November 2004 Cover
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The antibiotic erythromycin dramatically increases the risk of cardiac arrest, especially when it is taken with certain newer drugs, including protease inhibitors.
Because of some reports of patient deaths, cardiologists have known that erythromycin alone carried a slight risk, mostly for those who took it intravenously. The risk of cardiac death was more than five times higher in patients who took erythromycin with other drugs
that increase its concentration in the blood.
The new study is the first to systematically document that risk. It focused on erythromycin pills, which are usually sold as generics, together with certain treatments for infection, and calcium channel blockers for high blood pressure.
The danger seems to arise from the other drugs slowing erythromycin's breakdown. This increases its concentration, trapping salt inside resting heart muscles cells, delaying the time until the next heartbeat starts, and sometimes triggering an abnormal and potentially
fatal heart rhythm.
In addition to protease inhibitors, the blood pressure drugs verapamil (Verelan, Isoptin) and diltiazem (Cardizem, Tiazac) pose a risk with erythromycin, along with the antibiotic clarithromycin (Biaxin), fluconazole (Diflucan), ketoconazole (Nizoral), and itraconazole
(Sporanox). Taking erythromycin with grapefruit juice should also be avoided because it can boost blood levels of the antibiotic.
Editor's Note: from the New england Journal of Medicine
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