Azithromycin, which is taken three times and stopped four times, may be fatal when used in combination with these drugs

An elderly friend told Huazi that he had a cold and cough a while ago, so he took azithromycin and compound licorice tablets. As a result, he felt very uncomfortable in his heart, but his heart returned to normal after he stopped taking the medicine. Was it an adverse reaction to the medicine?

Huazi asked him if he had high blood pressure and was taking diuretics. He said that among the drugs he was taking was hydrochlorothiazide. Huazi said that his medications had accidentally mixed poisons, and it was fortunate that he stopped taking them in time, otherwise it could have been fatal.

1. Azithromycin: “Take three, stop four”

Azithromycin is a commonly used broad-spectrum antibiotic that can be used by both adults and children. Since the plasma half-life of azithromycin is very long, up to 48 hours, the most common use of azithromycin is to stop taking it after 3 consecutive days , and it can still maintain an effective therapeutic concentration within the next 4 days.

Because of its short medication cycle and high compliance, many people use azithromycin as a standing medicine at home. But in fact, all antibiotics are prescription drugs and require a doctor's prescription to use . However, pharmacies in many places are not strictly regulated, and antibiotics including azithromycin can be purchased at will, which not only causes the abuse of antibiotics, but also increases the risk of medication.

2. “Fatal Mix” with Other Drugs

1. Beware of hypokalemia when using with compound licorice tablets

Respiratory tract infections are often accompanied by coughing symptoms. If azithromycin is used together with compound licorice tablets, beware of hypokalemia . Because glycyrrhizin has a hormone-like effect, it will increase the excretion of potassium ions. It may cause hypokalemia and induce arrhythmia.

Azithromycin may cause adverse reactions such as QT interval prolongation, ventricular fibrillation, and torsades de pointes, which may further aggravate the symptoms of hypokalemia and even lead to malignant arrhythmias, posing a fatal risk.

Diuretics in antihypertensive drugs, such as hydrochlorothiazide and indapamide, can also increase the excretion of potassium ions and easily cause hypokalemia. Therefore, if the hypokalemia state is not corrected, it is not recommended to be used in combination with azithromycin .

2. Beware of liver damage when using with statins

Statins are basic drugs for cardiovascular and cerebrovascular diseases, among which simvastatin, lovastatin, and atorvastatin need to be metabolized by the liver enzyme CYP3A4. Azithromycin can inhibit the activity of CYP3A4 enzyme, which will cause the accumulation of statins , and may cause liver damage and rhabdomyolysis.

Therefore, when using the above three statins and the traditional Chinese medicine Xuezhikang (containing lovastatin), you should try to avoid taking azithromycin. If you must take it, you should reduce the dosage of the statin or switch to other statins to reduce the risk of medication.

3. Concomitant medications that may cause arrhythmia

Taking antipsychotics, antidepressants, fluoroquinolones (floxacin-type drugs), antiarrhythmic drugs and other drugs that cause QT interval prolongation together with azithromycin may aggravate adverse reactions and cause arrhythmias.

4. Combination drugs that may cause poisoning

Azithromycin can interfere with the metabolism of warfarin, aminophylline, cyclosporine, carbamazepine, terfenadine, phenytoin sodium and other drugs, increase blood drug concentrations, and may cause toxic reactions.

Digoxin is inactivated by intestinal flora, and azithromycin eliminates intestinal flora, leading to increased digoxin absorption and toxic reactions.

To sum up, azithromycin is a commonly used broad-spectrum antibiotic. Because of its long half-life, "take three days and stop four days" is the most commonly used medication regimen. Do not increase the dosage or extend the medication time at will.

Azithromycin can cause adverse reactions such as QT prolongation and torsade de pointes. It is also an inhibitor of the liver enzyme CYP3A4 and can interact with a variety of drugs. For elderly people with underlying diseases, it is more likely to cause adverse reactions. For safety, do not take medication on your own. Drugs must be used under the guidance of a doctor. If you have any questions about medication, consult a doctor or pharmacist. I am pharmacist Huazi. Welcome to follow me and share more health knowledge.