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Dihydroergotamine and Zithromax Injection

Determining the interaction of Dihydroergotamine and Zithromax Injection and the possibility of their joint administration.

Check result:
Dihydroergotamine <> Zithromax Injection
Relevance: 18.10.2023 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:

Medications like azithromycin have been found to increase the blood levels and effects of dihydroergotamine, leading to excessive narrowing of blood vessels in the body. This can reduce blood flow to vital organs and increase the risk of serious side effects such as high blood pressure, heart attack, stroke, and gangrene (death of tissues, usually in the arm or leg, that may require surgical amputation). It is not known if azithromycin will interact with dihydroergotamine in a similar way. You should seek immediate medical attention if you experience severe abdominal pain, nausea, vomiting, numbness or tingling, muscle pain or weakness, blue or purple discoloration of fingers or toes, pale or cold skin, chest pain or tightness, irregular heartbeat, severe headache, shortness of breath, blurred vision, confusion, and/or slurred speech during treatment with dihydroergotamine. Do not take larger doses or use the drug more frequently than prescribed. 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 significantly increase the plasma concentrations of ergot derivatives. The mechanism is macrolide inhibition of CYP450 3A4, the isoenzyme responsible for the metabolic clearance of ergotamine and related drugs. Macrolides that may significantly inhibit CYP450 3A4 include clarithromycin, erythromycin and troleandomycin, and clinical ergotism has been reported in patients receiving ergotamine or dihydroergotamine with these agents. Azithromycin is generally believed to have little, if any, effect on CYP450 3A4. No interaction with ergot derivatives has been reported in clinical trials with azithromycin; however, no specific drug interaction studies have been performed.

MANAGEMENT: Until more information is available, caution may be advisable when ergot alkaloids are prescribed in combination with azithromycin. Patients should be monitored for potential ergot toxicity including peripheral vasospasm, ischemia, thrombosis, tachycardia, and hypertension. Patients should be advised to notify their physician if they experience potential signs and symptoms of ergotism such as paraesthesia, cyanosis, cold or painful extremities, muscle pain or weakness, abdominal pain, irregular heartbeat, and chest pain or tightness.

References
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  • Horowitz RS, Dart RC, Gomez HF "Clinical ergotism with lingual ischemia induced by clarithromycin-ergotamine interaction." Arch Intern Med 156 (1996): 456-8
  • Ghali R, De Lean J, Douville Y, Noel HP, Labbe R "Erythromycin-associated ergotamine intoxication: arteriographic and electrophysiologic analysis of a rare cause of severe ischemia of the lower extremities and associated ischemic neuropathy." Ann Vasc Surg 7 (1993): 291-6
  • Leroy F, Asseman P, Pruvost P, Adnet P, Lacroix D, Thery C "Dihydroergotamine-erythromycin-induced ergotism." Ann Intern Med 109 (1988): 249
  • "Product Information. D.H.E. 45 (dihydroergotamine)." Sandoz Pharmaceuticals Corporation, East Hanover, NJ.
  • "Product Information. Cafergot (caffeine-ergotamine)." Novartis Pharmaceuticals, East Hanover, NJ.
  • Hayton AC "Precipitation of acute ergotism by triacetyloleandomycin." N Z Med J 69 (1969): 42
  • Ausband SC, Goodman PE "An unusual case of clarithromycin associated ergotism." J Emerg Med 4 (2001): 411-3
  • "Product Information. Migranal (dihydroergotamine nasal)." Novartis Pharmaceuticals, East Hanover, NJ.
  • Nakatsuka A, Nagai M, Yabe H, et al. "Effect of clarithromycin on the pharmacokinetics of cabergoline in healthy controls and in patients with Parkinson's disease." J Pharmacol Sci 100 (2006): 59-64
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  • Eadie MJ "Clinically significant drug interactions with agents specific for migraine attacks." Cns Drugs 15 (2001): 105-18
Dihydroergotamine

Generic Name: dihydroergotamine

Brand name: DHE. 45, Migranal

Synonyms: Dihydroergotamine (injection)

Zithromax Injection

Generic Name: azithromycin

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

Synonyms: Azithromycin, Azithromycin (Systemic)

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.

Interaction with food and lifestyle