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Pimozide and Zithromax IV

Determining the interaction of Pimozide and Zithromax IV and the possibility of their joint administration.

Check result:

Pimozide <> Zithromax IV

Relevance: 02.09.2022 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 and pimozide is not recommended. Taking these drugs together can affect the rhythm of your heart. Call your doctor if you have symptoms of irregular heartbeat, chest tightness, blurred vision or nausea. 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:

CONTRAINDICATED: Coadministration with the ketolide, telithromycin, as well as certain macrolide antibiotics may increase the plasma concentrations of pimozide. The mechanism is inhibition of pimozide metabolism via CYP450 3A4. High plasma levels of pimozide have been associated with prolongation of the QT interval on the ECG; ventricular arrhythmias including ventricular tachycardia, ventricular fibrillation, and torsade de pointes; cardiac arrest; and sudden death. Macrolides that may significantly inhibit CYP450 3A4 include clarithromycin, erythromycin, and troleandomycin. In a study involving 12 healthy subjects, clarithromycin (500 mg orally every 12 hours for 5 days) increased the mean peak plasma concentration (Cmax) and area under the concentration-time curve (AUC) of pimozide (6 mg single oral dose) by 39% and 113%, respectively, compared to placebo. These alterations corresponded with significant prolongations of the maximum QTc interval that exceeded those produced by pimozide alone. Isolated cases of sudden death have been reported following addition of clarithromycin to ongoing pimozide therapy.

MANAGEMENT: The use of pimozide with telithromycin or macrolide antibiotics is considered contraindicated by the manufacturers, although azithromycin and dirithromycin are generally believed to have little, if any, effect on CYP450 3A4.

References

European Agency for the Evaluation of Medicinal Products. Committee for Proprietary Medicinal Products "European Public Assessment Report Ketek (telithromycin) (Rev. 2) Available from: URL: http:www.emea.eu.int/humandocs/Humans/EPAR/Ketek/Ketek.htm." ([2001]):
Desta Z, Soukhova N, Flockhart DA "In Vitro Inhibition of Pimozide N-Dealkylation by Selective Serotonin Reuptake Inhibitors and Azithromycin." J Clin Psychopharmacol 22 (2002): 162-168
Krahenbuhl S, Sauter B, Kupferschmidt H, Krause M, Wyss PA, Meier PJ "Case report: reversible QT prolongation with torsades de pointes in a patient with pimozide intoxication." Am J Med Sci 309 (1995): 315-6
"Product Information. Orap Tablets (pimozide)." Gate Pharmaceuticals, Sellersville, PA.
"Product Information. Ketek (telithromycin)." Aventis Pharmaceuticals, Bridgewater, NJ.
Flockhart DA, Drici MD, Kerbusch T, et al "Studies on the mechanism of a fatal clarithromycin-pimozide interaction in a patient with tourette syndrome." J Clin Psychopharmacol 20 (2000): 317-24
Desta Z, Kerbusch T, Flockhart DA "Effect of clarithromycin on the pharmacokinetics and pharmacodynamics of pimozide in healthy poor and extensive metabolizers of cytochrome P450 2D6 (CYP2D6)." Clin Pharmacol Ther 65 (1999): 10-20
Amsden GW "Macrolides versus azalides: a drug interaction update." Ann Pharmacother 29 (1995): 906-17

Pimozide

Generic Name: pimozide

Brand name: Orap

Synonyms: n.a.

What is Pimozide?

Zithromax IV

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

What is Zithromax IV?

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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.

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