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Related Experiment Videos

Potentially fatal interaction between azithromycin and disopyramide.

E V Granowitz1, K J Tabor, J B Kirchhoffer

  • 1Department of Medicine, Baystate Medical Center, Springfield, Massachusetts 01199, USA. eric.granowitz@bhs.org

Pacing and Clinical Electrophysiology : PACE
|October 12, 2000
PubMed
Summary

Concurrent use of azithromycin with disopyramide can lead to dangerous disopyramide toxicity. This drug interaction, evidenced by elevated disopyramide levels and ventricular tachycardia, necessitates careful monitoring or avoidance of azithromycin in patients on disopyramide.

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Area of Science:

  • Clinical Pharmacology
  • Drug Interactions
  • Cardiology

Background:

  • Disopyramide is an antiarrhythmic medication used to treat irregular heart rhythms.
  • Azithromycin is a commonly prescribed macrolide antibiotic.
  • Drug metabolism pathways can be significantly altered by concurrent medication use.

Observation:

  • A case study identified a patient experiencing disopyramide toxicity during co-administration with azithromycin.
  • Clinical manifestations included elevated serum disopyramide concentrations and hemodynamically unstable ventricular tachycardia requiring cardioversion.

Findings:

  • Azithromycin, an azalide antibiotic, is presumed to inhibit the hepatic dealkylation of disopyramide.
  • This inhibition leads to reduced metabolism of disopyramide to its primary metabolite, mono-N-dealkyldisopyramide.

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  • The accumulation of active disopyramide likely precipitated the observed toxicity.

    • Implications:

    • Clinicians should exercise caution and consider avoiding the concurrent prescription of azithromycin in patients treated with disopyramide.
    • If the combination is clinically necessary, therapeutic drug monitoring of serum disopyramide levels is crucial.
    • This case highlights the importance of understanding drug-drug interactions affecting drug metabolism and patient safety.