the theophylline dosage. Theophylline has been reported to decrease plasma concentrations of erythromycin by increasing its renal clearance.

MANAGEMENT: Pharmacologic response and serum theophylline levels should be monitored more closely whenever a macrolide antibiotic is added to or withdrawn from therapy, and the methylxanthine dosage adjusted as necessary. For patients with theophylline levels at the upper end of the therapeutic range (15 to 20 mcg/mL), some clinicians suggest an initial reduction of the methylxanthine dosage by 25% when given with erythromycin and 50% with troleandomycin. Patients should be advised to contact their physician if they experience signs and symptoms of theophylline toxicity such as nausea, vomiting, diarrhea, headache, restlessness, insomnia, or irregular heartbeat.

References
  • Amsden GW "Macrolides versus azalides: a drug interaction update." Ann Pharmacother 29 (1995): 906-17
  • Upton RA "Pharmacokinetic interactions between theophylline and other medication (Part I)." Clin Pharmacokinet 20 (1991): 66-80
  • Ludden TM "Pharmacokinetic interactions of the macrolide antibiotics." Clin Pharmacokinet 10 (1985): 63-79
  • Reisz G, Pingleton SK, Melethil S, Ryan PB "The effect of erythromycin on theophylline pharmacokinetics in chronic bronchitis." Am Rev Respir Dis 127 (1983): 581-4
  • Jonkman JH, Upton RA "Pharmacokinetic drug interactions with theophylline." Clin Pharmacokinet 9 (1984): 309-34
  • Hildebrandt R, Moller H, Gundert-Remy U "Influence of theophylline on the renal clearance of erythromycin." Int J Clin Pharmacol Ther Toxicol 25 (1987): 601-4
  • Gillum JG, Israel DS, Scott RB, Climo MW, Polk RE "Effect of combination therapy with ciprofloxacin and clarithromycin on theophylline pharmacokinetics in healthy volunteers." Antimicrob Agents Chemother 40 (1996): 1715-6
  • Amsden GW "Erythromycin, clarithromycin, and azithromycin: are the differences real?" Clin Ther 18 (1996): 56-72
  • Richer C, Mathieu M, Bah H, Thuillez C, Duroux P, Giudicelli JF "Theophylline kinetics and ventilatory flow in bronchial asthma and chronic airflow obstruction: influence of erythromycin." Clin Pharmacol Ther 31 (1982): 579-86
  • Peters DH, Friedel HA, McTavish D "Azithromycin: a review of its antimicrobial activity, pharmacokinetic properties and clinical efficacy." Drugs 44 (1992): 750-99
  • Bachmann K, Jauregui L, Sides G, Sullivan TJ "Steady-state pharmacokinetics of theophylline in COPD patients treated with dirithromycin." J Clin Pharmacol 33 (1993): 861-5
  • Prince RA, Wing DS, Weinberger MM, et al "Effect of erythromycin on theophylline kinetics." J Allergy Clin Immunol 68 (1981): 427-31
  • Iliopoulou A, Aldhous ME, Johnston A, Turner P "Pharmacokinetic interaction between theophylline and erythromycin." Br J Clin Pharmacol 14 (1982): 495-9
  • Nahata M "Drug interactions with azithromycin and the macrolides: an overview." J Antimicrob Chemother 37 Suppl C (1996): 133-42
  • Tenenbein M "Theophylline toxicity due to drug interaction." J Emerg Med 7 (1989): 249-51
  • Principi N, Esposito S "Comparative tolerability of erythromycin and newer macrolide antibacterials in paediatric: Patients." Drug Safety 20 (1999): 25-41
  • Descotes J, Andre P, Evreux JC "Pharmacokinetic drug interactions with macrolide antibiotics." J Antimicrob Chemother 15 (1985): 659-64
  • Kozak PP, Cummins LH, Gillman SH "Administration of erythromycin to patients on theophylline." J Allergy Clin Immunol 60 (1977): 149-51
  • Zarowitz BJ, Szefler SJ, Lasezkay GM "Effect of erythromycin base on theophylline kinetics." Clin Pharmacol Ther 29 (1981): 601-5
  • Bachmann K, Nunlee M, Martin M, et al "Changes in the steady-state pharmacokinetics of theophylline during treatment with dirithromycin." J Clin Pharmacol 30 (1990): 1001-5
  • Pollak PT, Slayter KL "Reduced serum theophylline concentrations after discontinuation of azithromycin: evidence for an unusual interaction." Pharmacotherapy 17 (1997): 827-9
  • Rockwood RP, Embardo LS "Theophylline, ciprofloxacin, erythromycin: a potentially harmful regimen." Ann Pharmacother 27 (1993): 651-2
  • Wiggins J, Arbab O, Ayres JG, Skinner C "Elevated serum theophylline concentration following cessation of erythromycin treatment." Eur J Respir Dis 68 (1986): 298-300
  • Paulsen O, Hoglund P, Nilsson LG, Bengtsson HI "The interaction of erythromycin with theophylline." Eur J Clin Pharmacol 32 (1987): 493-8
  • Kamada AK, Hill MR, Brenner AM, Szefler SJ "Effect of low-dose troleandomycin on theophylline clearance: implications for therapeutic drug monitoring." Pharmacotherapy 12 (1992): 98-102
  • von Rosenstiel NA, Adam D "Macrolide antibacterials. Drug interactions of clinical significance." Drug Saf 13 (1995): 105-22
  • Parish RA, Haulman NJ, Burns RM "Interaction of theophylline with erythromycin base in a patient with seizure activity." Pediatrics 72 (1983): 828-30
  • Branigan TA, Robbins RA, Cady WJ, et al "The effects of erythromycin on the absorption and disposition kinetics of theophylline." Eur J Clin Pharmacol 21 (1981): 115-20
  • Renton KW, Gray JD, Hung OR "Depression of theophylline elimination by erythromycin." Clin Pharmacol Ther 30 (1981): 422-6
  • May DC, Jarboe CH, Ellenburg DT, et al "The effects of erythromycin on theophylline elimination in normal males." J Clin Pharmacol 22 (1982): 125-30
  • Pfeifer HJ, Greenblatt DJ, Friedman P "Effects of three antibiotics on theophylline kinetics." Clin Pharmacol Ther 26 (1979): 36-40
  • Maddux MS, Leeds NH, Organek HW, Hasegawa GR, Bauman JL "The effect of erythromycin on theophylline pharmacokinetics at steady state." Chest 81 (1982): 563-5
Aminophylline Intravenous

Generic Name: aminophylline

Brand name: Phyllocontin, Truphylline

Synonyms: Aminophylline (Intravenous)

Zithromax (Azithromycin Oral Suspension)

Generic Name: azithromycin

Brand name: Zithromax, Zmax, AzaSite, Azithromycin 3 Day Dose Pack, Azithromycin 5 Day Dose Pack, Zithromax Tri-Pak, Zithromax Z-Pak, Zithromax IV

Synonyms: Zithromax

In the course of checking the drug compatibility and interactions, data from the following reference sources was used: Drugs.com, Rxlist.com, Webmd.com, Medscape.com.