erythromycin lactobionate (Rx)

General Dosing Recommendations

15-20 mg/kg/day IV divided q6hr; infuse IV over 1 hr  

Up to 4 g/day may be administered for severe infections

Geriatric: Increased risk for hearing loss in elderly patients with 4 g/day or more

Acute Pelvic Inflammatory Disease

500 mg IV q6hr for 3 days; follow by 500 mg PO q12hr

Legionaire Disease

1-4 g IV in divided doses

Streptococcal Infections

250 mg PO q12hr

Renal Impairment

CrCl <10 mL/min: Administer 50-75% of usual dose

Other Indications & Uses

Group A beta-hemolytic strep, Actinobacillus actinomycetemcomitans, Actinomyces israelii, Actinomyces naeslundii, Actinomyces odontolyticus, Afipia felis, Arachnia propionica, Arcanobacterium (Corynebacterium) haemolyticum, Bacillus anthracis, Bartonella henselae, Bartonella quintana, Bordetella pertussis, Borrelia burgdorferi, Borrelia recurrentis, C. diphtheriae, C. trachomatis, Klebsiella granulomatis, Campylobacter jejuni, Capnocytophaga ochracea, Chlamydia pneumonia (TWAR agent), Chlamydia psittaci, Chlamydia trachomatis, Chryseobacterium meningosepticum, Corynebacterium jeikeium (CDC group JK), Corynebacterium minutissimum, Corynebacterium ulcerans, Coxiella burnetii, E. histolytica, Erysipelothrix rhusiopathiae, H. ducreyi, H. influenzae, Kingella sp., Lactobacillus sp, Legionella pneumophilia, Leptospira interrogans, Leptotrichia buccalis, Leuconostoc species, Listeria, Mycobacterium chelonae, Mycobacterium fortuitum, M. catarrhalis, Mycoplasma pneumoniae, N. gonorrhoeae, Rhodococcus equi, S. aureus, S. pyogenes (group A beta-hemolytic streptococci), S. pneumoniae, Spirillum minus, Streptobacillus moniliformis, Streptococcus (Group C, G), Streptococcus agalactiae (Group B), Streptococcus bovis (Group D), Streptococcus intermedius group (S. anginosus, S intermedius, S. constellatus), Streptococcus pneumoniae (PCN sensitive, MIC <0.1 mcg/mL), Streptococcus pyogenes (Group A), Treponema pallidum, U. urealyticum, Ureaplasma urealyticum, Vibrio cholerae, Viridans streptococci

Off-label: Campylobacter jejuni, Calymmatobacterium granulomatis, Haemophilus ducreyi, prophylaxis in colorectal surgery, anthrax, tetanus, Lyme disease

First line: Afipia felis, Arcanobacterium (Corynebacterium) haemolyticum, Bartonella henselae, Bartonella quintana, Campylobacter jejuni, Capnocytophaga ochracea, Chlamydia pneumonia, Corynebacterium minutissimum, Corynebacterium ulcerans, Haemophilus ducreyi, Mycobacterium fortuitum, Ureaplasma urealyticum (others eg, Haemophilus ducreyi not unanimous)

Usual Dosage Range, Infants & Children

15-20 mg/kg/day IV divided q6hr; infuse IV over 1 hr  

Higher doses may be administered for severe infection; not to exceed 4 g/day

Renal Impairment

CrCl <10 mL/min: Administer 50-75% of usual dose

Contraindicated (21)

• arsenic trioxide

  arsenic trioxide and erythromycin lactobionate both increase QTc interval. Contraindicated.

• dihydroergotamine

  erythromycin lactobionate will increase the level or effect of dihydroergotamine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.

• dihydroergotamine intranasal

  erythromycin lactobionate will increase the level or effect of dihydroergotamine intranasal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.

• disopyramide

  disopyramide and erythromycin lactobionate both increase QTc interval. Contraindicated.

• elagolix

  erythromycin lactobionate will increase the level or effect of elagolix by Other (see comment). Contraindicated. Concomitant use of elagolix and strong OATP1B1 inhibitors is contraindicated.

• fezolinetant

  erythromycin lactobionate will increase the level or effect of fezolinetant by affecting hepatic enzyme CYP1A2 metabolism. Contraindicated. Fezolinetant AUC and peak plasma concentration are increased if coadministered with drugs that are weak, moderate, or strong CYP1A2 inhibitors

• flibanserin

  erythromycin lactobionate will increase the level or effect of flibanserin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated. Coadministration of flibanserin with moderate or strong CYP3A4 inhibitors is contraindicated. Severe hypotension or syncope can occur.

• fluconazole

  erythromycin lactobionate and fluconazole both increase QTc interval. Contraindicated.
  
  fluconazole will increase the level or effect of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.

• ibutilide

  erythromycin lactobionate and ibutilide both increase QTc interval. Contraindicated.

• indapamide

  erythromycin lactobionate and indapamide both increase QTc interval. Contraindicated.

• lefamulin

  lefamulin will increase the level or effect of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated. Lefamulin is contraindicated with CYP3A substrates know to prolong the QT interval.

• lomitapide

  erythromycin lactobionate increases levels of lomitapide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated. Increases lomitapide levels several folds.

• lonafarnib

  erythromycin lactobionate will increase the level or effect of lonafarnib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated. Lonafarnib is a sensitive CYP3A4 substrate. Coadministration with strong or moderate CYP3A4 inhibitors is contraindicated.

• lovastatin

  erythromycin lactobionate will increase the level or effect of lovastatin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated. Strong CYP3A4 inhibitors increase systemic statin exposure and risk of myopathy, including rhabdomyolysis

• pentamidine

  erythromycin lactobionate and pentamidine both increase QTc interval. Contraindicated.

• pimozide

  erythromycin lactobionate and pimozide both increase QTc interval. Contraindicated.
  
  erythromycin lactobionate increases levels of pimozide by decreasing metabolism. Contraindicated. Risk of QT interval prolongation.

• procainamide

  erythromycin lactobionate and procainamide both increase QTc interval. Contraindicated.

• quinidine

  quinidine and erythromycin lactobionate both increase QTc interval. Contraindicated.

• saquinavir

  saquinavir will increase the level or effect of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.

• simvastatin

  erythromycin lactobionate will increase the level or effect of simvastatin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated. Increased risk for rhabdomyolysis with drugs that increase simvastatin systemic exposure
  
  erythromycin lactobionate increases toxicity of simvastatin by Other (see comment). Contraindicated. Comment: OATP1B1 inhibitors may increase risk of myopathy.

• sotalol

  erythromycin lactobionate and sotalol both increase QTc interval. Contraindicated.

Serious - Use Alternative (287)

• abametapir

  abametapir will increase the level or effect of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. For 2 weeks after abametapir application, avoid taking drugs that are CYP3A4 substrates. If not feasible, avoid use of abametapir.

• adagrasib

  adagrasib, erythromycin lactobionate. Either increases effects of the other by QTc interval. Avoid or Use Alternate Drug. Each drug prolongs the QTc interval, which may increased the risk of Torsade de pointes, other serious arryhthmias, and sudden death. If coadministration unavoidable, more frequent monitoring is recommended for such patients.

• afatinib

  erythromycin lactobionate increases levels of afatinib by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug. Reduce afatinib daily dose by 10 mg if not tolerated when coadministered with P-gp inhibitors.

• alfuzosin

  alfuzosin and erythromycin lactobionate both increase QTc interval. Avoid or Use Alternate Drug.

• almotriptan

  erythromycin lactobionate will increase the level or effect of almotriptan by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• alosetron

  erythromycin lactobionate will increase the level or effect of alosetron by affecting hepatic enzyme CYP1A2 metabolism. Avoid or Use Alternate Drug.

• alprazolam

  erythromycin lactobionate will increase the level or effect of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• amiodarone

  erythromycin lactobionate will increase the level or effect of amiodarone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
  
  amiodarone and erythromycin lactobionate both increase QTc interval. Avoid or Use Alternate Drug.

• amisulpride

  amisulpride and erythromycin lactobionate both increase QTc interval. Avoid or Use Alternate Drug. ECG monitoring is recommended if coadministered.

• amitriptyline

  erythromycin lactobionate will increase the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
  
  erythromycin lactobionate will increase the level or effect of amitriptyline by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug.
  
  amitriptyline and erythromycin lactobionate both increase QTc interval. Avoid or Use Alternate Drug.

• amobarbital

  amobarbital will decrease the level or effect of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• amoxapine

  amoxapine and erythromycin lactobionate both increase QTc interval. Avoid or Use Alternate Drug.

• anagrelide

  anagrelide and erythromycin lactobionate both increase QTc interval. Avoid or Use Alternate Drug.

• antithrombin alfa

  erythromycin lactobionate increases effects of antithrombin alfa by decreasing metabolism. Avoid or Use Alternate Drug.

• antithrombin III

  erythromycin lactobionate increases effects of antithrombin III by decreasing metabolism. Avoid or Use Alternate Drug.

• apalutamide

  apalutamide will decrease the level or effect of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Coadministration of apalutamide, a strong CYP3A4 inducer, with drugs that are CYP3A4 substrates can result in lower exposure to these medications. Avoid or substitute another drug for these medications when possible. Evaluate for loss of therapeutic effect if medication must be coadministered. Adjust dose according to prescribing information if needed.

• aprepitant

  erythromycin lactobionate will increase the level or effect of aprepitant by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
  
  aprepitant will increase the level or effect of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.

• argatroban

  erythromycin lactobionate increases effects of argatroban by decreasing metabolism. Avoid or Use Alternate Drug.

• aripiprazole

  erythromycin lactobionate will increase the level or effect of aripiprazole by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• armodafinil

  armodafinil will decrease the level or effect of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• artemether

  artemether and erythromycin lactobionate both increase QTc interval. Avoid or Use Alternate Drug.

• artemether/lumefantrine

  artemether/lumefantrine will decrease the level or effect of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.
  
  erythromycin lactobionate will increase the level or effect of artemether/lumefantrine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
  
  erythromycin lactobionate and artemether/lumefantrine both increase QTc interval. Avoid or Use Alternate Drug.

• asenapine

  asenapine and erythromycin lactobionate both increase QTc interval. Avoid or Use Alternate Drug.

• asenapine transdermal

  asenapine transdermal and erythromycin lactobionate both increase QTc interval. Avoid or Use Alternate Drug.

• atazanavir

  atazanavir will increase the level or effect of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.

• atomoxetine

  atomoxetine and erythromycin lactobionate both increase QTc interval. Avoid or Use Alternate Drug.

• atorvastatin

  erythromycin lactobionate will increase the level or effect of atorvastatin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
  
  erythromycin lactobionate increases toxicity of atorvastatin by Other (see comment). Avoid or Use Alternate Drug. Comment: OATP1B1 inhibitors may increase risk of myopathy.

• avapritinib

  erythromycin lactobionate will increase the level or effect of avapritinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of avapritinib with moderate CYP3A4 inhibitors. If unable to avoid, reduce avapritinib starting dose. See drug monograph Dosage Modifications.

• axitinib

  erythromycin lactobionate increases levels of axitinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. If unable to avoid coadministration with moderate CYP3A4 inhibitors, monitor closely and reduce dose if necessary .

• bazedoxifene/conjugated estrogens

  erythromycin lactobionate will increase the level or effect of bazedoxifene/conjugated estrogens by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• BCG vaccine live

  erythromycin lactobionate decreases effects of BCG vaccine live by pharmacodynamic antagonism. Contraindicated. Wait until Abx Tx complete to administer live bacterial vaccine.

• bemiparin

  erythromycin lactobionate increases effects of bemiparin by decreasing metabolism. Avoid or Use Alternate Drug.

• bivalirudin

  erythromycin lactobionate increases effects of bivalirudin by decreasing metabolism. Avoid or Use Alternate Drug.

• bosentan

  bosentan will decrease the level or effect of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• bosutinib

  erythromycin lactobionate increases levels of bosutinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• budesonide

  erythromycin lactobionate will increase the level or effect of budesonide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
  
  budesonide will decrease the level or effect of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• buprenorphine

  buprenorphine and erythromycin lactobionate both increase QTc interval. Avoid or Use Alternate Drug.

• buprenorphine buccal

  buprenorphine buccal and erythromycin lactobionate both increase QTc interval. Avoid or Use Alternate Drug.

• buprenorphine subdermal implant

  buprenorphine subdermal implant and erythromycin lactobionate both increase QTc interval. Avoid or Use Alternate Drug.

• buprenorphine transdermal

  buprenorphine transdermal and erythromycin lactobionate both increase QTc interval. Avoid or Use Alternate Drug.

• buprenorphine, long-acting injection

  buprenorphine, long-acting injection and erythromycin lactobionate both increase QTc interval. Avoid or Use Alternate Drug.

• buspirone

  erythromycin lactobionate will increase the level or effect of buspirone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• butabarbital

  butabarbital will decrease the level or effect of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• butalbital

  butalbital will decrease the level or effect of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• carbamazepine

  erythromycin lactobionate will increase the level or effect of carbamazepine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Monitor plasma levels when used concomitantly
  
  carbamazepine will decrease the level or effect of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• ceritinib

  ceritinib and erythromycin lactobionate both increase QTc interval. Avoid or Use Alternate Drug.
  
  ceritinib will increase the level or effect of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• chlorpromazine

  chlorpromazine and erythromycin lactobionate both increase QTc interval. Avoid or Use Alternate Drug.

• cholera vaccine

  erythromycin lactobionate, cholera vaccine. pharmacodynamic antagonism. Avoid or Use Alternate Drug. Avoid coadministration of cholera vaccine with systemic antibiotics since these agents may be active against the vaccine strain. Do not administer cholera vaccine to patients who have received oral or parenteral antibiotics within 14 days prior to vaccination.

• cilostazol

  erythromycin lactobionate will increase the level or effect of cilostazol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Dose reduction to 50 mg twice daily should be considered

• cimetidine

  cimetidine will increase the level or effect of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• cinacalcet

  erythromycin lactobionate will increase the level or effect of cinacalcet by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• citalopram

  citalopram and erythromycin lactobionate both increase QTc interval. Avoid or Use Alternate Drug.

• clarithromycin

  clarithromycin will increase the level or effect of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
  
  clarithromycin and erythromycin lactobionate both increase QTc interval. Avoid or Use Alternate Drug.

• clomipramine

  erythromycin lactobionate will increase the level or effect of clomipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
  
  clomipramine and erythromycin lactobionate both increase QTc interval. Avoid or Use Alternate Drug.

• clopidogrel

  erythromycin lactobionate will decrease the level or effect of clopidogrel by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Inhibition of CYP3A4 will reduce clopidogrel bioactivation

• clozapine

  erythromycin lactobionate will increase the level or effect of clozapine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
  
  clozapine and erythromycin lactobionate both increase QTc interval. Avoid or Use Alternate Drug.

• cobicistat

  cobicistat, erythromycin lactobionate. Either increases levels of the other by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Consider alternative antibiotics with concomitant use of cobicistat coadministered with atazanavir or darunavir. .

• cobimetinib

  erythromycin lactobionate will increase the level or effect of cobimetinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. If concurrent short term (14 days or less) use of moderate CYP3A inhibitors is unavoidable for patients who are taking cobimetinib 60 mg, reduce the cobimetinib dose to 20 mg. After discontinuation of a moderate CYP3A inhibitor, resume cobimetinib 60 mg. Use an alternative to a moderate CYP3A inhibitor in patients who are taking a reduced dose of cobimetinib (40 or 20 mg daily).

• colchicine

  erythromycin lactobionate will increase the level or effect of colchicine by Other (see comment). Avoid or Use Alternate Drug. Colchicine is a P-gp and CYP3A4 substrate. Avoid use with drugs that are both P-gp and strong CYP3A4 inhibitors. If coadministration is necessary, decrease colchicine dose or frequency as recommended in prescribing information. Use of any colchicine product in conjunction with strong CYP3A4 inhibitors is contraindicated in patients with renal or hepatic impairment.

• conivaptan

  conivaptan will increase the level or effect of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.

• conjugated estrogens

  erythromycin lactobionate will increase the level or effect of conjugated estrogens by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• conjugated estrogens, vaginal

  erythromycin lactobionate will increase the level or effect of conjugated estrogens, vaginal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• cortisone

  erythromycin lactobionate will increase the level or effect of cortisone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
  
  cortisone will decrease the level or effect of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• crizotinib

  crizotinib and erythromycin lactobionate both increase QTc interval. Avoid or Use Alternate Drug.

• cyclosporine

  erythromycin lactobionate will increase the level or effect of cyclosporine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
  
  cyclosporine will increase the level or effect of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• dalteparin

  erythromycin lactobionate increases effects of dalteparin by decreasing metabolism. Avoid or Use Alternate Drug.

• darifenacin

  erythromycin lactobionate will increase the level or effect of darifenacin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
  
  darifenacin will increase the level or effect of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• darunavir

  darunavir will increase the level or effect of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.

• dasatinib

  erythromycin lactobionate will increase the level or effect of dasatinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
  
  dasatinib will increase the level or effect of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.

• degarelix

  degarelix and erythromycin lactobionate both increase QTc interval. Avoid or Use Alternate Drug.

• desflurane

  desflurane and erythromycin lactobionate both increase QTc interval. Avoid or Use Alternate Drug.

• desipramine

  desipramine and erythromycin lactobionate both increase QTc interval. Avoid or Use Alternate Drug.

• dexamethasone

  erythromycin lactobionate will increase the level or effect of dexamethasone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
  
  dexamethasone will decrease the level or effect of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• DHEA, herbal

  DHEA, herbal will increase the level or effect of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• diazepam

  erythromycin lactobionate will increase the level or effect of diazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• digoxin

  erythromycin lactobionate will increase the level or effect of digoxin by altering intestinal flora. Applies only to oral form of both agents. Avoid or Use Alternate Drug.

• diltiazem

  erythromycin lactobionate will increase the level or effect of diltiazem by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Consider an alternative to erythromycin in patients receiving diltiazem. If no alternative is available, monitor for the effects of diltiazem following erythromycin initiation/discontinuation.
  
  diltiazem will increase the level or effect of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• dofetilide

  dofetilide and erythromycin lactobionate both increase QTc interval. Avoid or Use Alternate Drug.

• donepezil

  donepezil and erythromycin lactobionate both increase QTc interval. Avoid or Use Alternate Drug.

• doxepin

  doxepin and erythromycin lactobionate both increase QTc interval. Avoid or Use Alternate Drug.

• dronedarone

  erythromycin lactobionate will increase the level or effect of dronedarone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
  
  dronedarone will increase the level or effect of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.
  
  dronedarone and erythromycin lactobionate both increase QTc interval. Avoid or Use Alternate Drug.

• droperidol

  droperidol and erythromycin lactobionate both increase QTc interval. Avoid or Use Alternate Drug.

• duloxetine

  erythromycin lactobionate will increase the level or effect of duloxetine by affecting hepatic enzyme CYP1A2 metabolism. Avoid or Use Alternate Drug.

• edoxaban

  erythromycin lactobionate will increase the level or effect of edoxaban by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug. Dose adjustment may be required with strong P-gp inhibitors. DVT/PE treatment: Decrease dose to 30 mg PO once daily. NVAF: No dose reduction recommended

• efavirenz

  efavirenz will decrease the level or effect of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.
  
  efavirenz and erythromycin lactobionate both increase QTc interval. Avoid or Use Alternate Drug.

• elacestrant

  erythromycin lactobionate will increase the level or effect of elacestrant by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• eletriptan

  erythromycin lactobionate will increase the level or effect of eletriptan by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
  
  erythromycin lactobionate increases levels of eletriptan by decreasing metabolism. Contraindicated. Separate by 72 hours.

• eliglustat

  erythromycin lactobionate increases levels of eliglustat by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Moderate CYP3A4 inhibitors are not recommended with eliglustat poor or intermediate metabolizers; reduce eliglustat dose from 84 mg BID to 84 mg once daily in extensive metabolizers .
  
  eliglustat and erythromycin lactobionate both increase QTc interval. Avoid or Use Alternate Drug.

• eluxadoline

  erythromycin lactobionate increases levels of eluxadoline by decreasing metabolism. Avoid or Use Alternate Drug. Decrease eluxadoline dose to 75 mg PO BID if coadministered with OATP1B1 inhibitors. .

• encorafenib

  erythromycin lactobionate will increase the level or effect of encorafenib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. If concomitant use of a moderate CYP3A4 inhibitor is unavoidable, reduce encorafenib dose to one-half of the dose (eg, reduce from 450 mg/day to 225 mg/day). After discontinuing the inhibitor for 3-5 elimination half-lives, resume previous encorafenib dose.
  
  encorafenib and erythromycin lactobionate both increase QTc interval. Avoid or Use Alternate Drug.

• enoxaparin

  erythromycin lactobionate increases effects of enoxaparin by decreasing metabolism. Avoid or Use Alternate Drug.

• entrectinib

  erythromycin lactobionate and entrectinib both increase QTc interval. Avoid or Use Alternate Drug.
  
  erythromycin lactobionate will increase the level or effect of entrectinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of moderate CYP3A4 inhibitors with entrectinib, a CYP3A4 substrate. If coadministration unavoidable, reduce dose to 200 mg/day for patients aged 12 y or older with BSA >1.50m2. Resume previous entrectinib dose after discontinuing moderate CYP3A inhibitor for 3-5 elimination half-lives.

• enzalutamide

  enzalutamide will decrease the level or effect of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• epinephrine

  epinephrine and erythromycin lactobionate both increase QTc interval. Avoid or Use Alternate Drug.

• epinephrine racemic

  epinephrine racemic and erythromycin lactobionate both increase QTc interval. Avoid or Use Alternate Drug.

• erdafitinib

  erdafitinib will increase the level or effect of erythromycin lactobionate by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug. If coadministration unavoidable, separate administration by at least 6 hr before or after administration of P-gp substrates with narrow therapeutic index.

• ergotamine

  erythromycin lactobionate will increase the level or effect of ergotamine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• eribulin

  eribulin and erythromycin lactobionate both increase QTc interval. Avoid or Use Alternate Drug. Potential for enhanced QTc-prolonging effects; if concurrent use is necessary then ECG monitoring is recommended.

• erlotinib

  erythromycin lactobionate will increase the level or effect of erlotinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• escitalopram

  escitalopram increases toxicity of erythromycin lactobionate by QTc interval. Avoid or Use Alternate Drug.

• eslicarbazepine acetate

  eslicarbazepine acetate will decrease the level or effect of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• estradiol

  erythromycin lactobionate will increase the level or effect of estradiol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• estrogens conjugated synthetic

  erythromycin lactobionate will increase the level or effect of estrogens conjugated synthetic by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• estrogens esterified

  erythromycin lactobionate will increase the level or effect of estrogens esterified by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• estropipate

  erythromycin lactobionate will increase the level or effect of estropipate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• etonogestrel

  erythromycin lactobionate will increase the level or effect of etonogestrel by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• etravirine

  erythromycin lactobionate will increase the level or effect of etravirine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
  
  etravirine will decrease the level or effect of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.

• everolimus

  erythromycin lactobionate will increase the level or effect of everolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
  
  erythromycin lactobionate will increase the level or effect of everolimus by P-glycoprotein (MDR1) efflux transporter. Contraindicated.

• felodipine

  erythromycin lactobionate will increase the level or effect of felodipine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• fentanyl

  erythromycin lactobionate will increase the level or effect of fentanyl by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. If coadministration of CYP3A4 inhibitors with fentanyl is necessary, monitor patients for respiratory depression and sedation at frequent intervals and consider fentanyl dose adjustments until stable drug effects are achieved.

• fentanyl intranasal

  erythromycin lactobionate will increase the level or effect of fentanyl intranasal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. If coadministration of CYP3A4 inhibitors with fentanyl is necessary, monitor patients for respiratory depression and sedation at frequent intervals and consider fentanyl dose adjustments until stable drug effects are achieved.

• fentanyl transdermal

  erythromycin lactobionate will increase the level or effect of fentanyl transdermal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. If coadministration of CYP3A4 inhibitors with fentanyl is necessary, monitor patients for respiratory depression and sedation at frequent intervals and consider fentanyl dose adjustments until stable drug effects are achieved.

• fentanyl transmucosal

  erythromycin lactobionate will increase the level or effect of fentanyl transmucosal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. If coadministration of CYP3A4 inhibitors with fentanyl is necessary, monitor patients for respiratory depression and sedation at frequent intervals and consider fentanyl dose adjustments until stable drug effects are achieved.

• fesoterodine

  erythromycin lactobionate will increase the level or effect of fesoterodine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• fexinidazole

  fexinidazole and erythromycin lactobionate both increase QTc interval. Avoid or Use Alternate Drug. Avoid coadministration of fexinidazole with drugs known to block potassium channels and/or prolong QT interval.
  
  fexinidazole will increase the level or effect of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Fexinidazole inhibits CYP3A4. Coadministration may increase risk for adverse effects of CYP3A4 substrates.

• fingolimod

  fingolimod and erythromycin lactobionate both increase QTc interval. Avoid or Use Alternate Drug.

• fludrocortisone

  erythromycin lactobionate will increase the level or effect of fludrocortisone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
  
  fludrocortisone will decrease the level or effect of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• fluphenazine

  fluphenazine and erythromycin lactobionate both increase QTc interval. Avoid or Use Alternate Drug.

• fondaparinux

  erythromycin lactobionate increases effects of fondaparinux by decreasing metabolism. Avoid or Use Alternate Drug.

• formoterol

  erythromycin lactobionate and formoterol both increase QTc interval. Avoid or Use Alternate Drug.

• fosamprenavir

  erythromycin lactobionate will increase the level or effect of fosamprenavir by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
  
  fosamprenavir will increase the level or effect of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.

• fosaprepitant

  fosaprepitant will increase the level or effect of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.
  
  erythromycin lactobionate will increase the level or effect of fosaprepitant by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• fosphenytoin

  fosphenytoin will decrease the level or effect of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.

• gemifloxacin

  gemifloxacin and erythromycin lactobionate both increase QTc interval. Avoid or Use Alternate Drug.

• gilteritinib

  gilteritinib and erythromycin lactobionate both increase QTc interval. Avoid or Use Alternate Drug.

• glasdegib

  erythromycin lactobionate and glasdegib both increase QTc interval. Avoid or Use Alternate Drug. If coadministration unavoidable, monitor for increased risk of QTc interval prolongation.

• granisetron

  granisetron and erythromycin lactobionate both increase QTc interval. Avoid or Use Alternate Drug.

• grapefruit

  grapefruit will increase the level or effect of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• griseofulvin

  griseofulvin will decrease the level or effect of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.

• haloperidol

  erythromycin lactobionate and haloperidol both increase QTc interval. Avoid or Use Alternate Drug.

• heparin

  erythromycin lactobionate increases effects of heparin by decreasing metabolism. Avoid or Use Alternate Drug.

• hydrocortisone

  erythromycin lactobionate will increase the level or effect of hydrocortisone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
  
  hydrocortisone will decrease the level or effect of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• hydroxychloroquine sulfate

  hydroxychloroquine sulfate and erythromycin lactobionate both increase QTc interval. Avoid or Use Alternate Drug.

• hydroxyprogesterone caproate (DSC)

  erythromycin lactobionate will increase the level or effect of hydroxyprogesterone caproate (DSC) by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• idelalisib

  idelalisib will increase the level or effect of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Idelalisib is a strong CYP3A inhibitor; avoid coadministration with sensitive CYP3A substrates

• iloperidone

  erythromycin lactobionate will increase the level or effect of iloperidone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• imipramine

  erythromycin lactobionate will increase the level or effect of imipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
  
  imipramine and erythromycin lactobionate both increase QTc interval. Avoid or Use Alternate Drug.

• indinavir

  erythromycin lactobionate will increase the level or effect of indinavir by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
  
  indinavir will increase the level or effect of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• infigratinib

  erythromycin lactobionate will increase the level or effect of infigratinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• inotuzumab

  inotuzumab and erythromycin lactobionate both increase QTc interval. Avoid or Use Alternate Drug. If unable to avoid concomitant use, obtain ECGs and electrolytes before and after initiation of any drug known to prolong QTc, and periodically monitor as clinically indicated during treatment.

• irinotecan

  erythromycin lactobionate will increase the level or effect of irinotecan by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• irinotecan liposomal

  erythromycin lactobionate will increase the level or effect of irinotecan liposomal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• isoflurane

  isoflurane and erythromycin lactobionate both increase QTc interval. Avoid or Use Alternate Drug.

• isoniazid

  isoniazid will increase the level or effect of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• itraconazole

  itraconazole will increase the level or effect of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
  
  itraconazole and erythromycin lactobionate both increase QTc interval. Avoid or Use Alternate Drug.

• ivabradine

  erythromycin lactobionate will increase the level or effect of ivabradine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of ivabradine with moderate CYP3A4 inhibitors.

• ivosidenib

  ivosidenib and erythromycin lactobionate both increase QTc interval. Avoid or Use Alternate Drug. Avoid coadministration of QTc prolonging drugs with ivosidenib or replace with alternate therapies. If coadministration of a QTc prolonging drug is unavoidable, monitor for increased risk of QTc interval prolongation.
  
  ivosidenib will decrease the level or effect of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of sensitive CYP3A4 substrates with ivosidenib or replace with alternate therapies. If coadministration is unavoidable, monitor patients for loss of therapeutic effect of these drugs.

• ixabepilone

  erythromycin lactobionate will increase the level or effect of ixabepilone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• ketoconazole

  erythromycin lactobionate and ketoconazole both increase QTc interval. Avoid or Use Alternate Drug.

• lapatinib

  erythromycin lactobionate will increase the level or effect of lapatinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
  
  lapatinib will increase the level or effect of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.

• lasmiditan

  lasmiditan increases levels of erythromycin lactobionate by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug.

• lemborexant

  erythromycin lactobionate will increase the level or effect of lemborexant by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of lemborexant with moderate or strong CYP3A inhibitors.

• leniolisib

  leniolisib will increase the level or effect of erythromycin lactobionate by Other (see comment). Avoid or Use Alternate Drug. Leniolisib, an OATP1B1 and OATP1B3 inhibitor, may increase systemic exposure of these substrates

• levoketoconazole

  erythromycin lactobionate and levoketoconazole both increase QTc interval. Avoid or Use Alternate Drug.

• lithium

  lithium and erythromycin lactobionate both increase QTc interval. Avoid or Use Alternate Drug.

• lofepramine

  lofepramine and erythromycin lactobionate both increase QTc interval. Avoid or Use Alternate Drug.

• lopinavir

  erythromycin lactobionate will increase the level or effect of lopinavir by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
  
  lopinavir will increase the level or effect of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• loratadine

  erythromycin lactobionate will increase the level or effect of loratadine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• lumacaftor/ivacaftor

  lumacaftor/ivacaftor will decrease the level or effect of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• lumefantrine

  erythromycin lactobionate will increase the level or effect of lumefantrine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
  
  erythromycin lactobionate and lumefantrine both increase QTc interval. Avoid or Use Alternate Drug.
  
  lumefantrine will decrease the level or effect of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.

• lurbinectedin

  erythromycin lactobionate will increase the level or effect of lurbinectedin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• macimorelin

  macimorelin and erythromycin lactobionate both increase QTc interval. Avoid or Use Alternate Drug. Macimorelin causes an increase of ~11 msec in the corrected QT interval. Avoid coadministration with drugs that prolong QT interval, which could increase risk for developing torsade de pointes-type ventricular tachycardia. Allow sufficient washout time of drugs that are known to prolong the QT interval before administering macimorelin.

• maprotiline

  maprotiline and erythromycin lactobionate both increase QTc interval. Avoid or Use Alternate Drug.

• maraviroc

  erythromycin lactobionate will increase the level or effect of maraviroc by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• marijuana

  marijuana will increase the level or effect of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.

• mestranol

  erythromycin lactobionate will increase the level or effect of mestranol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• methadone

  erythromycin lactobionate will increase the level or effect of methadone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• methylprednisolone

  erythromycin lactobionate will increase the level or effect of methylprednisolone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
  
  methylprednisolone will decrease the level or effect of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• metronidazole

  metronidazole will increase the level or effect of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• miconazole vaginal

  miconazole vaginal will increase the level or effect of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.

• microbiota oral

  erythromycin lactobionate decreases effects of microbiota oral by pharmacodynamic antagonism. Avoid or Use Alternate Drug. Microbiota oral contains bacterial spores. Antibacterial agents may decrease efficacy if coadministered. Complete antibiotic regimens 2-4 days before initiating microbiota oral. .

• midazolam

  erythromycin lactobionate will increase the level or effect of midazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• midazolam intranasal

  erythromycin lactobionate will increase the level or effect of midazolam intranasal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Coadministration of moderate CYP3A4 inhibitors with midazolam intranasal causes higher midazolam systemic exposure, which may prolong sedation.

• mifepristone

  mifepristone will increase the level or effect of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• mirtazapine

  mirtazapine and erythromycin lactobionate both increase QTc interval. Avoid or Use Alternate Drug.

• mizolastine

  erythromycin lactobionate increases levels of mizolastine by decreasing metabolism. Contraindicated.

• mobocertinib

  erythromycin lactobionate will increase the level or effect of mobocertinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. If use of moderate CYP3A4 inhibitor unavoidable, reduce mobocertinib dose by ~50% (eg, 160 to 80 mg); closely monitor QTc interval.
  
  mobocertinib and erythromycin lactobionate both increase QTc interval. Avoid or Use Alternate Drug. If coadministration unavoidable, reduce mobocertinib dose and monitor QTc interval more frequently.

• moxifloxacin

  erythromycin lactobionate and moxifloxacin both increase QTc interval. Avoid or Use Alternate Drug.

• nafcillin

  nafcillin will decrease the level or effect of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.

• naloxegol

  erythromycin lactobionate will increase the level or effect of naloxegol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. If coadministation of naloxegol with moderate CYP3A4 inhibitors is unavoidable, reduce naloxegol dose to 12.5 mg qDay

• nefazodone

  nefazodone will increase the level or effect of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• nelfinavir

  erythromycin lactobionate will increase the level or effect of nelfinavir by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
  
  nelfinavir will increase the level or effect of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• neratinib

  erythromycin lactobionate will increase the level or effect of neratinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of neratinib with strong/moderate CYP3A4 inhibitors.

• nevirapine

  nevirapine will decrease the level or effect of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.

• nicardipine

  erythromycin lactobionate will increase the level or effect of nicardipine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• nifedipine

  nifedipine will increase the level or effect of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• nilotinib

  erythromycin lactobionate will increase the level or effect of nilotinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
  
  erythromycin lactobionate and nilotinib both increase QTc interval. Avoid or Use Alternate Drug.
  
  nilotinib will increase the level or effect of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.

• nilutamide

  nilutamide will increase the level or effect of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• nintedanib

  erythromycin lactobionate increases levels of nintedanib by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug. If nintedanib adverse effects occur, management may require interruption, dose reduction, or discontinuation of therapy.

• nisoldipine

  erythromycin lactobionate will increase the level or effect of nisoldipine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• nortriptyline

  nortriptyline and erythromycin lactobionate both increase QTc interval. Avoid or Use Alternate Drug.

• octreotide

  erythromycin lactobionate and octreotide both increase QTc interval. Avoid or Use Alternate Drug.

• octreotide (Antidote)

  erythromycin lactobionate and octreotide (Antidote) both increase QTc interval. Avoid or Use Alternate Drug.

• olanzapine

  olanzapine and erythromycin lactobionate both increase QTc interval. Avoid or Use Alternate Drug.

• olaparib

  erythromycin lactobionate will increase the level or effect of olaparib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. If coadministration with moderate CYP3A inhibitors cannot be avoided, reduce olaparib dose to 200 mg (capsule) or 150 mg (tablet) PO BID. Do not substitute tablets with capsules.

• omaveloxolone

  erythromycin lactobionate will increase the level or effect of omaveloxolone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. If unavoidable, reduce omaveloxolone dose to 100 mg/day. Closely monitor for adverse effects. If adverse effects emerge, further reduce to 50 mg/day.

• ondansetron

  erythromycin lactobionate and ondansetron both increase QTc interval. Avoid or Use Alternate Drug. Avoid with congenital long QT syndrome; ECG monitoring recommended with concomitant medications that prolong QT interval, electrolyte abnormalities, CHF, or bradyarrhythmias.

• osimertinib

  erythromycin lactobionate will increase the level or effect of osimertinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of osimertinib with strong CYP3A4 inhibitors. If no other alternative treatment exists, monitor patient more closely for adverse effects.

• oxaliplatin

  oxaliplatin and erythromycin lactobionate both increase QTc interval. Avoid or Use Alternate Drug.

• oxcarbazepine

  oxcarbazepine will decrease the level or effect of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• pacritinib

  erythromycin lactobionate will increase the level or effect of pacritinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• panobinostat

  erythromycin lactobionate and panobinostat both increase QTc interval. Avoid or Use Alternate Drug. Panobinostat is known to significantly prolong QT interval. Panobinostat prescribing information states use with drugs known to prolong QTc is not recommended.

• pazopanib

  erythromycin lactobionate will increase the level or effect of pazopanib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of pazopanib with strong CYP3A4 inhibitors if possible; if must coadminister, decrease pazopanib dose to 400 mg/day

• pemigatinib

  erythromycin lactobionate will increase the level or effect of pemigatinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. If coadministration with strong or moderate CYP3A4 inhibitors is unavoidable, reduce pemigatinib dose (refer to drug monograph dosage modifications). After discontinuing the CYP3A4 inhibitor for 3 elimination half-lives, may resume previous pemigatinib dose.

• pentobarbital

  pentobarbital will decrease the level or effect of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• perphenazine

  perphenazine and erythromycin lactobionate both increase QTc interval. Avoid or Use Alternate Drug.

• pexidartinib

  erythromycin lactobionate and pexidartinib both increase Other (see comment). Avoid or Use Alternate Drug. Pexidartinib can cause hepatotoxicity. Avoid coadministration of pexidartinib with other products know to cause hepatoxicity.
  
  erythromycin lactobionate will increase the level or effect of pexidartinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. If coadministration with strong or moderate CYP3A4 inhibitors is unavoidable, reduce pexidartinib dose (refer to drug monograph dosage modifications). After discontinuing the CYP3A4 inhibitor for 3 elimination half-lives, may resume previous pexidartinib dose.

• phenindione

  erythromycin lactobionate increases effects of phenindione by decreasing metabolism. Avoid or Use Alternate Drug.

• phenobarbital

  phenobarbital will decrease the level or effect of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• phenytoin

  phenytoin will decrease the level or effect of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.

• pitavastatin

  erythromycin lactobionate increases levels of pitavastatin by decreasing metabolism. Avoid or Use Alternate Drug. Do not exceed 1 mg/d pitavastatin.
  
  erythromycin lactobionate increases toxicity of pitavastatin by Other (see comment). Avoid or Use Alternate Drug. Comment: OATP1B1 inhibitors may increase risk of myopathy.

• pitolisant

  erythromycin lactobionate and pitolisant both increase QTc interval. Avoid or Use Alternate Drug.

• pomalidomide

  erythromycin lactobionate increases levels of pomalidomide by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug.

• posaconazole

  posaconazole will increase the level or effect of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• prednisolone

  erythromycin lactobionate will increase the level or effect of prednisolone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• prednisone

  erythromycin lactobionate will increase the level or effect of prednisone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
  
  prednisone will decrease the level or effect of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• pretomanid

  erythromycin lactobionate, pretomanid. Either increases toxicity of the other by Other (see comment). Avoid or Use Alternate Drug. Comment: Pretomanid regimen associated with hepatotoxicity. Avoid alcohol and hepatotoxic agents, including herbal supplements and drugs other than bedaquiline and linezolid.

• primaquine

  primaquine and erythromycin lactobionate both increase QTc interval. Avoid or Use Alternate Drug.

• primidone

  primidone will decrease the level or effect of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• prochlorperazine

  prochlorperazine and erythromycin lactobionate both increase QTc interval. Avoid or Use Alternate Drug.

• promazine

  promazine and erythromycin lactobionate both increase QTc interval. Avoid or Use Alternate Drug.

• promethazine

  promethazine and erythromycin lactobionate both increase QTc interval. Avoid or Use Alternate Drug.

• protamine

  erythromycin lactobionate increases effects of protamine by decreasing metabolism. Avoid or Use Alternate Drug.

• protriptyline

  protriptyline and erythromycin lactobionate both increase QTc interval. Avoid or Use Alternate Drug.

• quetiapine

  erythromycin lactobionate will increase the level or effect of quetiapine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• quinidine

  erythromycin lactobionate will increase the level or effect of quinidine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• quinupristin/dalfopristin

  quinupristin/dalfopristin will increase the level or effect of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
  
  quinupristin/dalfopristin increases levels of erythromycin lactobionate by decreasing metabolism. Contraindicated. Risk of prolonged QTc interval.

• ranolazine

  erythromycin lactobionate will increase the level or effect of ranolazine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• repaglinide

  erythromycin lactobionate will increase the level or effect of repaglinide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• revefenacin

  erythromycin lactobionate increases levels of revefenacin by Other (see comment). Avoid or Use Alternate Drug. Comment: OATP1B1 and OATP1B3 transport inhibitors may increase systemic exposure of revefenacin's active metabolite. Coadministration not recommended.

• ribociclib

  ribociclib increases toxicity of erythromycin lactobionate by QTc interval. Avoid or Use Alternate Drug.

• rifabutin

  erythromycin lactobionate increases levels of rifabutin by decreasing metabolism. Contraindicated.
  
  rifabutin will decrease the level or effect of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• rifampin

  rifampin will decrease the level or effect of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• rifapentine

  rifapentine will decrease the level or effect of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.

• rimegepant

  erythromycin lactobionate will increase the level or effect of rimegepant by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug.

• riociguat

  erythromycin lactobionate will increase the level or effect of riociguat by decreasing metabolism. Avoid or Use Alternate Drug. Coadministration of riociguat (substrate of CYP isoenzymes 1A1, 2C8, 3A, 2J2) with strong CYP inhibitors may require a decreased initial dose of 0.5 mg PO TID; monitor for signs of hypotension and reduce dose if needed

• ritonavir

  erythromycin lactobionate will increase the level or effect of ritonavir by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
  
  ritonavir will increase the level or effect of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.

• romidepsin

  erythromycin lactobionate will increase the level or effect of romidepsin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• rufinamide

  rufinamide will decrease the level or effect of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• saquinavir

  erythromycin lactobionate will increase the level or effect of saquinavir by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• secobarbital

  secobarbital will decrease the level or effect of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• selumetinib

  erythromycin lactobionate will increase the level or effect of selumetinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. If coadministration with strong or moderate CYP3A4 inhibitors cannot be avoided, reduce selumetinib dosage (refer to selumetinib monograph for further information). After discontinuation of the strong or moderate CYP3A4 inhibitor for 3 elimination half-lives, resume selumetinib dose that was taken before initiating the inhibitor.

• sevoflurane

  sevoflurane and erythromycin lactobionate both increase QTc interval. Avoid or Use Alternate Drug.

• silodosin

  erythromycin lactobionate will increase the level or effect of silodosin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• siponimod

  erythromycin lactobionate will increase the level or effect of siponimod by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Coadministration of siponimod with a moderate or strong CYP3A4 inhibitor PLUS a moderate or strong CYP2C9 inhibitor is not recommended.
  
  siponimod and erythromycin lactobionate both increase QTc interval. Avoid or Use Alternate Drug.

• sirolimus

  erythromycin lactobionate will increase the level or effect of sirolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• solifenacin

  erythromycin lactobionate will increase the level or effect of solifenacin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
  
  solifenacin and erythromycin lactobionate both increase QTc interval. Avoid or Use Alternate Drug.

• sotorasib

  sotorasib will decrease the level or effect of erythromycin lactobionate by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug. If use is unavoidable, refer to the prescribing information of the P-gp substrate for dosage modifications.

• St John's Wort

  St John's Wort will decrease the level or effect of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• sulbactam/durlobactam

  erythromycin lactobionate will increase the level or effect of sulbactam/durlobactam by Other (see comment). Avoid or Use Alternate Drug. Sulbactam is predicted to have active secretion by OATP1 as a significant portion of total clearance; therefore, inhibition of OAT1 may increase sulbactam plasma concentrations

• sunitinib

  erythromycin lactobionate will increase the level or effect of sunitinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
  
  sunitinib and erythromycin lactobionate both increase QTc interval. Avoid or Use Alternate Drug.

• tacrolimus

  erythromycin lactobionate will increase the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
  
  tacrolimus and erythromycin lactobionate both increase QTc interval. Avoid or Use Alternate Drug.

• tadalafil

  erythromycin lactobionate will increase the level or effect of tadalafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. For ED limit tadalafil to max of 2.5 mg/day (for daily use) or 10 mg dose every 72 hr (for use as needed). Avoid concurrent use of tadalafil for pulmonary HTN in patients taking strong CYP3A4 inhibitors.

• tazemetostat

  erythromycin lactobionate will increase the level or effect of tazemetostat by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of tazemetostat with moderate CYP3A4 inhibitors. If coadministration is unavoidable, reduce tazemetostat current dose (see drug monograph Dosage Modifications).

• temsirolimus

  erythromycin lactobionate will increase the level or effect of temsirolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• tepotinib

  tepotinib will increase the level or effect of erythromycin lactobionate by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug. If concomitant use unavoidable, reduce the P-gp substrate dosage if recommended in its approved product labeling.

• tetrabenazine

  tetrabenazine and erythromycin lactobionate both increase QTc interval. Avoid or Use Alternate Drug.

• theophylline

  erythromycin lactobionate will increase the level or effect of theophylline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• thioridazine

  thioridazine and erythromycin lactobionate both increase QTc interval. Avoid or Use Alternate Drug.

• tipranavir

  erythromycin lactobionate will increase the level or effect of tipranavir by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• tizanidine

  erythromycin lactobionate will increase the level or effect of tizanidine by affecting hepatic enzyme CYP1A2 metabolism. Avoid or Use Alternate Drug.

• tolterodine

  erythromycin lactobionate will increase the level or effect of tolterodine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• tolvaptan

  erythromycin lactobionate will increase the level or effect of tolvaptan by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• topiramate

  topiramate will decrease the level or effect of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• topotecan

  erythromycin lactobionate will increase the level or effect of topotecan by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug. Product labeling for PO topotecan recommends avoiding concomitant use of P-gp inhibitors; the interaction with IV topotecan may be less severe but is still likely of clinical significance

• toremifene

  erythromycin lactobionate increases levels of toremifene by decreasing metabolism. Avoid or Use Alternate Drug. Concurrent use of toremifene with agents causing QT prolongation should be avoided. If concomitant use is required it's recommended that toremifene be interrupted. If interruption not possible, patients requiring therapy with a drug that prolongs QT should be closely monitored. ECGs should be obtained for high risk patients.

• trazodone

  trazodone and erythromycin lactobionate both increase QTc interval. Avoid or Use Alternate Drug.

• triamcinolone acetonide injectable suspension

  erythromycin lactobionate will increase the level or effect of triamcinolone acetonide injectable suspension by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
  
  triamcinolone acetonide injectable suspension will decrease the level or effect of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• triazolam

  erythromycin lactobionate will increase the level or effect of triazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• trifluoperazine

  trifluoperazine and erythromycin lactobionate both increase QTc interval. Avoid or Use Alternate Drug.

• trimipramine

  trimipramine and erythromycin lactobionate both increase QTc interval. Avoid or Use Alternate Drug.

• trofinetide

  trofinetide will increase the level or effect of erythromycin lactobionate by Other (see comment). Avoid or Use Alternate Drug. Trofinetide (an OATP131 and OATP13B inhibitor) may increase plasma levels of OATP131 or OATP13B substrates. Avoid coadministration with sensitive substrates.

• tucatinib

  tucatinib will increase the level or effect of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid concomitant use of tucatinib with CYP3A substrates, where minimal concentration changes may lead to serious or life-threatening toxicities. If unavoidable, reduce CYP3A substrate dose according to product labeling.

• typhoid vaccine live

  erythromycin lactobionate decreases effects of typhoid vaccine live by pharmacodynamic antagonism. Contraindicated. Wait until Abx Tx complete to administer live bacterial vaccine.

• umeclidinium bromide/vilanterol inhaled

  erythromycin lactobionate increases toxicity of umeclidinium bromide/vilanterol inhaled by QTc interval. Avoid or Use Alternate Drug. Exercise extreme caution when vilanterol coadministered with drugs that prolong QTc interval; adrenergic agonist effects on the cardiovascular system may be potentiated.

• vandetanib

  erythromycin lactobionate, vandetanib. Either increases toxicity of the other by QTc interval. Avoid or Use Alternate Drug. Avoid coadministration with drugs known to prolong QT interval; if a drug known to prolong QT interval must be used, more frequent ECG monitoring is recommended.

• vemurafenib

  vemurafenib and erythromycin lactobionate both increase QTc interval. Avoid or Use Alternate Drug. Concomitant use of vemurafenib with drugs that prolong QT interval is not recommended. Erythromycin may also increase vemurafenib levels.

• venetoclax

  erythromycin lactobionate will increase the level or effect of venetoclax by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. If a moderate CYP3A inhibitor must be used, reduce the venetoclax dose by at least 50%. Monitor more closely for signs of venetoclax toxicities.
  
  erythromycin lactobionate will increase the level or effect of venetoclax by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug. If a P-gp inhibitor must be used, reduce the venetoclax dose by at least 50%. Monitor more closely for signs of venetoclax toxicities.

• verapamil

  erythromycin lactobionate will increase the level or effect of verapamil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
  
  verapamil will increase the level or effect of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.

• vilanterol/fluticasone furoate inhaled

  erythromycin lactobionate increases toxicity of vilanterol/fluticasone furoate inhaled by QTc interval. Avoid or Use Alternate Drug. Exercise extreme caution when vilanterol coadministered with drugs that prolong QTc interval; adrenergic agonist effects on the cardiovascular system may be potentiated.

• vilazodone

  erythromycin lactobionate increases levels of vilazodone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. If intolerable adverse effects occur when coadministered with moderate CYP3A4 inhibitors, reduce daily dose to 20 mg.

• voriconazole

  voriconazole will increase the level or effect of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.

• vorinostat

  vorinostat and erythromycin lactobionate both increase QTc interval. Avoid or Use Alternate Drug.

• voxelotor

  voxelotor will increase the level or effect of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Voxelotor increases systemic exposure of sensitive CYP3A4 substrates. Avoid coadministration with sensitive CYP3A4 substrates with a narrow therapeutic index. Consider dose reduction of the sensitive CYP3A4 substrate(s) if unable to avoid.

• zafirlukast

  zafirlukast will increase the level or effect of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• zavegepant intranasal

  erythromycin lactobionate will increase the level or effect of zavegepant intranasal by Other (see comment). Avoid or Use Alternate Drug. OATP1B3 inhibitors may result in a significant increase in systemic exposure of zavegepant (an OATP1B3 substrate).

• ziprasidone

  erythromycin lactobionate and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug.

Monitor Closely (284)

• acalabrutinib

  erythromycin lactobionate will increase the level or effect of acalabrutinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Decrease acalabrutinib dose to 100 mg once daily if coadministered with a moderate CYP3A inhibitor.

• albuterol

  albuterol and erythromycin lactobionate both increase QTc interval. Use Caution/Monitor.

• alfentanil

  erythromycin lactobionate will increase the level or effect of alfentanil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• alfuzosin

  erythromycin lactobionate will increase the level or effect of alfuzosin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
  
  erythromycin lactobionate and alfuzosin both increase QTc interval. Use Caution/Monitor.

• aliskiren

  erythromycin lactobionate will increase the level or effect of aliskiren by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• alosetron

  erythromycin lactobionate will increase the level or effect of alosetron by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• aluminum hydroxide

  aluminum hydroxide increases levels of erythromycin lactobionate by unknown mechanism. Use Caution/Monitor.

• amifampridine

  erythromycin lactobionate increases toxicity of amifampridine by Other (see comment). Modify Therapy/Monitor Closely. Comment: Amifampridine can cause seizures. Coadministration with drugs that lower seizure threshold may increase this risk.

• amikacin

  erythromycin lactobionate will increase the level or effect of amikacin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• amlodipine

  erythromycin lactobionate will increase the level or effect of amlodipine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• apomorphine

  apomorphine and erythromycin lactobionate both increase QTc interval. Use Caution/Monitor.

• arformoterol

  arformoterol and erythromycin lactobionate both increase QTc interval. Use Caution/Monitor.

• aripiprazole

  aripiprazole and erythromycin lactobionate both increase QTc interval. Use Caution/Monitor.

• armodafinil

  erythromycin lactobionate will increase the level or effect of armodafinil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• atazanavir

  erythromycin lactobionate will increase the level or effect of atazanavir by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• atogepant

  erythromycin lactobionate will increase the level or effect of atogepant by Other (see comment). Modify Therapy/Monitor Closely. Recommended dosage of atogepant (an OATP1B1 substrate) with concomitant use of OATP inhibitors is 10 mg or 30 mg qDay.

• atorvastatin

  erythromycin lactobionate will increase the level or effect of atorvastatin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• avanafil

  erythromycin lactobionate will increase the level or effect of avanafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. CYP3A4 inhibitors may reduce avanafil clearance increasing systemic exposure to avanafil; increased levels may result in increased associated adverse events; the maximum recommended dose of STENDRA is 50 mg, not to exceed once every 24 hours for patients taking concomitant moderate CYP3A4 inhibitors

• azithromycin

  azithromycin and erythromycin lactobionate both increase QTc interval. Use Caution/Monitor.
  
  azithromycin will increase the level or effect of erythromycin lactobionate by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• balsalazide

  erythromycin lactobionate will decrease the level or effect of balsalazide by altering intestinal flora. Applies only to oral form of both agents. Use Caution/Monitor.

• bazedoxifene/conjugated estrogens

  erythromycin lactobionate will decrease the level or effect of bazedoxifene/conjugated estrogens by altering intestinal flora. Applies only to oral forms of hormone. Low risk of contraceptive failure. Modify Therapy/Monitor Closely.
  
  erythromycin lactobionate will increase the level or effect of bazedoxifene/conjugated estrogens by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• bedaquiline

  erythromycin lactobionate and bedaquiline both increase QTc interval. Modify Therapy/Monitor Closely. ECG should be monitored closely

• belzutifan

  belzutifan will decrease the level or effect of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. If unable to avoid coadministration of belzutifan with sensitive CYP3A4 substrates, consider increasing the sensitive CYP3A4 substrate dose in accordance with its prescribing information.

• bendamustine

  erythromycin lactobionate decreases effects of bendamustine by decreasing metabolism. Use Caution/Monitor. Decreased conversion of bendamustine to active metabolites.

• berotralstat

  erythromycin lactobionate increases levels of berotralstat by P-glycoprotein (MDR1) efflux transporter. Modify Therapy/Monitor Closely. Reduced berotralstat dose to 110 mg/day when coadministered with P-gp inhibitors.
  
  berotralstat will increase the level or effect of erythromycin lactobionate by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Monitor or titrate P-gp substrate dose if coadministered.

• betrixaban

  erythromycin lactobionate increases levels of betrixaban by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Decrease betrixaban dose to 80 mg PO once, then 40 mg PO qDay if coadministered with a P-gp inhibitor.

• bexarotene

  erythromycin lactobionate will increase the level or effect of bexarotene by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• biotin

  erythromycin lactobionate will decrease the level or effect of biotin by altering intestinal flora. Applies only to oral form of both agents. Use Caution/Monitor.

• bortezomib

  erythromycin lactobionate will increase the level or effect of bortezomib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• bosentan

  erythromycin lactobionate will increase the level or effect of bosentan by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• brexpiprazole

  erythromycin lactobionate will increase the level or effect of brexpiprazole by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Administer a quarter of brexpiprazole dose if coadministered with a moderate CYP3A4 inhibitor PLUS a strong/moderate CYP2D6 inhibitor.

• bromocriptine

  erythromycin lactobionate increases levels of bromocriptine by unknown mechanism. Use Caution/Monitor.

• budesonide

  erythromycin lactobionate will increase the level or effect of budesonide by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• buprenorphine subdermal implant

  erythromycin lactobionate will increase the level or effect of buprenorphine subdermal implant by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Monitor patients already on buprenorphine subdermal implant who require newly-initiated treatment with CYP3A4 inhibitors for signs and symptoms of overmedication. If the dose of the concomitant CYP3A4 inhibitor cannot be reduced or discontinued, implant removal may be necessary and the patient should then be treated with a buprenorphine dosage form that permits dose adjustments. If a CYP3A4 inhibitor is discontinued in a patient who has been stabilized on buprenorphine, monitor the patient for withdrawal.

• buprenorphine, long-acting injection

  erythromycin lactobionate will increase the level or effect of buprenorphine, long-acting injection by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Patients who transfer to buprenorphine long-acting injection from transmucosal buprenorphine coadministered with CYP3A4 inhibitors should be monitored to ensure buprenorphine plasma levels are adequate. Within 2 weeks, if signs and symptoms of buprenorphine toxicity or overdose occur and the concomitant CYP3A4 inhibitor cannot be reduced or discontinued, transition the patient back to a buprenorphine formulation that permits dose adjustments.

• cabazitaxel

  erythromycin lactobionate will increase the level or effect of cabazitaxel by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Caution should be exercised with concomitant use of moderate CYP3A4 inhibitors.

• cabozantinib

  erythromycin lactobionate will increase the level or effect of cabozantinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• calcium carbonate

  calcium carbonate increases levels of erythromycin lactobionate by unknown mechanism. Use Caution/Monitor.

• cannabidiol

  erythromycin lactobionate will increase the level or effect of cannabidiol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Consider reducing the cannabidiol dose when coadministered with a moderate CYP3A4 inhibitor.

• cefdinir

  erythromycin lactobionate decreases effects of cefdinir by pharmacodynamic antagonism. Use Caution/Monitor. bacteriostatic agents may inhibit the effects of bactericidal agents.

• cefditoren

  erythromycin lactobionate decreases effects of cefditoren by pharmacodynamic antagonism. Use Caution/Monitor. bacteriostatic agents may inhibit the effects of bactericidal agents.

• cefoxitin

  erythromycin lactobionate decreases effects of cefoxitin by pharmacodynamic antagonism. Use Caution/Monitor. bacteriostatic agents may inhibit the effects of bactericidal agents.

• cefpodoxime

  erythromycin lactobionate decreases effects of cefpodoxime by pharmacodynamic antagonism. Use Caution/Monitor. bacteriostatic agents may inhibit the effects of bactericidal agents.

• ceftriaxone

  erythromycin lactobionate decreases effects of ceftriaxone by pharmacodynamic antagonism. Use Caution/Monitor. bacteriostatic agents may inhibit the effects of bactericidal agents.

• cefuroxime

  erythromycin lactobionate decreases effects of cefuroxime by pharmacodynamic antagonism. Use Caution/Monitor. bacteriostatic agents may inhibit the effects of bactericidal agents.

• cenobamate

  cenobamate will decrease the level or effect of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

• ceritinib

  erythromycin lactobionate increases levels of ceritinib by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• cevimeline

  erythromycin lactobionate will increase the level or effect of cevimeline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• chloroquine

  chloroquine increases toxicity of erythromycin lactobionate by QTc interval. Use Caution/Monitor.

• ciprofloxacin

  ciprofloxacin and erythromycin lactobionate both increase QTc interval. Use Caution/Monitor. Coadministration of ciprofloxacin with drugs known to prolong QT interval could increase risk of developing torsade de pointes in predisposed patients; however less likely with ciprofloxacin than other quinolones.

• citalopram

  erythromycin lactobionate increases levels of citalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. ECG monitoring is recommended, along with drugs that may prolong the QT interval.

• clarithromycin

  erythromycin lactobionate will increase the level or effect of clarithromycin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• clomipramine

  erythromycin lactobionate will increase the level or effect of clomipramine by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.

• clozapine

  erythromycin lactobionate will increase the level or effect of clozapine by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.

• conivaptan

  erythromycin lactobionate will increase the level or effect of conivaptan by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• conjugated estrogens

  erythromycin lactobionate will decrease the level or effect of conjugated estrogens by altering intestinal flora. Applies only to oral forms of hormone. Low risk of contraceptive failure. Modify Therapy/Monitor Closely.
  
  erythromycin lactobionate will increase the level or effect of conjugated estrogens by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• conjugated estrogens, vaginal

  erythromycin lactobionate will increase the level or effect of conjugated estrogens, vaginal by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• cortisone

  erythromycin lactobionate will increase the level or effect of cortisone by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• crizotinib

  erythromycin lactobionate increases levels of crizotinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Caution should be exercised with concomitant use of moderate CYP3A inhibitors. .
  
  crizotinib increases levels of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Dose reduction may be needed for coadministered drugs that are predominantly metabolized by CYP3A. ECG monitoring is recommended, along with drugs that may prolong the QT interval.
  
  crizotinib increases levels of erythromycin lactobionate by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. ECG monitoring is recommended, along with drugs that may prolong the QT interval.

• cyclosporine

  erythromycin lactobionate will increase the level or effect of cyclosporine by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
  
  cyclosporine will increase the level or effect of erythromycin lactobionate by Other (see comment). Use Caution/Monitor. may increase plasma concentrations of organic anion transporter protein substrates

• dabigatran

  erythromycin lactobionate will increase the level or effect of dabigatran by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Atrial fibrillation: Avoid coadministering dabigatran with P-gp inhibitors if CrCl <30 mL/min. DVT/PE treatment: Avoid coadministering dabigatran with P-gp inhibitors if CrCl <50 mL/min

• dabrafenib

  dabrafenib will decrease the level or effect of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely.

• dactinomycin

  erythromycin lactobionate will increase the level or effect of dactinomycin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• dapsone

  erythromycin lactobionate will increase the level or effect of dapsone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• daridorexant

  erythromycin lactobionate will increase the level or effect of daridorexant by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Daridorexant dose should not exceed 25 mg per night when coadministered with moderate CYP3A4 inhibitors.

• darunavir

  erythromycin lactobionate will increase the level or effect of darunavir by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely.

• dasatinib

  dasatinib and erythromycin lactobionate both increase QTc interval. Modify Therapy/Monitor Closely.

• daunorubicin

  erythromycin lactobionate will increase the level or effect of daunorubicin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• deferasirox

  deferasirox will decrease the level or effect of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• deflazacort

  erythromycin lactobionate will increase the level or effect of deflazacort by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Decrease deflazacort dose to one-third of the recommended dose if coadministered with moderate or strong CYP3A4 inhibitors.
  
  erythromycin lactobionate will increase the level or effect of deflazacort by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• deutetrabenazine

  deutetrabenazine and erythromycin lactobionate both increase QTc interval. Use Caution/Monitor. At the maximum recommended dose, deutetrabenazine does not prolong QT interval to a clinically relevant extent. Certain circumstances may increase risk of torsade de pointes and/or sudden death in association with drugs that prolong the QTc interval (eg, bradycardia, hypokalemia or hypomagnesemia, coadministration with other drugs that prolong QTc interval, presence of congenital QT prolongation).

• dexamethasone

  erythromycin lactobionate will increase the level or effect of dexamethasone by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• diazepam intranasal

  erythromycin lactobionate will increase the level or effect of diazepam intranasal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Strong or moderate CYP3A4 inhibitors may decrease rate of diazepam elimination, thereby increasing adverse reactions to diazepam.

• dienogest/estradiol valerate

  erythromycin lactobionate will decrease the level or effect of dienogest/estradiol valerate by altering intestinal flora. Applies only to oral forms of hormone. Low risk of contraceptive failure. Use Caution/Monitor. An alternate or additional form of birth control may be advisable during concomitant use.
  
  erythromycin lactobionate will increase the level or effect of dienogest/estradiol valerate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Monitor for potential adverse effects such as nausea, irregular uterine bleeding, breast tenderness and headache.

• digoxin

  erythromycin lactobionate will increase the level or effect of digoxin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• disopyramide

  erythromycin lactobionate will increase the level or effect of disopyramide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• docetaxel

  erythromycin lactobionate will increase the level or effect of docetaxel by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
  
  erythromycin lactobionate will increase the level or effect of docetaxel by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• dolasetron

  dolasetron and erythromycin lactobionate both increase QTc interval. Modify Therapy/Monitor Closely.

• donepezil

  erythromycin lactobionate will increase the level or effect of donepezil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• doxorubicin

  erythromycin lactobionate will increase the level or effect of doxorubicin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
  
  erythromycin lactobionate will increase the level or effect of doxorubicin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• doxorubicin liposomal

  erythromycin lactobionate will increase the level or effect of doxorubicin liposomal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
  
  erythromycin lactobionate will increase the level or effect of doxorubicin liposomal by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• dutasteride

  erythromycin lactobionate will increase the level or effect of dutasteride by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• duvelisib

  duvelisib will increase the level or effect of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Coadministration with duvelisib increases AUC of a sensitive CYP3A4 substrate which may increase the risk of toxicities of these drugs. Consider reducing the dose of the sensitive CYP3A4 substrate and monitor for signs of toxicities of the coadministered sensitive CYP3A substrate.

• efavirenz

  erythromycin lactobionate will increase the level or effect of efavirenz by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• elagolix

  elagolix will increase the level or effect of erythromycin lactobionate by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
  
  elagolix will decrease the level or effect of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Elagolix is a weak-to-moderate CYP3A4 inducer. Monitor CYP3A substrates if coadministered. Consider increasing CYP3A substrate dose if needed.

• eliglustat

  eliglustat increases levels of erythromycin lactobionate by P-glycoprotein (MDR1) efflux transporter. Modify Therapy/Monitor Closely. Monitor therapeutic drug concentrations, as indicated, or consider reducing the dosage of the P-gp substrate and titrate to clinical effect.

• eltrombopag

  erythromycin lactobionate will increase the level or effect of eltrombopag by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.

• eluxadoline

  eluxadoline increases levels of erythromycin lactobionate by decreasing metabolism. Use Caution/Monitor. Eluxadoline may increase the systemic exposure of coadministered OATP1B1 substrates.

• elvitegravir/cobicistat/emtricitabine/tenofovir DF

  elvitegravir/cobicistat/emtricitabine/tenofovir DF increases levels of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Cobicistat is a CYP3A4 inhibitor; contraindicated with CYP3A4 substrates for which elevated plasma concentrations are associated with serious and/or life-threatening events.

• encorafenib

  encorafenib, erythromycin lactobionate. affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Encorafenib both inhibits and induces CYP3A4 at clinically relevant plasma concentrations. Coadministration of encorafenib with sensitive CYP3A4 substrates may result in increased toxicity or decreased efficacy of these agents.
  
  encorafenib will increase the level or effect of erythromycin lactobionate by Other (see comment). Modify Therapy/Monitor Closely. Encorafenib (a OATP1B3 inhibitor) may increase the concentration and toxicities of OATP1B3 substrates. Closely monitor for signs and symptoms of increased exposure and consider adjusting the dose of these substrates.

• eplerenone

  erythromycin lactobionate will increase the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• erlotinib

  erythromycin lactobionate will increase the level or effect of erlotinib by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• estradiol

  erythromycin lactobionate will decrease the level or effect of estradiol by altering intestinal flora. Applies only to oral forms of hormone. Low risk of contraceptive failure. Modify Therapy/Monitor Closely.
  
  erythromycin lactobionate will increase the level or effect of estradiol by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• estrogens conjugated synthetic

  erythromycin lactobionate will decrease the level or effect of estrogens conjugated synthetic by altering intestinal flora. Applies only to oral forms of hormone. Low risk of contraceptive failure. Modify Therapy/Monitor Closely.
  
  erythromycin lactobionate will increase the level or effect of estrogens conjugated synthetic by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• estrogens esterified

  erythromycin lactobionate will decrease the level or effect of estrogens esterified by altering intestinal flora. Applies only to oral forms of hormone. Low risk of contraceptive failure. Modify Therapy/Monitor Closely.
  
  erythromycin lactobionate will increase the level or effect of estrogens esterified by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• estropipate

  erythromycin lactobionate will decrease the level or effect of estropipate by altering intestinal flora. Applies only to oral forms of hormone. Low risk of contraceptive failure. Modify Therapy/Monitor Closely.
  
  erythromycin lactobionate will increase the level or effect of estropipate by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• eszopiclone

  erythromycin lactobionate increases levels of eszopiclone by enhancing GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
  
  erythromycin lactobionate increases levels of eszopiclone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Reduce eszopiclone starting dose to 1 mg/day.

• ethinylestradiol

  erythromycin lactobionate will decrease the level or effect of ethinylestradiol by altering intestinal flora. Applies only to oral forms of hormone. Low risk of contraceptive failure. Use Caution/Monitor. Antibiotics may decrease hormonal contraceptive efficacy.

• etoposide

  erythromycin lactobionate will increase the level or effect of etoposide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
  
  erythromycin lactobionate will increase the level or effect of etoposide by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• eucalyptus

  erythromycin lactobionate will increase the level or effect of eucalyptus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• exemestane

  erythromycin lactobionate will increase the level or effect of exemestane by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• ezogabine

  ezogabine, erythromycin lactobionate. Either increases toxicity of the other by QTc interval. Use Caution/Monitor. Slight and transient QT-prolongation observed with ezogabine, particularly when dose titrated to 1200 mg/day. QT interval should be monitored when ezogabine is prescribed with agents known to increase QT interval.

• fedratinib

  fedratinib will increase the level or effect of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Adjust dose of drugs that are CYP3A4 substrates as necessary.

• finasteride

  erythromycin lactobionate will increase the level or effect of finasteride by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• finerenone

  erythromycin lactobionate will increase the level or effect of finerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Monitor serum potassium during initiation and dosage adjustment of either finererone or moderate CYP3A4 inhibitors. Adjust finererone dosage as needed.

• flecainide

  erythromycin lactobionate and flecainide both increase QTc interval. Modify Therapy/Monitor Closely.

• fludrocortisone

  erythromycin lactobionate will increase the level or effect of fludrocortisone by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• fluoxetine

  erythromycin lactobionate and fluoxetine both increase QTc interval. Modify Therapy/Monitor Closely.

• fluvastatin

  erythromycin lactobionate increases toxicity of fluvastatin by Other (see comment). Use Caution/Monitor. Comment: OATP1B1 inhibitors may increase risk of myopathy.

• fluvoxamine

  fluvoxamine and erythromycin lactobionate both increase QTc interval. Modify Therapy/Monitor Closely.

• foscarnet

  erythromycin lactobionate and foscarnet both increase QTc interval. Modify Therapy/Monitor Closely.

• fostamatinib

  fostamatinib will increase the level or effect of erythromycin lactobionate by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Concomitant use of fostamatinib may increase concentrations of P-gp substrates. Monitor for toxicities of the P-gp substrate drug that may require dosage reduction when given concurrently with fostamatinib.

• fostemsavir

  fostemsavir will increase the level or effect of erythromycin lactobionate by Other (see comment). Modify Therapy/Monitor Closely. Fostemsavir inhibits OATP1B1/3 transporter. If possible, avoid coadministration or modify dose of OATP1B1/3 substrates coadministered with fostemsavir.
  
  erythromycin lactobionate and fostemsavir both increase QTc interval. Use Caution/Monitor. QTc prolongation reported with higher than recommended doses of fostemsavir.

• gadobenate

  gadobenate and erythromycin lactobionate both increase QTc interval. Use Caution/Monitor.

• galantamine

  erythromycin lactobionate will increase the level or effect of galantamine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• gemtuzumab

  erythromycin lactobionate and gemtuzumab both increase QTc interval. Use Caution/Monitor.

• gentamicin

  erythromycin lactobionate will increase the level or effect of gentamicin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• goserelin

  goserelin increases levels of erythromycin lactobionate by QTc interval. Use Caution/Monitor. Increases risk of torsades de pointes.

• guanfacine

  erythromycin lactobionate will increase the level or effect of guanfacine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Strong or moderate CYP3A4 inhibitors significantly increase guanfacine plasma concentrations. FDA-approved labeling for extended-release (ER) guanfacine recommends that, if coadministered, the guanfacine dosage should be decreased to half of the recommended dose. Specific recommendations for immediate-release (IR) guanfacine are not available.

• histrelin

  histrelin increases levels of erythromycin lactobionate by QTc interval. Use Caution/Monitor. Increases risk of torsades de pointes.

• hydrocortisone

  erythromycin lactobionate will increase the level or effect of hydrocortisone by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• hydroxyzine

  hydroxyzine increases toxicity of erythromycin lactobionate by QTc interval. Use Caution/Monitor. Increases risk of torsades de pointes.

• ibrutinib

  erythromycin lactobionate increases levels of ibrutinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Coadministration with moderate CYP3A4 inhibitors, reduce ibrutinib dose to 280 mg qDay (B-cell malignancies) or 420 mg qDay (graft versus host disease). After CYP3A inhibitor discontinuation, resume previous dose of ibrutinib.

• ifosfamide

  erythromycin lactobionate will decrease the level or effect of ifosfamide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Use of a CYP3A4 inhibitor may decrease metabolism of ifosfamide, potentially reducing ifosfamide therapeutic effects.

• iloperidone

  erythromycin lactobionate and iloperidone both increase QTc interval. Modify Therapy/Monitor Closely.
  
  iloperidone increases levels of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Iloperidone is a time-dependent CYP3A inhibitor and may lead to increased plasma levels of drugs predominantly eliminated by CYP3A4.

• imatinib

  erythromycin lactobionate will increase the level or effect of imatinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
  
  erythromycin lactobionate will increase the level or effect of imatinib by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• imipramine

  erythromycin lactobionate will increase the level or effect of imipramine by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.

• indacaterol, inhaled

  erythromycin lactobionate increases levels of indacaterol, inhaled by Other (see comment). Use Caution/Monitor. Comment: Data suggests that systemic clearance is influenced by modulation of both P-gp and CYP3A4 activities. No dose adjustment is warranted at the 75 mcg dose.
  
  indacaterol, inhaled, erythromycin lactobionate. QTc interval. Use Caution/Monitor. Drugs that are known to prolong the QTc interval may have an increased the risk of ventricular arrhythmias.

• indinavir

  erythromycin lactobionate will increase the level or effect of indinavir by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• irinotecan

  erythromycin lactobionate will increase the level or effect of irinotecan by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• irinotecan liposomal

  erythromycin lactobionate will increase the level or effect of irinotecan liposomal by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• isavuconazonium sulfate

  erythromycin lactobionate will increase the level or effect of isavuconazonium sulfate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• isradipine

  erythromycin lactobionate will increase the level or effect of isradipine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• istradefylline

  istradefylline will increase the level or effect of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Istradefylline 40 mg/day increased peak levels and AUC of CYP3A4 substrates in clinical trials. This effect was not observed with istradefylline 20 mg/day. Consider dose reduction of sensitive CYP3A4 substrates.
  
  istradefylline will increase the level or effect of erythromycin lactobionate by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Istradefylline 40 mg/day increased peak levels and AUC of P-gp substrates in clinical trials. Consider dose reduction of sensitive P-gp substrates.

• itraconazole

  erythromycin lactobionate will increase the level or effect of itraconazole by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
  
  erythromycin lactobionate will increase the level or effect of itraconazole by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• ivacaftor

  erythromycin lactobionate will increase the level or effect of ivacaftor by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Reduce ivacaftor dose if coadministered with moderate CYP3A4 inhibitors. See specific ivacaftor-containing product for precise dosage modification.
  
  ivacaftor increases levels of erythromycin lactobionate by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Ivacaftor and its M1 metabolite has the potential to inhibit P-gp; may significantly increase systemic exposure to sensitive P-gp substrates with a narrow therapeutic index.

• ivermectin

  erythromycin lactobionate will increase the level or effect of ivermectin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• ivosidenib

  erythromycin lactobionate will increase the level or effect of ivosidenib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Coadministration with moderate CYP3A4 inhibitors may increase ivosidenib plasma concentrations, thus increasing the risk of QTc prolongation. Monitor for increased risk of QTc interval prolongation.

• ketoconazole

  erythromycin lactobionate will increase the level or effect of ketoconazole by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
  
  ketoconazole will increase the level or effect of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• lapatinib

  erythromycin lactobionate will increase the level or effect of lapatinib by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
  
  erythromycin lactobionate and lapatinib both increase QTc interval. Modify Therapy/Monitor Closely.

• larotrectinib

  erythromycin lactobionate will increase the level or effect of larotrectinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• lenacapavir

  lenacapavir will increase the level or effect of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Lencapavir (a moderate CYP3A4 inhibitor) may increase CYP3A4 substrates initiated within 9 months after last SC dose of lenacapavir, which may increase potential risk of adverse reactions of CYP3A4 substrates.

• lenvatinib

  erythromycin lactobionate and lenvatinib both increase QTc interval. Use Caution/Monitor. Lenvatinib prescribing information recommends monitoring ECG closely when coadministered with QT prolonging drugs.

• letermovir

  letermovir increases levels of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• leuprolide

  leuprolide increases toxicity of erythromycin lactobionate by QTc interval. Use Caution/Monitor. Increases risk of torsades de pointes.

• levamlodipine

  erythromycin lactobionate will increase the level or effect of levamlodipine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Coadministration with moderate and strong CYP3A inhibitors results in increased systemic exposure to amlodipine and may require dose reduction. Monitor for symptoms of hypotension and edema when amlodipine is coadministered with CYP3A inhibitors to determine the need for dose adjustment.

• levofloxacin

  erythromycin lactobionate and levofloxacin both increase QTc interval. Modify Therapy/Monitor Closely.

• levoketoconazole

  levoketoconazole will increase the level or effect of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
  
  erythromycin lactobionate will increase the level or effect of levoketoconazole by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• levonorgestrel oral/ethinylestradiol/ferrous bisglycinate

  erythromycin lactobionate will decrease the level or effect of levonorgestrel oral/ethinylestradiol/ferrous bisglycinate by altering intestinal flora. Applies only to oral forms of hormone. Low risk of contraceptive failure. Use Caution/Monitor. Antibiotics may decrease hormonal contraceptive efficacy.

• lidocaine

  erythromycin lactobionate will increase the level or effect of lidocaine by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.

• loperamide

  erythromycin lactobionate will increase the level or effect of loperamide by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• lorlatinib

  lorlatinib will decrease the level or effect of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• lumateperone

  erythromycin lactobionate will increase the level or effect of lumateperone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Reduce lumateperone dose to 21 mg/day if coadministered with moderate CYP3A4 inhibitors.

• lurasidone

  erythromycin lactobionate increases levels of lurasidone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Manufacturer recommends decreasing starting dose of lurasidone to 20 mg/day and maximum daily dose of lurasidone 80 mg when coadministered with moderate CYP3A4 inhibitors. Concurrent use may increase risk of lurasidone-related adverse reactions.

• maraviroc

  erythromycin lactobionate will increase the level or effect of maraviroc by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• mavacamten

  erythromycin lactobionate will increase the level or effect of mavacamten by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Inititiation of moderate CYP3A4 inhibitors may require decreased mavacamten dose.

• mefloquine

  erythromycin lactobionate will increase the level or effect of mefloquine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• mestranol

  erythromycin lactobionate will decrease the level or effect of mestranol by altering intestinal flora. Applies only to oral forms of hormone. Low risk of contraceptive failure. Modify Therapy/Monitor Closely.
  
  erythromycin lactobionate will increase the level or effect of mestranol by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• methadone

  erythromycin lactobionate and methadone both increase QTc interval. Modify Therapy/Monitor Closely.

• methylprednisolone

  erythromycin lactobionate will increase the level or effect of methylprednisolone by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• mexiletine

  erythromycin lactobionate will increase the level or effect of mexiletine by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.

• mifepristone

  erythromycin lactobionate will increase the level or effect of mifepristone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
  
  mifepristone, erythromycin lactobionate. QTc interval. Modify Therapy/Monitor Closely. Use alternatives if available.

• mipomersen

  mipomersen, erythromycin lactobionate. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: Both drugs have potential to increase hepatic enzymes; monitor LFTs.

• mitotane

  mitotane decreases levels of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Mitotane is a strong inducer of cytochrome P-4503A4; monitor when coadministered with CYP3A4 substrates for possible dosage adjustments.

• mitoxantrone

  erythromycin lactobionate will increase the level or effect of mitoxantrone by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• montelukast

  erythromycin lactobionate will increase the level or effect of montelukast by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• naldemedine

  erythromycin lactobionate increases levels of naldemedine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Monitor naldemedine for potential adverse effects if coadministered with strong or moderate CYP3A4 inhibitors.
  
  erythromycin lactobionate increases levels of naldemedine by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Monitor naldemedine for potential adverse effects if coadministered with P-gp inhibitors.

• nelfinavir

  erythromycin lactobionate will increase the level or effect of nelfinavir by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• neomycin PO

  erythromycin lactobionate will increase the level or effect of neomycin PO by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• niacin

  erythromycin lactobionate will decrease the level or effect of niacin by altering intestinal flora. Applies only to oral form of both agents. Use Caution/Monitor.

• nifedipine

  erythromycin lactobionate will increase the level or effect of nifedipine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Consider initiating nifedipine at the lowest dose available if given concomitantly with this medication

• nilotinib

  erythromycin lactobionate will increase the level or effect of nilotinib by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• nimodipine

  erythromycin lactobionate will increase the level or effect of nimodipine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• nirmatrelvir

  nirmatrelvir will increase the level or effect of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Monitor for increased erythromycin adverse effects, including QTc interval prolongation.

• nirmatrelvir/ritonavir

  nirmatrelvir/ritonavir will increase the level or effect of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Monitor for increased erythromycin adverse effects, including QTc interval prolongation.

• nitrendipine

  erythromycin lactobionate will increase the level or effect of nitrendipine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• ofloxacin

  erythromycin lactobionate and ofloxacin both increase QTc interval. Modify Therapy/Monitor Closely.

• olanzapine

  erythromycin lactobionate will increase the level or effect of olanzapine by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.

• oliceridine

  erythromycin lactobionate will increase the level or effect of oliceridine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. If concomitant use is necessary, may require less frequent oliceridine dosing. Closely monitor for respiratory depression and sedation and titrate subsequent doses accordingly. If inhibitor is discontinued, consider increase oliceridine dosage until stable drug effects are achieved. Monitor for signs of opioid withdrawal.

• olodaterol inhaled

  erythromycin lactobionate and olodaterol inhaled both increase QTc interval. Use Caution/Monitor. Drugs that prolong the QTc interval and may potentiate the effects of beta2 agonists on the cardiovascular system; increased risk of ventricular arrhythmias

• osilodrostat

  osilodrostat and erythromycin lactobionate both increase QTc interval. Use Caution/Monitor.

• osimertinib

  osimertinib and erythromycin lactobionate both increase QTc interval. Use Caution/Monitor. Conduct periodic monitoring with ECGs and electrolytes in patients taking drugs known to prolong the QTc interval.

• oxaliplatin

  oxaliplatin will increase the level or effect of erythromycin lactobionate by Other (see comment). Use Caution/Monitor. Monitor for ECG changes if therapy is initiated in patients with drugs known to prolong QT interval.

• oxybutynin

  erythromycin lactobionate will increase the level or effect of oxybutynin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• ozanimod

  ozanimod and erythromycin lactobionate both increase QTc interval. Modify Therapy/Monitor Closely. The potential additive effects on heart rate, treatment with ozanimod should generally not be initiated in patients who are concurrently treated with QT prolonging drugs with known arrhythmogenic properties.

• paclitaxel

  erythromycin lactobionate will increase the level or effect of paclitaxel by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
  
  erythromycin lactobionate will increase the level or effect of paclitaxel by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• paclitaxel protein bound

  erythromycin lactobionate will increase the level or effect of paclitaxel protein bound by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
  
  erythromycin lactobionate will increase the level or effect of paclitaxel protein bound by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• palbociclib

  erythromycin lactobionate will increase the level or effect of palbociclib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• paliperidone

  erythromycin lactobionate will increase the level or effect of paliperidone by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
  
  erythromycin lactobionate and paliperidone both increase QTc interval. Modify Therapy/Monitor Closely.

• pantothenic acid

  erythromycin lactobionate will decrease the level or effect of pantothenic acid by altering intestinal flora. Applies only to oral form of both agents. Use Caution/Monitor.

• parecoxib

  erythromycin lactobionate will increase the level or effect of parecoxib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• paromomycin

  erythromycin lactobionate will increase the level or effect of paromomycin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• paroxetine

  erythromycin lactobionate and paroxetine both increase QTc interval. Modify Therapy/Monitor Closely.

• pasireotide

  erythromycin lactobionate and pasireotide both increase QTc interval. Modify Therapy/Monitor Closely.

• pazopanib

  erythromycin lactobionate and pazopanib both increase QTc interval. Use Caution/Monitor.

• pimozide

  erythromycin lactobionate will increase the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• pioglitazone

  erythromycin lactobionate will increase the level or effect of pioglitazone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• piperacillin

  erythromycin lactobionate decreases effects of piperacillin by pharmacodynamic antagonism. Use Caution/Monitor. bacteriostatic agents may inhibit the effects of bactericidal agents.

• ponatinib

  ponatinib increases levels of erythromycin lactobionate by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• posaconazole

  erythromycin lactobionate will increase the level or effect of posaconazole by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
  
  erythromycin lactobionate and posaconazole both increase QTc interval. Modify Therapy/Monitor Closely.

• pravastatin

  erythromycin lactobionate increases toxicity of pravastatin by Other (see comment). Use Caution/Monitor. Comment: OATP1B1 inhibitors may increase risk of myopathy.

• prednisolone

  erythromycin lactobionate will increase the level or effect of prednisolone by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• prednisone

  erythromycin lactobionate will increase the level or effect of prednisone by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• propafenone

  erythromycin lactobionate will increase the level or effect of propafenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• pyridoxine

  erythromycin lactobionate will decrease the level or effect of pyridoxine by altering intestinal flora. Applies only to oral form of both agents. Use Caution/Monitor.

• pyridoxine (Antidote)

  erythromycin lactobionate will decrease the level or effect of pyridoxine (Antidote) by altering intestinal flora. Applies only to oral form of both agents. Use Caution/Monitor.

• quetiapine

  quetiapine, erythromycin lactobionate. Either increases toxicity of the other by QTc interval. Use Caution/Monitor. Avoid use with drugs that prolong QT and in patients with risk factors for prolonged QT interval. Postmarketing cases show QT prolongation with overdose in patients with concomitant illness or with drugs known to cause electrolyte imbalance or prolong QT.

• quinine

  erythromycin lactobionate will increase the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
  
  erythromycin lactobionate and quinine both increase QTc interval. Use Caution/Monitor.

• ramelteon

  erythromycin lactobionate will increase the level or effect of ramelteon by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.
  
  erythromycin lactobionate will increase the level or effect of ramelteon by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• ranolazine

  erythromycin lactobionate and ranolazine both increase QTc interval. Modify Therapy/Monitor Closely.

• rasagiline

  erythromycin lactobionate will increase the level or effect of rasagiline by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.

• ribociclib

  ribociclib will increase the level or effect of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• rifaximin

  erythromycin lactobionate increases levels of rifaximin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• rilpivirine

  erythromycin lactobionate increases levels of rilpivirine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Where possible, alternatives such as azithromycin should be considered.
  
  rilpivirine increases toxicity of erythromycin lactobionate by QTc interval. Use Caution/Monitor. Rilpivirine should be used with caution when co-administered with a drug with a known risk of Torsades de Pointes.

• rimegepant

  erythromycin lactobionate will increase the level or effect of rimegepant by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Avoid repeating rimegepant dose within 48 hr if coadministered with a moderate CYP3A4 inhibitor.

• risperidone

  erythromycin lactobionate will increase the level or effect of risperidone by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
  
  erythromycin lactobionate and risperidone both increase QTc interval. Modify Therapy/Monitor Closely.

• ritonavir

  erythromycin lactobionate will increase the level or effect of ritonavir by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• rivaroxaban

  erythromycin lactobionate increases levels of rivaroxaban by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Patients with renal impairment receiving rivaroxaban with drugs that are combined P-gp and weak or moderate CYP3A4 inhibitors may have significant increases in exposure compared with patients with normal renal function and no inhibitor use, since both pathways of rivaroxaban elimination are affected. Since these increases may increase bleeding risk, use rivaroxaban in this situation only if the potential benefit justifies the potential risk.

• roflumilast

  erythromycin lactobionate increases levels of roflumilast by Other (see comment). Modify Therapy/Monitor Closely. Comment: Coadministration with dual inhibitors of CYP3A4 and CYP1A2 may increase systemic exposure and result in increased adverse reactions.

• romidepsin

  erythromycin lactobionate will increase the level or effect of romidepsin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
  
  erythromycin lactobionate and romidepsin both increase QTc interval. Modify Therapy/Monitor Closely.

• ropinirole

  erythromycin lactobionate will increase the level or effect of ropinirole by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.

• rosuvastatin

  erythromycin lactobionate increases toxicity of rosuvastatin by Other (see comment). Use Caution/Monitor. Comment: OATP1B1 inhibitors may increase risk of myopathy.

• rucaparib

  rucaparib will increase the level or effect of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Adjust dosage of CYP3A4 substrates, if clinically indicated.

• ruxolitinib

  erythromycin lactobionate will increase the level or effect of ruxolitinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• ruxolitinib topical

  erythromycin lactobionate will increase the level or effect of ruxolitinib topical by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• sacubitril/valsartan

  erythromycin lactobionate will increase the level or effect of sacubitril/valsartan by Other (see comment). Use Caution/Monitor. The results from an in vitro study with human liver tissue indicate that valsartan is a substrate of the hepatic uptake transporter OATP1B1; coadministration with OATP1B1 inhibitors may increase valsartan systemic exposure

• saquinavir

  erythromycin lactobionate will increase the level or effect of saquinavir by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• sarecycline

  sarecycline will increase the level or effect of erythromycin lactobionate by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Monitor for toxicities of P-gp substrates that may require dosage reduction when coadministered with P-gp inhibitors.

• saxagliptin

  erythromycin lactobionate will increase the level or effect of saxagliptin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• selpercatinib

  selpercatinib increases toxicity of erythromycin lactobionate by QTc interval. Use Caution/Monitor.

• sertraline

  sertraline and erythromycin lactobionate both increase QTc interval. Use Caution/Monitor.

• sildenafil

  erythromycin lactobionate will increase the level or effect of sildenafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Consider a starting dose of 25 mg in patients treated with erythromycin.

• silodosin

  erythromycin lactobionate will increase the level or effect of silodosin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• sirolimus

  erythromycin lactobionate will increase the level or effect of sirolimus by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• sodium bicarbonate

  sodium bicarbonate increases levels of erythromycin lactobionate by unknown mechanism. Use Caution/Monitor.

• sodium citrate/citric acid

  sodium citrate/citric acid increases levels of erythromycin lactobionate by unknown mechanism. Use Caution/Monitor.

• sodium picosulfate/magnesium oxide/anhydrous citric acid

  erythromycin lactobionate decreases effects of sodium picosulfate/magnesium oxide/anhydrous citric acid by altering metabolism. Use Caution/Monitor. Coadministration with antibiotics decreases efficacy by altering colonic bacterial flora needed to convert sodium picosulfate to active drug.

• sonidegib

  erythromycin lactobionate will increase the level or effect of sonidegib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Avoid coadministration of sonidegib with moderate CYP3A4 inhibitors. If a moderate CYP3A inhibitor must be used, administer the moderate CYP3A inhibitor for <14 days and monitor closely for adverse reactions, particularly musculoskeletal adverse reactions.

• sorafenib

  sorafenib and erythromycin lactobionate both increase QTc interval. Use Caution/Monitor.

• sparsentan

  erythromycin lactobionate will increase the level or effect of sparsentan by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. No dosage adjustment needed. Monitor blood pressure, serum potassium, edema, and kidney function regularly if sparsentan is coadministered with moderate CYP3A4 inhibitors.

• stiripentol

  stiripentol, erythromycin lactobionate. affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Stiripentol is a CYP3A4 inhibitor and inducer. Monitor CYP3A4 substrates coadministered with stiripentol for increased or decreased effects. CYP3A4 substrates may require dosage adjustment.
  
  stiripentol will increase the level or effect of erythromycin lactobionate by P-glycoprotein (MDR1) efflux transporter. Modify Therapy/Monitor Closely. Consider reducing the dose of P-glycoprotein (P-gp) substrates, if adverse reactions are experienced when administered concomitantly with stiripentol.

• streptomycin

  erythromycin lactobionate will increase the level or effect of streptomycin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• sufentanil

  erythromycin lactobionate will increase the level or effect of sufentanil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• sufentanil SL

  erythromycin lactobionate will increase the level or effect of sufentanil SL by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Coadministration of sufentanil SL with any CYP3A4 inhibitor may increase sufentanil plasma concentration, and, thereby increase or prolonged adverse effects, including potentially fatal respiratory depression.

• sulfamethoxazole

  sulfamethoxazole and erythromycin lactobionate both increase QTc interval. Modify Therapy/Monitor Closely.

• suvorexant

  erythromycin lactobionate will increase the level or effect of suvorexant by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Decrease suvorexant starting dose to 5 mg HS if coadministered with moderate CYP3A4 inhibitors

• tacrolimus

  erythromycin lactobionate will increase the level or effect of tacrolimus by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• talazoparib

  erythromycin lactobionate will increase the level or effect of talazoparib by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Talazoparib is a P-glycoprotein (P-gp) substrate; coadministration with P-gp inhibitors may increase talazoparib systemic exposure.

• tamoxifen

  erythromycin lactobionate, tamoxifen. affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. CYP3A4 inhibition decreases metabolism of tamoxifen to N-desmethyl tamoxifen (active metabolite with similar biologic activity).

• tamsulosin

  erythromycin lactobionate increases levels of tamsulosin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Dose reduction may be needed for coadministered drugs that are predominantly metabolized by CYP3A.

• tazemetostat

  tazemetostat will decrease the level or effect of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• tecovirimat

  tecovirimat will decrease the level or effect of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Tecovirimat is a weak CYP3A4 inducer. Monitor sensitive CYP3A4 substrates for effectiveness if coadministered.

• telavancin

  erythromycin lactobionate and telavancin both increase QTc interval. Modify Therapy/Monitor Closely.

• tezacaftor

  erythromycin lactobionate will increase the level or effect of tezacaftor by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Adjust tezacaftor dosage regimen if coadministered with a moderate CYP3A inhibitor.

• theophylline

  erythromycin lactobionate will increase the level or effect of theophylline by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.

• thiamine

  erythromycin lactobionate will decrease the level or effect of thiamine by altering intestinal flora. Applies only to oral form of both agents. Use Caution/Monitor.

• tinidazole

  erythromycin lactobionate will increase the level or effect of tinidazole by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• tobramycin

  erythromycin lactobionate will increase the level or effect of tobramycin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• tobramycin inhaled

  tobramycin inhaled and erythromycin lactobionate both increase nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. Avoid concurrent or sequential use to decrease risk for ototoxicity

• tofacitinib

  erythromycin lactobionate increases levels of tofacitinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. No specific dose adjustment recommended when tofacitinib coadministered with moderate CYP3A4 inhibitors; decrease tofacitinib dose if coadministered with both moderate CYP3A4 and potent CYP2C19 inhibitors.

• tolvaptan

  erythromycin lactobionate will increase the level or effect of tolvaptan by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• trabectedin

  erythromycin lactobionate will increase the level or effect of trabectedin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• tramadol

  erythromycin lactobionate will increase the level or effect of tramadol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. May require decreased tramadol dose or adjustment of dosing interval; increased risk for serious adverse events including seizures and serotonin syndrome

• trazodone

  erythromycin lactobionate will increase the level or effect of trazodone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• trimethoprim

  erythromycin lactobionate and trimethoprim both increase QTc interval. Modify Therapy/Monitor Closely.

• triptorelin

  triptorelin increases toxicity of erythromycin lactobionate by QTc interval. Use Caution/Monitor. Increases risk of torsades de pointes.

• tropisetron

  erythromycin lactobionate and tropisetron both increase QTc interval. Modify Therapy/Monitor Closely.

• tucatinib

  tucatinib will increase the level or effect of erythromycin lactobionate by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Consider reducing the dosage of P-gp substrates, where minimal concentration changes may lead to serious or life-threatening toxicities.

• valbenazine

  valbenazine and erythromycin lactobionate both increase QTc interval. Use Caution/Monitor.

• valsartan

  erythromycin lactobionate will increase the level or effect of valsartan by Other (see comment). Use Caution/Monitor. The results from an in vitro study with human liver tissue indicate that valsartan is a substrate of the hepatic uptake transporter OATP1B1; coadministration with OATP1B1 inhibitors may increase valsartan systemic exposure

• vardenafil

  erythromycin lactobionate will increase the level or effect of vardenafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Limit vardenafil dose to 5 mg/24 hr

• venlafaxine

  erythromycin lactobionate and venlafaxine both increase QTc interval. Modify Therapy/Monitor Closely.

• vinblastine

  erythromycin lactobionate will increase the level or effect of vinblastine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
  
  erythromycin lactobionate will increase the level or effect of vinblastine by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• vincristine

  erythromycin lactobionate will increase the level or effect of vincristine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
  
  erythromycin lactobionate will increase the level or effect of vincristine by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• vincristine liposomal

  erythromycin lactobionate will increase the level or effect of vincristine liposomal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
  
  erythromycin lactobionate will increase the level or effect of vincristine liposomal by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• vinorelbine

  erythromycin lactobionate will increase the level or effect of vinorelbine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• vitamin K1 (phytonadione)

  erythromycin lactobionate will decrease the level or effect of vitamin K1 (phytonadione) by altering intestinal flora. Applies only to oral form of both agents. Use Caution/Monitor.

• voclosporin

  erythromycin lactobionate will increase the level or effect of voclosporin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Reduce voclosporin daily dosage to 15.8 mg PO in AM and 7.9 mg PO in PM.
  
  voclosporin, erythromycin lactobionate. Either increases effects of the other by QTc interval. Use Caution/Monitor.

• voriconazole

  erythromycin lactobionate and voriconazole both increase QTc interval. Modify Therapy/Monitor Closely.

• zaleplon

  erythromycin lactobionate will increase the level or effect of zaleplon by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• zanubrutinib

  erythromycin lactobionate will increase the level or effect of zanubrutinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Reduce zanubrutinib (a CYP3A4 substrate) to 80 mg PO BID to when coadministered with a moderate CYP3A4 inhibitor. Interrupt dose as recommended for adverse reactions. After discontinuing the CYP3A4 inhibitor, resume previous dose of zanubrutinib.

• ziprasidone

  erythromycin lactobionate will increase the level or effect of ziprasidone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• zolpidem

  erythromycin lactobionate will increase the level or effect of zolpidem by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• zonisamide

  erythromycin lactobionate will increase the level or effect of zonisamide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

Minor (43)

• acetazolamide

  acetazolamide will increase the level or effect of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• aliskiren

  erythromycin lactobionate will increase the level or effect of aliskiren by P-glycoprotein (MDR1) efflux transporter. Minor/Significance Unknown.

• alvimopan

  erythromycin lactobionate will increase the level or effect of alvimopan by P-glycoprotein (MDR1) efflux transporter. Minor/Significance Unknown.

• ambrisentan

  erythromycin lactobionate will increase the level or effect of ambrisentan by P-glycoprotein (MDR1) efflux transporter. Minor/Significance Unknown.

• amobarbital

  amobarbital decreases levels of erythromycin lactobionate by increasing elimination. Minor/Significance Unknown.

• amoxicillin

  erythromycin lactobionate decreases effects of amoxicillin by pharmacodynamic antagonism. Minor/Significance Unknown.

• ampicillin

  erythromycin lactobionate decreases effects of ampicillin by pharmacodynamic antagonism. Minor/Significance Unknown.

• anastrozole

  anastrozole will increase the level or effect of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• antipyrine

  erythromycin lactobionate will increase the level or effect of antipyrine by affecting hepatic enzyme CYP1A2 metabolism. Minor/Significance Unknown.

• armodafinil

  erythromycin lactobionate will increase the level or effect of armodafinil by P-glycoprotein (MDR1) efflux transporter. Minor/Significance Unknown.

• asenapine

  erythromycin lactobionate will increase the level or effect of asenapine by affecting hepatic enzyme CYP1A2 metabolism. Minor/Significance Unknown.

• butabarbital

  butabarbital decreases levels of erythromycin lactobionate by increasing elimination. Minor/Significance Unknown.

• butalbital

  butalbital decreases levels of erythromycin lactobionate by increasing elimination. Minor/Significance Unknown.

• caffeine

  erythromycin lactobionate will increase the level or effect of caffeine by affecting hepatic enzyme CYP1A2 metabolism. Minor/Significance Unknown.

• chlorpropamide

  erythromycin lactobionate increases levels of chlorpropamide by unknown mechanism. Minor/Significance Unknown. Risk of hepatotoxicity.

• clindamycin

  clindamycin, erythromycin lactobionate. Either decreases effects of the other by pharmacodynamic antagonism. Minor/Significance Unknown.

• cyclophosphamide

  cyclophosphamide will increase the level or effect of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• desloratadine

  erythromycin lactobionate increases levels of desloratadine by decreasing metabolism. Minor/Significance Unknown.

• dicloxacillin

  erythromycin lactobionate decreases effects of dicloxacillin by pharmacodynamic antagonism. Minor/Significance Unknown.

• estradiol vaginal

  erythromycin lactobionate will increase the level or effect of estradiol vaginal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• ethanol

  ethanol decreases levels of erythromycin lactobionate by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

• fexofenadine

  erythromycin lactobionate will increase the level or effect of fexofenadine by P-glycoprotein (MDR1) efflux transporter. Minor/Significance Unknown.

• frovatriptan

  erythromycin lactobionate will increase the level or effect of frovatriptan by affecting hepatic enzyme CYP1A2 metabolism. Minor/Significance Unknown.

• lansoprazole

  erythromycin lactobionate will increase the level or effect of lansoprazole by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• loratadine

  erythromycin lactobionate will increase the level or effect of loratadine by P-glycoprotein (MDR1) efflux transporter. Minor/Significance Unknown.

• methylprednisolone

  erythromycin lactobionate increases levels of methylprednisolone by decreasing metabolism. Minor/Significance Unknown.

• nafcillin

  erythromycin lactobionate decreases effects of nafcillin by pharmacodynamic antagonism. Minor/Significance Unknown. bacteriostatic antibiotics may interfere with the bactericidal actions of penicillins.

• oxacillin

  erythromycin lactobionate decreases effects of oxacillin by pharmacodynamic antagonism. Minor/Significance Unknown. bacteriostatic agents may inhibit the effects of bactericidal agents.

• penicillin G aqueous

  erythromycin lactobionate decreases effects of penicillin G aqueous by pharmacodynamic antagonism. Minor/Significance Unknown.

• penicillin VK

  erythromycin lactobionate decreases effects of penicillin VK by pharmacodynamic antagonism. Minor/Significance Unknown.

• pentobarbital

  pentobarbital decreases levels of erythromycin lactobionate by increasing elimination. Minor/Significance Unknown.

• phenobarbital

  phenobarbital decreases levels of erythromycin lactobionate by increasing elimination. Minor/Significance Unknown.

• pivmecillinam

  erythromycin lactobionate decreases effects of pivmecillinam by pharmacodynamic antagonism. Minor/Significance Unknown.

• prednisone

  erythromycin lactobionate increases levels of prednisone by decreasing metabolism. Minor/Significance Unknown. Risk of toxic steroid concentrations and altered mental status.

• primidone

  primidone decreases levels of erythromycin lactobionate by increasing elimination. Minor/Significance Unknown.

• rabeprazole

  erythromycin lactobionate will increase the level or effect of rabeprazole by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• riluzole

  erythromycin lactobionate will increase the level or effect of riluzole by affecting hepatic enzyme CYP1A2 metabolism. Minor/Significance Unknown.

• rosuvastatin

  erythromycin lactobionate decreases levels of rosuvastatin by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

• secobarbital

  secobarbital decreases levels of erythromycin lactobionate by increasing elimination. Minor/Significance Unknown.

• temocillin

  erythromycin lactobionate decreases effects of temocillin by pharmacodynamic antagonism. Minor/Significance Unknown.

• ticarcillin

  erythromycin lactobionate decreases effects of ticarcillin by pharmacodynamic antagonism. Minor/Significance Unknown.

• valproic acid

  erythromycin lactobionate increases levels of valproic acid by decreasing metabolism. Minor/Significance Unknown.

• zafirlukast

  erythromycin lactobionate decreases levels of zafirlukast by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

• abametapir

  Serious - Use Alternative (1)abametapir will increase the level or effect of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. For 2 weeks after abametapir application, avoid taking drugs that are CYP3A4 substrates. If not feasible, avoid use of abametapir.

• acalabrutinib

  Monitor Closely (1)erythromycin lactobionate will increase the level or effect of acalabrutinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Decrease acalabrutinib dose to 100 mg once daily if coadministered with a moderate CYP3A inhibitor.

• acetazolamide

  Minor (1)acetazolamide will increase the level or effect of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• adagrasib

  Serious - Use Alternative (1)adagrasib, erythromycin lactobionate. Either increases effects of the other by QTc interval. Avoid or Use Alternate Drug. Each drug prolongs the QTc interval, which may increased the risk of Torsade de pointes, other serious arryhthmias, and sudden death. If coadministration unavoidable, more frequent monitoring is recommended for such patients.

• afatinib

  Serious - Use Alternative (1)erythromycin lactobionate increases levels of afatinib by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug. Reduce afatinib daily dose by 10 mg if not tolerated when coadministered with P-gp inhibitors.

• albuterol

  Monitor Closely (1)albuterol and erythromycin lactobionate both increase QTc interval. Use Caution/Monitor.

• alfentanil

  Monitor Closely (1)erythromycin lactobionate will increase the level or effect of alfentanil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• alfuzosin

  Monitor Closely (2)erythromycin lactobionate and alfuzosin both increase QTc interval. Use Caution/Monitor.
  
  erythromycin lactobionate will increase the level or effect of alfuzosin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.Serious - Use Alternative (1)alfuzosin and erythromycin lactobionate both increase QTc interval. Avoid or Use Alternate Drug.

• aliskiren

  Monitor Closely (1)erythromycin lactobionate will increase the level or effect of aliskiren by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.Minor (1)erythromycin lactobionate will increase the level or effect of aliskiren by P-glycoprotein (MDR1) efflux transporter. Minor/Significance Unknown.

• almotriptan

  Serious - Use Alternative (1)erythromycin lactobionate will increase the level or effect of almotriptan by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• alosetron

  Monitor Closely (1)erythromycin lactobionate will increase the level or effect of alosetron by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.Serious - Use Alternative (1)erythromycin lactobionate will increase the level or effect of alosetron by affecting hepatic enzyme CYP1A2 metabolism. Avoid or Use Alternate Drug.

• alprazolam

  Serious - Use Alternative (1)erythromycin lactobionate will increase the level or effect of alprazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• aluminum hydroxide

  Monitor Closely (1)aluminum hydroxide increases levels of erythromycin lactobionate by unknown mechanism. Use Caution/Monitor.

• alvimopan

  Minor (1)erythromycin lactobionate will increase the level or effect of alvimopan by P-glycoprotein (MDR1) efflux transporter. Minor/Significance Unknown.

• ambrisentan

  Minor (1)erythromycin lactobionate will increase the level or effect of ambrisentan by P-glycoprotein (MDR1) efflux transporter. Minor/Significance Unknown.

• amifampridine

  Monitor Closely (1)erythromycin lactobionate increases toxicity of amifampridine by Other (see comment). Modify Therapy/Monitor Closely. Comment: Amifampridine can cause seizures. Coadministration with drugs that lower seizure threshold may increase this risk.

• amikacin

  Monitor Closely (1)erythromycin lactobionate will increase the level or effect of amikacin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• amiodarone

  Serious - Use Alternative (2)erythromycin lactobionate will increase the level or effect of amiodarone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
  
  amiodarone and erythromycin lactobionate both increase QTc interval. Avoid or Use Alternate Drug.

• amisulpride

  Serious - Use Alternative (1)amisulpride and erythromycin lactobionate both increase QTc interval. Avoid or Use Alternate Drug. ECG monitoring is recommended if coadministered.

• amitriptyline

  Serious - Use Alternative (3)amitriptyline and erythromycin lactobionate both increase QTc interval. Avoid or Use Alternate Drug.
  
  erythromycin lactobionate will increase the level or effect of amitriptyline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
  
  erythromycin lactobionate will increase the level or effect of amitriptyline by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug.

• amlodipine

  Monitor Closely (1)erythromycin lactobionate will increase the level or effect of amlodipine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• amobarbital

  Serious - Use Alternative (1)amobarbital will decrease the level or effect of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.Minor (1)amobarbital decreases levels of erythromycin lactobionate by increasing elimination. Minor/Significance Unknown.

• amoxapine

  Serious - Use Alternative (1)amoxapine and erythromycin lactobionate both increase QTc interval. Avoid or Use Alternate Drug.

• amoxicillin

  Minor (1)erythromycin lactobionate decreases effects of amoxicillin by pharmacodynamic antagonism. Minor/Significance Unknown.

• ampicillin

  Minor (1)erythromycin lactobionate decreases effects of ampicillin by pharmacodynamic antagonism. Minor/Significance Unknown.

• anagrelide

  Serious - Use Alternative (1)anagrelide and erythromycin lactobionate both increase QTc interval. Avoid or Use Alternate Drug.

• anastrozole

  Minor (1)anastrozole will increase the level or effect of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• antipyrine

  Minor (1)erythromycin lactobionate will increase the level or effect of antipyrine by affecting hepatic enzyme CYP1A2 metabolism. Minor/Significance Unknown.

• antithrombin alfa

  Serious - Use Alternative (1)erythromycin lactobionate increases effects of antithrombin alfa by decreasing metabolism. Avoid or Use Alternate Drug.

• antithrombin III

  Serious - Use Alternative (1)erythromycin lactobionate increases effects of antithrombin III by decreasing metabolism. Avoid or Use Alternate Drug.

• apalutamide

  Serious - Use Alternative (1)apalutamide will decrease the level or effect of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Coadministration of apalutamide, a strong CYP3A4 inducer, with drugs that are CYP3A4 substrates can result in lower exposure to these medications. Avoid or substitute another drug for these medications when possible. Evaluate for loss of therapeutic effect if medication must be coadministered. Adjust dose according to prescribing information if needed.

• apomorphine

  Monitor Closely (1)apomorphine and erythromycin lactobionate both increase QTc interval. Use Caution/Monitor.

• aprepitant

  Serious - Use Alternative (2)aprepitant will increase the level or effect of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.
  
  erythromycin lactobionate will increase the level or effect of aprepitant by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• arformoterol

  Monitor Closely (1)arformoterol and erythromycin lactobionate both increase QTc interval. Use Caution/Monitor.

• argatroban

  Serious - Use Alternative (1)erythromycin lactobionate increases effects of argatroban by decreasing metabolism. Avoid or Use Alternate Drug.

• aripiprazole

  Monitor Closely (1)aripiprazole and erythromycin lactobionate both increase QTc interval. Use Caution/Monitor.Serious - Use Alternative (1)erythromycin lactobionate will increase the level or effect of aripiprazole by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• armodafinil

  Monitor Closely (1)erythromycin lactobionate will increase the level or effect of armodafinil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.Serious - Use Alternative (1)armodafinil will decrease the level or effect of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.Minor (1)erythromycin lactobionate will increase the level or effect of armodafinil by P-glycoprotein (MDR1) efflux transporter. Minor/Significance Unknown.

• arsenic trioxide

  Contraindicated (1)arsenic trioxide and erythromycin lactobionate both increase QTc interval. Contraindicated.

• artemether

  Serious - Use Alternative (1)artemether and erythromycin lactobionate both increase QTc interval. Avoid or Use Alternate Drug.

• artemether/lumefantrine

  Serious - Use Alternative (3)erythromycin lactobionate and artemether/lumefantrine both increase QTc interval. Avoid or Use Alternate Drug.
  
  artemether/lumefantrine will decrease the level or effect of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.
  
  erythromycin lactobionate will increase the level or effect of artemether/lumefantrine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• asenapine

  Serious - Use Alternative (1)asenapine and erythromycin lactobionate both increase QTc interval. Avoid or Use Alternate Drug.Minor (1)erythromycin lactobionate will increase the level or effect of asenapine by affecting hepatic enzyme CYP1A2 metabolism. Minor/Significance Unknown.

• asenapine transdermal

  Serious - Use Alternative (1)asenapine transdermal and erythromycin lactobionate both increase QTc interval. Avoid or Use Alternate Drug.

• atazanavir

  Monitor Closely (1)erythromycin lactobionate will increase the level or effect of atazanavir by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.Serious - Use Alternative (1)atazanavir will increase the level or effect of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.

• atogepant

  Monitor Closely (1)erythromycin lactobionate will increase the level or effect of atogepant by Other (see comment). Modify Therapy/Monitor Closely. Recommended dosage of atogepant (an OATP1B1 substrate) with concomitant use of OATP inhibitors is 10 mg or 30 mg qDay.

• atomoxetine

  Serious - Use Alternative (1)atomoxetine and erythromycin lactobionate both increase QTc interval. Avoid or Use Alternate Drug.

• atorvastatin

  Monitor Closely (1)erythromycin lactobionate will increase the level or effect of atorvastatin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.Serious - Use Alternative (2)erythromycin lactobionate will increase the level or effect of atorvastatin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
  
  erythromycin lactobionate increases toxicity of atorvastatin by Other (see comment). Avoid or Use Alternate Drug. Comment: OATP1B1 inhibitors may increase risk of myopathy.

• avanafil

  Monitor Closely (1)erythromycin lactobionate will increase the level or effect of avanafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. CYP3A4 inhibitors may reduce avanafil clearance increasing systemic exposure to avanafil; increased levels may result in increased associated adverse events; the maximum recommended dose of STENDRA is 50 mg, not to exceed once every 24 hours for patients taking concomitant moderate CYP3A4 inhibitors

• avapritinib

  Serious - Use Alternative (1)erythromycin lactobionate will increase the level or effect of avapritinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of avapritinib with moderate CYP3A4 inhibitors. If unable to avoid, reduce avapritinib starting dose. See drug monograph Dosage Modifications.

• axitinib

  Serious - Use Alternative (1)erythromycin lactobionate increases levels of axitinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. If unable to avoid coadministration with moderate CYP3A4 inhibitors, monitor closely and reduce dose if necessary .

• azithromycin

  Monitor Closely (2)azithromycin will increase the level or effect of erythromycin lactobionate by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
  
  azithromycin and erythromycin lactobionate both increase QTc interval. Use Caution/Monitor.

• balsalazide

  Monitor Closely (1)erythromycin lactobionate will decrease the level or effect of balsalazide by altering intestinal flora. Applies only to oral form of both agents. Use Caution/Monitor.

• bazedoxifene/conjugated estrogens

  Monitor Closely (2)erythromycin lactobionate will increase the level or effect of bazedoxifene/conjugated estrogens by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
  
  erythromycin lactobionate will decrease the level or effect of bazedoxifene/conjugated estrogens by altering intestinal flora. Applies only to oral forms of hormone. Low risk of contraceptive failure. Modify Therapy/Monitor Closely.Serious - Use Alternative (1)erythromycin lactobionate will increase the level or effect of bazedoxifene/conjugated estrogens by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• BCG vaccine live

  Serious - Use Alternative (1)erythromycin lactobionate decreases effects of BCG vaccine live by pharmacodynamic antagonism. Contraindicated. Wait until Abx Tx complete to administer live bacterial vaccine.

• bedaquiline

  Monitor Closely (1)erythromycin lactobionate and bedaquiline both increase QTc interval. Modify Therapy/Monitor Closely. ECG should be monitored closely

• belzutifan

  Monitor Closely (1)belzutifan will decrease the level or effect of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. If unable to avoid coadministration of belzutifan with sensitive CYP3A4 substrates, consider increasing the sensitive CYP3A4 substrate dose in accordance with its prescribing information.

• bemiparin

  Serious - Use Alternative (1)erythromycin lactobionate increases effects of bemiparin by decreasing metabolism. Avoid or Use Alternate Drug.

• bendamustine

  Monitor Closely (1)erythromycin lactobionate decreases effects of bendamustine by decreasing metabolism. Use Caution/Monitor. Decreased conversion of bendamustine to active metabolites.

• berotralstat

  Monitor Closely (2)berotralstat will increase the level or effect of erythromycin lactobionate by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Monitor or titrate P-gp substrate dose if coadministered.
  
  erythromycin lactobionate increases levels of berotralstat by P-glycoprotein (MDR1) efflux transporter. Modify Therapy/Monitor Closely. Reduced berotralstat dose to 110 mg/day when coadministered with P-gp inhibitors.

• betrixaban

  Monitor Closely (1)erythromycin lactobionate increases levels of betrixaban by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Decrease betrixaban dose to 80 mg PO once, then 40 mg PO qDay if coadministered with a P-gp inhibitor.

• bexarotene

  Monitor Closely (1)erythromycin lactobionate will increase the level or effect of bexarotene by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• biotin

  Monitor Closely (1)erythromycin lactobionate will decrease the level or effect of biotin by altering intestinal flora. Applies only to oral form of both agents. Use Caution/Monitor.

• bivalirudin

  Serious - Use Alternative (1)erythromycin lactobionate increases effects of bivalirudin by decreasing metabolism. Avoid or Use Alternate Drug.

• bortezomib

  Monitor Closely (1)erythromycin lactobionate will increase the level or effect of bortezomib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• bosentan

  Monitor Closely (1)erythromycin lactobionate will increase the level or effect of bosentan by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.Serious - Use Alternative (1)bosentan will decrease the level or effect of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• bosutinib

  Serious - Use Alternative (1)erythromycin lactobionate increases levels of bosutinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• brexpiprazole

  Monitor Closely (1)erythromycin lactobionate will increase the level or effect of brexpiprazole by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Administer a quarter of brexpiprazole dose if coadministered with a moderate CYP3A4 inhibitor PLUS a strong/moderate CYP2D6 inhibitor.

• bromocriptine

  Monitor Closely (1)erythromycin lactobionate increases levels of bromocriptine by unknown mechanism. Use Caution/Monitor.

• budesonide

  Monitor Closely (1)erythromycin lactobionate will increase the level or effect of budesonide by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.Serious - Use Alternative (2)erythromycin lactobionate will increase the level or effect of budesonide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
  
  budesonide will decrease the level or effect of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• buprenorphine

  Serious - Use Alternative (1)buprenorphine and erythromycin lactobionate both increase QTc interval. Avoid or Use Alternate Drug.

• buprenorphine buccal

  Serious - Use Alternative (1)buprenorphine buccal and erythromycin lactobionate both increase QTc interval. Avoid or Use Alternate Drug.

• buprenorphine subdermal implant

  Monitor Closely (1)erythromycin lactobionate will increase the level or effect of buprenorphine subdermal implant by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Monitor patients already on buprenorphine subdermal implant who require newly-initiated treatment with CYP3A4 inhibitors for signs and symptoms of overmedication. If the dose of the concomitant CYP3A4 inhibitor cannot be reduced or discontinued, implant removal may be necessary and the patient should then be treated with a buprenorphine dosage form that permits dose adjustments. If a CYP3A4 inhibitor is discontinued in a patient who has been stabilized on buprenorphine, monitor the patient for withdrawal.Serious - Use Alternative (1)buprenorphine subdermal implant and erythromycin lactobionate both increase QTc interval. Avoid or Use Alternate Drug.

• buprenorphine transdermal

  Serious - Use Alternative (1)buprenorphine transdermal and erythromycin lactobionate both increase QTc interval. Avoid or Use Alternate Drug.

• buprenorphine, long-acting injection

  Monitor Closely (1)erythromycin lactobionate will increase the level or effect of buprenorphine, long-acting injection by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Patients who transfer to buprenorphine long-acting injection from transmucosal buprenorphine coadministered with CYP3A4 inhibitors should be monitored to ensure buprenorphine plasma levels are adequate. Within 2 weeks, if signs and symptoms of buprenorphine toxicity or overdose occur and the concomitant CYP3A4 inhibitor cannot be reduced or discontinued, transition the patient back to a buprenorphine formulation that permits dose adjustments.Serious - Use Alternative (1)buprenorphine, long-acting injection and erythromycin lactobionate both increase QTc interval. Avoid or Use Alternate Drug.

• buspirone

  Serious - Use Alternative (1)erythromycin lactobionate will increase the level or effect of buspirone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• butabarbital

  Serious - Use Alternative (1)butabarbital will decrease the level or effect of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.Minor (1)butabarbital decreases levels of erythromycin lactobionate by increasing elimination. Minor/Significance Unknown.

• butalbital

  Serious - Use Alternative (1)butalbital will decrease the level or effect of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.Minor (1)butalbital decreases levels of erythromycin lactobionate by increasing elimination. Minor/Significance Unknown.

• cabazitaxel

  Monitor Closely (1)erythromycin lactobionate will increase the level or effect of cabazitaxel by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Caution should be exercised with concomitant use of moderate CYP3A4 inhibitors.

• cabozantinib

  Monitor Closely (1)erythromycin lactobionate will increase the level or effect of cabozantinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• caffeine

  Minor (1)erythromycin lactobionate will increase the level or effect of caffeine by affecting hepatic enzyme CYP1A2 metabolism. Minor/Significance Unknown.

• calcium carbonate

  Monitor Closely (1)calcium carbonate increases levels of erythromycin lactobionate by unknown mechanism. Use Caution/Monitor.

• cannabidiol

  Monitor Closely (1)erythromycin lactobionate will increase the level or effect of cannabidiol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Consider reducing the cannabidiol dose when coadministered with a moderate CYP3A4 inhibitor.

• carbamazepine

  Serious - Use Alternative (2)carbamazepine will decrease the level or effect of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
  
  erythromycin lactobionate will increase the level or effect of carbamazepine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Monitor plasma levels when used concomitantly

• cefdinir

  Monitor Closely (1)erythromycin lactobionate decreases effects of cefdinir by pharmacodynamic antagonism. Use Caution/Monitor. bacteriostatic agents may inhibit the effects of bactericidal agents.

• cefditoren

  Monitor Closely (1)erythromycin lactobionate decreases effects of cefditoren by pharmacodynamic antagonism. Use Caution/Monitor. bacteriostatic agents may inhibit the effects of bactericidal agents.

• cefoxitin

  Monitor Closely (1)erythromycin lactobionate decreases effects of cefoxitin by pharmacodynamic antagonism. Use Caution/Monitor. bacteriostatic agents may inhibit the effects of bactericidal agents.

• cefpodoxime

  Monitor Closely (1)erythromycin lactobionate decreases effects of cefpodoxime by pharmacodynamic antagonism. Use Caution/Monitor. bacteriostatic agents may inhibit the effects of bactericidal agents.

• ceftriaxone

  Monitor Closely (1)erythromycin lactobionate decreases effects of ceftriaxone by pharmacodynamic antagonism. Use Caution/Monitor. bacteriostatic agents may inhibit the effects of bactericidal agents.

• cefuroxime

  Monitor Closely (1)erythromycin lactobionate decreases effects of cefuroxime by pharmacodynamic antagonism. Use Caution/Monitor. bacteriostatic agents may inhibit the effects of bactericidal agents.

• cenobamate

  Monitor Closely (1)cenobamate will decrease the level or effect of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Increase dose of CYP3A4 substrate, as needed, when coadministered with cenobamate.

• ceritinib

  Monitor Closely (1)erythromycin lactobionate increases levels of ceritinib by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.Serious - Use Alternative (2)ceritinib and erythromycin lactobionate both increase QTc interval. Avoid or Use Alternate Drug.
  
  ceritinib will increase the level or effect of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• cevimeline

  Monitor Closely (1)erythromycin lactobionate will increase the level or effect of cevimeline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• chloroquine

  Monitor Closely (1)chloroquine increases toxicity of erythromycin lactobionate by QTc interval. Use Caution/Monitor.

• chlorpromazine

  Serious - Use Alternative (1)chlorpromazine and erythromycin lactobionate both increase QTc interval. Avoid or Use Alternate Drug.

• chlorpropamide

  Minor (1)erythromycin lactobionate increases levels of chlorpropamide by unknown mechanism. Minor/Significance Unknown. Risk of hepatotoxicity.

• cholera vaccine

  Serious - Use Alternative (1)erythromycin lactobionate, cholera vaccine. pharmacodynamic antagonism. Avoid or Use Alternate Drug. Avoid coadministration of cholera vaccine with systemic antibiotics since these agents may be active against the vaccine strain. Do not administer cholera vaccine to patients who have received oral or parenteral antibiotics within 14 days prior to vaccination.

• cilostazol

  Serious - Use Alternative (1)erythromycin lactobionate will increase the level or effect of cilostazol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Dose reduction to 50 mg twice daily should be considered

• cimetidine

  Serious - Use Alternative (1)cimetidine will increase the level or effect of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• cinacalcet

  Serious - Use Alternative (1)erythromycin lactobionate will increase the level or effect of cinacalcet by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• ciprofloxacin

  Monitor Closely (1)ciprofloxacin and erythromycin lactobionate both increase QTc interval. Use Caution/Monitor. Coadministration of ciprofloxacin with drugs known to prolong QT interval could increase risk of developing torsade de pointes in predisposed patients; however less likely with ciprofloxacin than other quinolones.

• citalopram

  Monitor Closely (1)erythromycin lactobionate increases levels of citalopram by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. ECG monitoring is recommended, along with drugs that may prolong the QT interval.Serious - Use Alternative (1)citalopram and erythromycin lactobionate both increase QTc interval. Avoid or Use Alternate Drug.

• clarithromycin

  Monitor Closely (1)erythromycin lactobionate will increase the level or effect of clarithromycin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.Serious - Use Alternative (2)clarithromycin will increase the level or effect of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
  
  clarithromycin and erythromycin lactobionate both increase QTc interval. Avoid or Use Alternate Drug.

• clindamycin

  Minor (1)clindamycin, erythromycin lactobionate. Either decreases effects of the other by pharmacodynamic antagonism. Minor/Significance Unknown.

• clomipramine

  Monitor Closely (1)erythromycin lactobionate will increase the level or effect of clomipramine by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.Serious - Use Alternative (2)clomipramine and erythromycin lactobionate both increase QTc interval. Avoid or Use Alternate Drug.
  
  erythromycin lactobionate will increase the level or effect of clomipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• clopidogrel

  Serious - Use Alternative (1)erythromycin lactobionate will decrease the level or effect of clopidogrel by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Inhibition of CYP3A4 will reduce clopidogrel bioactivation

• clozapine

  Monitor Closely (1)erythromycin lactobionate will increase the level or effect of clozapine by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.Serious - Use Alternative (2)erythromycin lactobionate will increase the level or effect of clozapine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
  
  clozapine and erythromycin lactobionate both increase QTc interval. Avoid or Use Alternate Drug.

• cobicistat

  Serious - Use Alternative (1)cobicistat, erythromycin lactobionate. Either increases levels of the other by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Consider alternative antibiotics with concomitant use of cobicistat coadministered with atazanavir or darunavir. .

• cobimetinib

  Serious - Use Alternative (1)erythromycin lactobionate will increase the level or effect of cobimetinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. If concurrent short term (14 days or less) use of moderate CYP3A inhibitors is unavoidable for patients who are taking cobimetinib 60 mg, reduce the cobimetinib dose to 20 mg. After discontinuation of a moderate CYP3A inhibitor, resume cobimetinib 60 mg. Use an alternative to a moderate CYP3A inhibitor in patients who are taking a reduced dose of cobimetinib (40 or 20 mg daily).

• colchicine

  Serious - Use Alternative (1)erythromycin lactobionate will increase the level or effect of colchicine by Other (see comment). Avoid or Use Alternate Drug. Colchicine is a P-gp and CYP3A4 substrate. Avoid use with drugs that are both P-gp and strong CYP3A4 inhibitors. If coadministration is necessary, decrease colchicine dose or frequency as recommended in prescribing information. Use of any colchicine product in conjunction with strong CYP3A4 inhibitors is contraindicated in patients with renal or hepatic impairment.

• conivaptan

  Monitor Closely (1)erythromycin lactobionate will increase the level or effect of conivaptan by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.Serious - Use Alternative (1)conivaptan will increase the level or effect of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.

• conjugated estrogens

  Monitor Closely (2)erythromycin lactobionate will increase the level or effect of conjugated estrogens by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
  
  erythromycin lactobionate will decrease the level or effect of conjugated estrogens by altering intestinal flora. Applies only to oral forms of hormone. Low risk of contraceptive failure. Modify Therapy/Monitor Closely.Serious - Use Alternative (1)erythromycin lactobionate will increase the level or effect of conjugated estrogens by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• conjugated estrogens, vaginal

  Monitor Closely (1)erythromycin lactobionate will increase the level or effect of conjugated estrogens, vaginal by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.Serious - Use Alternative (1)erythromycin lactobionate will increase the level or effect of conjugated estrogens, vaginal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• cortisone

  Monitor Closely (1)erythromycin lactobionate will increase the level or effect of cortisone by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.Serious - Use Alternative (2)erythromycin lactobionate will increase the level or effect of cortisone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
  
  cortisone will decrease the level or effect of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• crizotinib

  Monitor Closely (3)crizotinib increases levels of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Dose reduction may be needed for coadministered drugs that are predominantly metabolized by CYP3A. ECG monitoring is recommended, along with drugs that may prolong the QT interval.
  
  crizotinib increases levels of erythromycin lactobionate by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. ECG monitoring is recommended, along with drugs that may prolong the QT interval.
  
  erythromycin lactobionate increases levels of crizotinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Caution should be exercised with concomitant use of moderate CYP3A inhibitors. .Serious - Use Alternative (1)crizotinib and erythromycin lactobionate both increase QTc interval. Avoid or Use Alternate Drug.

• cyclophosphamide

  Minor (1)cyclophosphamide will increase the level or effect of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• cyclosporine

  Monitor Closely (2)erythromycin lactobionate will increase the level or effect of cyclosporine by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
  
  cyclosporine will increase the level or effect of erythromycin lactobionate by Other (see comment). Use Caution/Monitor. may increase plasma concentrations of organic anion transporter protein substratesSerious - Use Alternative (2)erythromycin lactobionate will increase the level or effect of cyclosporine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
  
  cyclosporine will increase the level or effect of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• dabigatran

  Monitor Closely (1)erythromycin lactobionate will increase the level or effect of dabigatran by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Atrial fibrillation: Avoid coadministering dabigatran with P-gp inhibitors if CrCl <30 mL/min. DVT/PE treatment: Avoid coadministering dabigatran with P-gp inhibitors if CrCl <50 mL/min

• dabrafenib

  Monitor Closely (1)dabrafenib will decrease the level or effect of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely.

• dactinomycin

  Monitor Closely (1)erythromycin lactobionate will increase the level or effect of dactinomycin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• dalteparin

  Serious - Use Alternative (1)erythromycin lactobionate increases effects of dalteparin by decreasing metabolism. Avoid or Use Alternate Drug.

• dapsone

  Monitor Closely (1)erythromycin lactobionate will increase the level or effect of dapsone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• daridorexant

  Monitor Closely (1)erythromycin lactobionate will increase the level or effect of daridorexant by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Daridorexant dose should not exceed 25 mg per night when coadministered with moderate CYP3A4 inhibitors.

• darifenacin

  Serious - Use Alternative (2)erythromycin lactobionate will increase the level or effect of darifenacin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
  
  darifenacin will increase the level or effect of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• darunavir

  Monitor Closely (1)erythromycin lactobionate will increase the level or effect of darunavir by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely.Serious - Use Alternative (1)darunavir will increase the level or effect of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.

• dasatinib

  Monitor Closely (1)dasatinib and erythromycin lactobionate both increase QTc interval. Modify Therapy/Monitor Closely.Serious - Use Alternative (2)dasatinib will increase the level or effect of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.
  
  erythromycin lactobionate will increase the level or effect of dasatinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• daunorubicin

  Monitor Closely (1)erythromycin lactobionate will increase the level or effect of daunorubicin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• deferasirox

  Monitor Closely (1)deferasirox will decrease the level or effect of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• deflazacort

  Monitor Closely (2)erythromycin lactobionate will increase the level or effect of deflazacort by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
  
  erythromycin lactobionate will increase the level or effect of deflazacort by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Decrease deflazacort dose to one-third of the recommended dose if coadministered with moderate or strong CYP3A4 inhibitors.

• degarelix

  Serious - Use Alternative (1)degarelix and erythromycin lactobionate both increase QTc interval. Avoid or Use Alternate Drug.

• desflurane

  Serious - Use Alternative (1)desflurane and erythromycin lactobionate both increase QTc interval. Avoid or Use Alternate Drug.

• desipramine

  Serious - Use Alternative (1)desipramine and erythromycin lactobionate both increase QTc interval. Avoid or Use Alternate Drug.

• desloratadine

  Minor (1)erythromycin lactobionate increases levels of desloratadine by decreasing metabolism. Minor/Significance Unknown.

• deutetrabenazine

  Monitor Closely (1)deutetrabenazine and erythromycin lactobionate both increase QTc interval. Use Caution/Monitor. At the maximum recommended dose, deutetrabenazine does not prolong QT interval to a clinically relevant extent. Certain circumstances may increase risk of torsade de pointes and/or sudden death in association with drugs that prolong the QTc interval (eg, bradycardia, hypokalemia or hypomagnesemia, coadministration with other drugs that prolong QTc interval, presence of congenital QT prolongation).

• dexamethasone

  Monitor Closely (1)erythromycin lactobionate will increase the level or effect of dexamethasone by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.Serious - Use Alternative (2)erythromycin lactobionate will increase the level or effect of dexamethasone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
  
  dexamethasone will decrease the level or effect of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• DHEA, herbal

  Serious - Use Alternative (1)DHEA, herbal will increase the level or effect of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• diazepam

  Serious - Use Alternative (1)erythromycin lactobionate will increase the level or effect of diazepam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• diazepam intranasal

  Monitor Closely (1)erythromycin lactobionate will increase the level or effect of diazepam intranasal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Strong or moderate CYP3A4 inhibitors may decrease rate of diazepam elimination, thereby increasing adverse reactions to diazepam.

• dicloxacillin

  Minor (1)erythromycin lactobionate decreases effects of dicloxacillin by pharmacodynamic antagonism. Minor/Significance Unknown.

• dienogest/estradiol valerate

  Monitor Closely (2)erythromycin lactobionate will decrease the level or effect of dienogest/estradiol valerate by altering intestinal flora. Applies only to oral forms of hormone. Low risk of contraceptive failure. Use Caution/Monitor. An alternate or additional form of birth control may be advisable during concomitant use.
  
  erythromycin lactobionate will increase the level or effect of dienogest/estradiol valerate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Monitor for potential adverse effects such as nausea, irregular uterine bleeding, breast tenderness and headache.

• digoxin

  Monitor Closely (1)erythromycin lactobionate will increase the level or effect of digoxin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.Serious - Use Alternative (1)erythromycin lactobionate will increase the level or effect of digoxin by altering intestinal flora. Applies only to oral form of both agents. Avoid or Use Alternate Drug.

• dihydroergotamine

  Contraindicated (1)erythromycin lactobionate will increase the level or effect of dihydroergotamine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.

• dihydroergotamine intranasal

  Contraindicated (1)erythromycin lactobionate will increase the level or effect of dihydroergotamine intranasal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.

• diltiazem

  Serious - Use Alternative (2)erythromycin lactobionate will increase the level or effect of diltiazem by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Consider an alternative to erythromycin in patients receiving diltiazem. If no alternative is available, monitor for the effects of diltiazem following erythromycin initiation/discontinuation.
  
  diltiazem will increase the level or effect of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• disopyramide

  Contraindicated (1)disopyramide and erythromycin lactobionate both increase QTc interval. Contraindicated.Monitor Closely (1)erythromycin lactobionate will increase the level or effect of disopyramide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• docetaxel

  Monitor Closely (2)erythromycin lactobionate will increase the level or effect of docetaxel by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
  
  erythromycin lactobionate will increase the level or effect of docetaxel by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• dofetilide

  Serious - Use Alternative (1)dofetilide and erythromycin lactobionate both increase QTc interval. Avoid or Use Alternate Drug.

• dolasetron

  Monitor Closely (1)dolasetron and erythromycin lactobionate both increase QTc interval. Modify Therapy/Monitor Closely.

• donepezil

  Monitor Closely (1)erythromycin lactobionate will increase the level or effect of donepezil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.Serious - Use Alternative (1)donepezil and erythromycin lactobionate both increase QTc interval. Avoid or Use Alternate Drug.

• doxepin

  Serious - Use Alternative (1)doxepin and erythromycin lactobionate both increase QTc interval. Avoid or Use Alternate Drug.

• doxorubicin

  Monitor Closely (2)erythromycin lactobionate will increase the level or effect of doxorubicin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
  
  erythromycin lactobionate will increase the level or effect of doxorubicin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• doxorubicin liposomal

  Monitor Closely (2)erythromycin lactobionate will increase the level or effect of doxorubicin liposomal by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
  
  erythromycin lactobionate will increase the level or effect of doxorubicin liposomal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• dronedarone

  Serious - Use Alternative (3)erythromycin lactobionate will increase the level or effect of dronedarone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
  
  dronedarone and erythromycin lactobionate both increase QTc interval. Avoid or Use Alternate Drug.
  
  dronedarone will increase the level or effect of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.

• droperidol

  Serious - Use Alternative (1)droperidol and erythromycin lactobionate both increase QTc interval. Avoid or Use Alternate Drug.

• duloxetine

  Serious - Use Alternative (1)erythromycin lactobionate will increase the level or effect of duloxetine by affecting hepatic enzyme CYP1A2 metabolism. Avoid or Use Alternate Drug.

• dutasteride

  Monitor Closely (1)erythromycin lactobionate will increase the level or effect of dutasteride by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• duvelisib

  Monitor Closely (1)duvelisib will increase the level or effect of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Coadministration with duvelisib increases AUC of a sensitive CYP3A4 substrate which may increase the risk of toxicities of these drugs. Consider reducing the dose of the sensitive CYP3A4 substrate and monitor for signs of toxicities of the coadministered sensitive CYP3A substrate.

• edoxaban

  Serious - Use Alternative (1)erythromycin lactobionate will increase the level or effect of edoxaban by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug. Dose adjustment may be required with strong P-gp inhibitors. DVT/PE treatment: Decrease dose to 30 mg PO once daily. NVAF: No dose reduction recommended

• efavirenz

  Monitor Closely (1)erythromycin lactobionate will increase the level or effect of efavirenz by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.Serious - Use Alternative (2)efavirenz will decrease the level or effect of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.
  
  efavirenz and erythromycin lactobionate both increase QTc interval. Avoid or Use Alternate Drug.

• elacestrant

  Serious - Use Alternative (1)erythromycin lactobionate will increase the level or effect of elacestrant by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• elagolix

  Contraindicated (1)erythromycin lactobionate will increase the level or effect of elagolix by Other (see comment). Contraindicated. Concomitant use of elagolix and strong OATP1B1 inhibitors is contraindicated.Monitor Closely (2)elagolix will increase the level or effect of erythromycin lactobionate by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
  
  elagolix will decrease the level or effect of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Elagolix is a weak-to-moderate CYP3A4 inducer. Monitor CYP3A substrates if coadministered. Consider increasing CYP3A substrate dose if needed.

• eletriptan

  Serious - Use Alternative (2)erythromycin lactobionate increases levels of eletriptan by decreasing metabolism. Contraindicated. Separate by 72 hours.
  
  erythromycin lactobionate will increase the level or effect of eletriptan by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• eliglustat

  Monitor Closely (1)eliglustat increases levels of erythromycin lactobionate by P-glycoprotein (MDR1) efflux transporter. Modify Therapy/Monitor Closely. Monitor therapeutic drug concentrations, as indicated, or consider reducing the dosage of the P-gp substrate and titrate to clinical effect.Serious - Use Alternative (2)erythromycin lactobionate increases levels of eliglustat by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Moderate CYP3A4 inhibitors are not recommended with eliglustat poor or intermediate metabolizers; reduce eliglustat dose from 84 mg BID to 84 mg once daily in extensive metabolizers .
  
  eliglustat and erythromycin lactobionate both increase QTc interval. Avoid or Use Alternate Drug.

• eltrombopag

  Monitor Closely (1)erythromycin lactobionate will increase the level or effect of eltrombopag by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.

• eluxadoline

  Monitor Closely (1)eluxadoline increases levels of erythromycin lactobionate by decreasing metabolism. Use Caution/Monitor. Eluxadoline may increase the systemic exposure of coadministered OATP1B1 substrates.Serious - Use Alternative (1)erythromycin lactobionate increases levels of eluxadoline by decreasing metabolism. Avoid or Use Alternate Drug. Decrease eluxadoline dose to 75 mg PO BID if coadministered with OATP1B1 inhibitors. .

• elvitegravir/cobicistat/emtricitabine/tenofovir DF

  Monitor Closely (1)elvitegravir/cobicistat/emtricitabine/tenofovir DF increases levels of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Cobicistat is a CYP3A4 inhibitor; contraindicated with CYP3A4 substrates for which elevated plasma concentrations are associated with serious and/or life-threatening events.

• encorafenib

  Monitor Closely (2)encorafenib, erythromycin lactobionate. affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Encorafenib both inhibits and induces CYP3A4 at clinically relevant plasma concentrations. Coadministration of encorafenib with sensitive CYP3A4 substrates may result in increased toxicity or decreased efficacy of these agents.
  
  encorafenib will increase the level or effect of erythromycin lactobionate by Other (see comment). Modify Therapy/Monitor Closely. Encorafenib (a OATP1B3 inhibitor) may increase the concentration and toxicities of OATP1B3 substrates. Closely monitor for signs and symptoms of increased exposure and consider adjusting the dose of these substrates.Serious - Use Alternative (2)erythromycin lactobionate will increase the level or effect of encorafenib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. If concomitant use of a moderate CYP3A4 inhibitor is unavoidable, reduce encorafenib dose to one-half of the dose (eg, reduce from 450 mg/day to 225 mg/day). After discontinuing the inhibitor for 3-5 elimination half-lives, resume previous encorafenib dose.
  
  encorafenib and erythromycin lactobionate both increase QTc interval. Avoid or Use Alternate Drug.

• enoxaparin

  Serious - Use Alternative (1)erythromycin lactobionate increases effects of enoxaparin by decreasing metabolism. Avoid or Use Alternate Drug.

• entrectinib

  Serious - Use Alternative (2)erythromycin lactobionate and entrectinib both increase QTc interval. Avoid or Use Alternate Drug.
  
  erythromycin lactobionate will increase the level or effect of entrectinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of moderate CYP3A4 inhibitors with entrectinib, a CYP3A4 substrate. If coadministration unavoidable, reduce dose to 200 mg/day for patients aged 12 y or older with BSA >1.50m2. Resume previous entrectinib dose after discontinuing moderate CYP3A inhibitor for 3-5 elimination half-lives.

• enzalutamide

  Serious - Use Alternative (1)enzalutamide will decrease the level or effect of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• epinephrine

  Serious - Use Alternative (1)epinephrine and erythromycin lactobionate both increase QTc interval. Avoid or Use Alternate Drug.

• epinephrine racemic

  Serious - Use Alternative (1)epinephrine racemic and erythromycin lactobionate both increase QTc interval. Avoid or Use Alternate Drug.

• eplerenone

  Monitor Closely (1)erythromycin lactobionate will increase the level or effect of eplerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• erdafitinib

  Serious - Use Alternative (1)erdafitinib will increase the level or effect of erythromycin lactobionate by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug. If coadministration unavoidable, separate administration by at least 6 hr before or after administration of P-gp substrates with narrow therapeutic index.

• ergotamine

  Serious - Use Alternative (1)erythromycin lactobionate will increase the level or effect of ergotamine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• eribulin

  Serious - Use Alternative (1)eribulin and erythromycin lactobionate both increase QTc interval. Avoid or Use Alternate Drug. Potential for enhanced QTc-prolonging effects; if concurrent use is necessary then ECG monitoring is recommended.

• erlotinib

  Monitor Closely (1)erythromycin lactobionate will increase the level or effect of erlotinib by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.Serious - Use Alternative (1)erythromycin lactobionate will increase the level or effect of erlotinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• escitalopram

  Serious - Use Alternative (1)escitalopram increases toxicity of erythromycin lactobionate by QTc interval. Avoid or Use Alternate Drug.

• eslicarbazepine acetate

  Serious - Use Alternative (1)eslicarbazepine acetate will decrease the level or effect of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• estradiol

  Monitor Closely (2)erythromycin lactobionate will increase the level or effect of estradiol by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
  
  erythromycin lactobionate will decrease the level or effect of estradiol by altering intestinal flora. Applies only to oral forms of hormone. Low risk of contraceptive failure. Modify Therapy/Monitor Closely.Serious - Use Alternative (1)erythromycin lactobionate will increase the level or effect of estradiol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• estradiol vaginal

  Minor (1)erythromycin lactobionate will increase the level or effect of estradiol vaginal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• estrogens conjugated synthetic

  Monitor Closely (2)erythromycin lactobionate will increase the level or effect of estrogens conjugated synthetic by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
  
  erythromycin lactobionate will decrease the level or effect of estrogens conjugated synthetic by altering intestinal flora. Applies only to oral forms of hormone. Low risk of contraceptive failure. Modify Therapy/Monitor Closely.Serious - Use Alternative (1)erythromycin lactobionate will increase the level or effect of estrogens conjugated synthetic by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• estrogens esterified

  Monitor Closely (2)erythromycin lactobionate will increase the level or effect of estrogens esterified by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
  
  erythromycin lactobionate will decrease the level or effect of estrogens esterified by altering intestinal flora. Applies only to oral forms of hormone. Low risk of contraceptive failure. Modify Therapy/Monitor Closely.Serious - Use Alternative (1)erythromycin lactobionate will increase the level or effect of estrogens esterified by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• estropipate

  Monitor Closely (2)erythromycin lactobionate will increase the level or effect of estropipate by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
  
  erythromycin lactobionate will decrease the level or effect of estropipate by altering intestinal flora. Applies only to oral forms of hormone. Low risk of contraceptive failure. Modify Therapy/Monitor Closely.Serious - Use Alternative (1)erythromycin lactobionate will increase the level or effect of estropipate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• eszopiclone

  Monitor Closely (2)erythromycin lactobionate increases levels of eszopiclone by enhancing GI absorption. Applies only to oral form of both agents. Use Caution/Monitor.
  
  erythromycin lactobionate increases levels of eszopiclone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Reduce eszopiclone starting dose to 1 mg/day.

• ethanol

  Minor (1)ethanol decreases levels of erythromycin lactobionate by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

• ethinylestradiol

  Monitor Closely (1)erythromycin lactobionate will decrease the level or effect of ethinylestradiol by altering intestinal flora. Applies only to oral forms of hormone. Low risk of contraceptive failure. Use Caution/Monitor. Antibiotics may decrease hormonal contraceptive efficacy.

• etonogestrel

  Serious - Use Alternative (1)erythromycin lactobionate will increase the level or effect of etonogestrel by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• etoposide

  Monitor Closely (2)erythromycin lactobionate will increase the level or effect of etoposide by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
  
  erythromycin lactobionate will increase the level or effect of etoposide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• etravirine

  Serious - Use Alternative (2)etravirine will decrease the level or effect of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.
  
  erythromycin lactobionate will increase the level or effect of etravirine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• eucalyptus

  Monitor Closely (1)erythromycin lactobionate will increase the level or effect of eucalyptus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• everolimus

  Serious - Use Alternative (2)erythromycin lactobionate will increase the level or effect of everolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
  
  erythromycin lactobionate will increase the level or effect of everolimus by P-glycoprotein (MDR1) efflux transporter. Contraindicated.

• exemestane

  Monitor Closely (1)erythromycin lactobionate will increase the level or effect of exemestane by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• ezogabine

  Monitor Closely (1)ezogabine, erythromycin lactobionate. Either increases toxicity of the other by QTc interval. Use Caution/Monitor. Slight and transient QT-prolongation observed with ezogabine, particularly when dose titrated to 1200 mg/day. QT interval should be monitored when ezogabine is prescribed with agents known to increase QT interval.

• fedratinib

  Monitor Closely (1)fedratinib will increase the level or effect of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Adjust dose of drugs that are CYP3A4 substrates as necessary.

• felodipine

  Serious - Use Alternative (1)erythromycin lactobionate will increase the level or effect of felodipine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• fentanyl

  Serious - Use Alternative (1)erythromycin lactobionate will increase the level or effect of fentanyl by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. If coadministration of CYP3A4 inhibitors with fentanyl is necessary, monitor patients for respiratory depression and sedation at frequent intervals and consider fentanyl dose adjustments until stable drug effects are achieved.

• fentanyl intranasal

  Serious - Use Alternative (1)erythromycin lactobionate will increase the level or effect of fentanyl intranasal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. If coadministration of CYP3A4 inhibitors with fentanyl is necessary, monitor patients for respiratory depression and sedation at frequent intervals and consider fentanyl dose adjustments until stable drug effects are achieved.

• fentanyl transdermal

  Serious - Use Alternative (1)erythromycin lactobionate will increase the level or effect of fentanyl transdermal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. If coadministration of CYP3A4 inhibitors with fentanyl is necessary, monitor patients for respiratory depression and sedation at frequent intervals and consider fentanyl dose adjustments until stable drug effects are achieved.

• fentanyl transmucosal

  Serious - Use Alternative (1)erythromycin lactobionate will increase the level or effect of fentanyl transmucosal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. If coadministration of CYP3A4 inhibitors with fentanyl is necessary, monitor patients for respiratory depression and sedation at frequent intervals and consider fentanyl dose adjustments until stable drug effects are achieved.

• fesoterodine

  Serious - Use Alternative (1)erythromycin lactobionate will increase the level or effect of fesoterodine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• fexinidazole

  Serious - Use Alternative (2)fexinidazole and erythromycin lactobionate both increase QTc interval. Avoid or Use Alternate Drug. Avoid coadministration of fexinidazole with drugs known to block potassium channels and/or prolong QT interval.
  
  fexinidazole will increase the level or effect of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Fexinidazole inhibits CYP3A4. Coadministration may increase risk for adverse effects of CYP3A4 substrates.

• fexofenadine

  Minor (1)erythromycin lactobionate will increase the level or effect of fexofenadine by P-glycoprotein (MDR1) efflux transporter. Minor/Significance Unknown.

• fezolinetant

  Contraindicated (1)erythromycin lactobionate will increase the level or effect of fezolinetant by affecting hepatic enzyme CYP1A2 metabolism. Contraindicated. Fezolinetant AUC and peak plasma concentration are increased if coadministered with drugs that are weak, moderate, or strong CYP1A2 inhibitors

• finasteride

  Monitor Closely (1)erythromycin lactobionate will increase the level or effect of finasteride by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• finerenone

  Monitor Closely (1)erythromycin lactobionate will increase the level or effect of finerenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Monitor serum potassium during initiation and dosage adjustment of either finererone or moderate CYP3A4 inhibitors. Adjust finererone dosage as needed.

• fingolimod

  Serious - Use Alternative (1)fingolimod and erythromycin lactobionate both increase QTc interval. Avoid or Use Alternate Drug.

• flecainide

  Monitor Closely (1)erythromycin lactobionate and flecainide both increase QTc interval. Modify Therapy/Monitor Closely.

• flibanserin

  Contraindicated (1)erythromycin lactobionate will increase the level or effect of flibanserin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated. Coadministration of flibanserin with moderate or strong CYP3A4 inhibitors is contraindicated. Severe hypotension or syncope can occur.

• fluconazole

  Contraindicated (2)erythromycin lactobionate and fluconazole both increase QTc interval. Contraindicated.
  
  fluconazole will increase the level or effect of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.

• fludrocortisone

  Monitor Closely (1)erythromycin lactobionate will increase the level or effect of fludrocortisone by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.Serious - Use Alternative (2)erythromycin lactobionate will increase the level or effect of fludrocortisone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
  
  fludrocortisone will decrease the level or effect of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• fluoxetine

  Monitor Closely (1)erythromycin lactobionate and fluoxetine both increase QTc interval. Modify Therapy/Monitor Closely.

• fluphenazine

  Serious - Use Alternative (1)fluphenazine and erythromycin lactobionate both increase QTc interval. Avoid or Use Alternate Drug.

• fluvastatin

  Monitor Closely (1)erythromycin lactobionate increases toxicity of fluvastatin by Other (see comment). Use Caution/Monitor. Comment: OATP1B1 inhibitors may increase risk of myopathy.

• fluvoxamine

  Monitor Closely (1)fluvoxamine and erythromycin lactobionate both increase QTc interval. Modify Therapy/Monitor Closely.

• fondaparinux

  Serious - Use Alternative (1)erythromycin lactobionate increases effects of fondaparinux by decreasing metabolism. Avoid or Use Alternate Drug.

• formoterol

  Serious - Use Alternative (1)erythromycin lactobionate and formoterol both increase QTc interval. Avoid or Use Alternate Drug.

• fosamprenavir

  Serious - Use Alternative (2)fosamprenavir will increase the level or effect of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.
  
  erythromycin lactobionate will increase the level or effect of fosamprenavir by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• fosaprepitant

  Serious - Use Alternative (2)fosaprepitant will increase the level or effect of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.
  
  erythromycin lactobionate will increase the level or effect of fosaprepitant by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• foscarnet

  Monitor Closely (1)erythromycin lactobionate and foscarnet both increase QTc interval. Modify Therapy/Monitor Closely.

• fosphenytoin

  Serious - Use Alternative (1)fosphenytoin will decrease the level or effect of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.

• fostamatinib

  Monitor Closely (1)fostamatinib will increase the level or effect of erythromycin lactobionate by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Concomitant use of fostamatinib may increase concentrations of P-gp substrates. Monitor for toxicities of the P-gp substrate drug that may require dosage reduction when given concurrently with fostamatinib.

• fostemsavir

  Monitor Closely (2)erythromycin lactobionate and fostemsavir both increase QTc interval. Use Caution/Monitor. QTc prolongation reported with higher than recommended doses of fostemsavir.
  
  fostemsavir will increase the level or effect of erythromycin lactobionate by Other (see comment). Modify Therapy/Monitor Closely. Fostemsavir inhibits OATP1B1/3 transporter. If possible, avoid coadministration or modify dose of OATP1B1/3 substrates coadministered with fostemsavir.

• frovatriptan

  Minor (1)erythromycin lactobionate will increase the level or effect of frovatriptan by affecting hepatic enzyme CYP1A2 metabolism. Minor/Significance Unknown.

• gadobenate

  Monitor Closely (1)gadobenate and erythromycin lactobionate both increase QTc interval. Use Caution/Monitor.

• galantamine

  Monitor Closely (1)erythromycin lactobionate will increase the level or effect of galantamine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• gemifloxacin

  Serious - Use Alternative (1)gemifloxacin and erythromycin lactobionate both increase QTc interval. Avoid or Use Alternate Drug.

• gemtuzumab

  Monitor Closely (1)erythromycin lactobionate and gemtuzumab both increase QTc interval. Use Caution/Monitor.

• gentamicin

  Monitor Closely (1)erythromycin lactobionate will increase the level or effect of gentamicin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• gilteritinib

  Serious - Use Alternative (1)gilteritinib and erythromycin lactobionate both increase QTc interval. Avoid or Use Alternate Drug.

• glasdegib

  Serious - Use Alternative (1)erythromycin lactobionate and glasdegib both increase QTc interval. Avoid or Use Alternate Drug. If coadministration unavoidable, monitor for increased risk of QTc interval prolongation.

• goserelin

  Monitor Closely (1)goserelin increases levels of erythromycin lactobionate by QTc interval. Use Caution/Monitor. Increases risk of torsades de pointes.

• granisetron

  Serious - Use Alternative (1)granisetron and erythromycin lactobionate both increase QTc interval. Avoid or Use Alternate Drug.

• grapefruit

  Serious - Use Alternative (1)grapefruit will increase the level or effect of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• griseofulvin

  Serious - Use Alternative (1)griseofulvin will decrease the level or effect of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.

• guanfacine

  Monitor Closely (1)erythromycin lactobionate will increase the level or effect of guanfacine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Strong or moderate CYP3A4 inhibitors significantly increase guanfacine plasma concentrations. FDA-approved labeling for extended-release (ER) guanfacine recommends that, if coadministered, the guanfacine dosage should be decreased to half of the recommended dose. Specific recommendations for immediate-release (IR) guanfacine are not available.

• haloperidol

  Serious - Use Alternative (1)erythromycin lactobionate and haloperidol both increase QTc interval. Avoid or Use Alternate Drug.

• heparin

  Serious - Use Alternative (1)erythromycin lactobionate increases effects of heparin by decreasing metabolism. Avoid or Use Alternate Drug.

• histrelin

  Monitor Closely (1)histrelin increases levels of erythromycin lactobionate by QTc interval. Use Caution/Monitor. Increases risk of torsades de pointes.

• hydrocortisone

  Monitor Closely (1)erythromycin lactobionate will increase the level or effect of hydrocortisone by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.Serious - Use Alternative (2)erythromycin lactobionate will increase the level or effect of hydrocortisone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
  
  hydrocortisone will decrease the level or effect of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• hydroxychloroquine sulfate

  Serious - Use Alternative (1)hydroxychloroquine sulfate and erythromycin lactobionate both increase QTc interval. Avoid or Use Alternate Drug.

• hydroxyprogesterone caproate (DSC)

  Serious - Use Alternative (1)erythromycin lactobionate will increase the level or effect of hydroxyprogesterone caproate (DSC) by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• hydroxyzine

  Monitor Closely (1)hydroxyzine increases toxicity of erythromycin lactobionate by QTc interval. Use Caution/Monitor. Increases risk of torsades de pointes.

• ibrutinib

  Monitor Closely (1)erythromycin lactobionate increases levels of ibrutinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Coadministration with moderate CYP3A4 inhibitors, reduce ibrutinib dose to 280 mg qDay (B-cell malignancies) or 420 mg qDay (graft versus host disease). After CYP3A inhibitor discontinuation, resume previous dose of ibrutinib.

• ibutilide

  Contraindicated (1)erythromycin lactobionate and ibutilide both increase QTc interval. Contraindicated.

• idelalisib

  Serious - Use Alternative (1)idelalisib will increase the level or effect of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Idelalisib is a strong CYP3A inhibitor; avoid coadministration with sensitive CYP3A substrates

• ifosfamide

  Monitor Closely (1)erythromycin lactobionate will decrease the level or effect of ifosfamide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Use of a CYP3A4 inhibitor may decrease metabolism of ifosfamide, potentially reducing ifosfamide therapeutic effects.

• iloperidone

  Monitor Closely (2)erythromycin lactobionate and iloperidone both increase QTc interval. Modify Therapy/Monitor Closely.
  
  iloperidone increases levels of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Iloperidone is a time-dependent CYP3A inhibitor and may lead to increased plasma levels of drugs predominantly eliminated by CYP3A4.Serious - Use Alternative (1)erythromycin lactobionate will increase the level or effect of iloperidone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• imatinib

  Monitor Closely (2)erythromycin lactobionate will increase the level or effect of imatinib by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
  
  erythromycin lactobionate will increase the level or effect of imatinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• imipramine

  Monitor Closely (1)erythromycin lactobionate will increase the level or effect of imipramine by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.Serious - Use Alternative (2)imipramine and erythromycin lactobionate both increase QTc interval. Avoid or Use Alternate Drug.
  
  erythromycin lactobionate will increase the level or effect of imipramine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• indacaterol, inhaled

  Monitor Closely (2)indacaterol, inhaled, erythromycin lactobionate. QTc interval. Use Caution/Monitor. Drugs that are known to prolong the QTc interval may have an increased the risk of ventricular arrhythmias.
  
  erythromycin lactobionate increases levels of indacaterol, inhaled by Other (see comment). Use Caution/Monitor. Comment: Data suggests that systemic clearance is influenced by modulation of both P-gp and CYP3A4 activities. No dose adjustment is warranted at the 75 mcg dose.

• indapamide

  Contraindicated (1)erythromycin lactobionate and indapamide both increase QTc interval. Contraindicated.

• indinavir

  Monitor Closely (1)erythromycin lactobionate will increase the level or effect of indinavir by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.Serious - Use Alternative (2)erythromycin lactobionate will increase the level or effect of indinavir by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
  
  indinavir will increase the level or effect of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• infigratinib

  Serious - Use Alternative (1)erythromycin lactobionate will increase the level or effect of infigratinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• inotuzumab

  Serious - Use Alternative (1)inotuzumab and erythromycin lactobionate both increase QTc interval. Avoid or Use Alternate Drug. If unable to avoid concomitant use, obtain ECGs and electrolytes before and after initiation of any drug known to prolong QTc, and periodically monitor as clinically indicated during treatment.

• irinotecan

  Monitor Closely (1)erythromycin lactobionate will increase the level or effect of irinotecan by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.Serious - Use Alternative (1)erythromycin lactobionate will increase the level or effect of irinotecan by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• irinotecan liposomal

  Monitor Closely (1)erythromycin lactobionate will increase the level or effect of irinotecan liposomal by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.Serious - Use Alternative (1)erythromycin lactobionate will increase the level or effect of irinotecan liposomal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• isavuconazonium sulfate

  Monitor Closely (1)erythromycin lactobionate will increase the level or effect of isavuconazonium sulfate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• isoflurane

  Serious - Use Alternative (1)isoflurane and erythromycin lactobionate both increase QTc interval. Avoid or Use Alternate Drug.

• isoniazid

  Serious - Use Alternative (1)isoniazid will increase the level or effect of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• isradipine

  Monitor Closely (1)erythromycin lactobionate will increase the level or effect of isradipine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• istradefylline

  Monitor Closely (2)istradefylline will increase the level or effect of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Istradefylline 40 mg/day increased peak levels and AUC of CYP3A4 substrates in clinical trials. This effect was not observed with istradefylline 20 mg/day. Consider dose reduction of sensitive CYP3A4 substrates.
  
  istradefylline will increase the level or effect of erythromycin lactobionate by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Istradefylline 40 mg/day increased peak levels and AUC of P-gp substrates in clinical trials. Consider dose reduction of sensitive P-gp substrates.

• itraconazole

  Monitor Closely (2)erythromycin lactobionate will increase the level or effect of itraconazole by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
  
  erythromycin lactobionate will increase the level or effect of itraconazole by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.Serious - Use Alternative (2)itraconazole will increase the level or effect of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
  
  itraconazole and erythromycin lactobionate both increase QTc interval. Avoid or Use Alternate Drug.

• ivabradine

  Serious - Use Alternative (1)erythromycin lactobionate will increase the level or effect of ivabradine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of ivabradine with moderate CYP3A4 inhibitors.

• ivacaftor

  Monitor Closely (2)ivacaftor increases levels of erythromycin lactobionate by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Ivacaftor and its M1 metabolite has the potential to inhibit P-gp; may significantly increase systemic exposure to sensitive P-gp substrates with a narrow therapeutic index.
  
  erythromycin lactobionate will increase the level or effect of ivacaftor by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Reduce ivacaftor dose if coadministered with moderate CYP3A4 inhibitors. See specific ivacaftor-containing product for precise dosage modification.

• ivermectin

  Monitor Closely (1)erythromycin lactobionate will increase the level or effect of ivermectin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• ivosidenib

  Monitor Closely (1)erythromycin lactobionate will increase the level or effect of ivosidenib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Coadministration with moderate CYP3A4 inhibitors may increase ivosidenib plasma concentrations, thus increasing the risk of QTc prolongation. Monitor for increased risk of QTc interval prolongation.Serious - Use Alternative (2)ivosidenib and erythromycin lactobionate both increase QTc interval. Avoid or Use Alternate Drug. Avoid coadministration of QTc prolonging drugs with ivosidenib or replace with alternate therapies. If coadministration of a QTc prolonging drug is unavoidable, monitor for increased risk of QTc interval prolongation.
  
  ivosidenib will decrease the level or effect of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of sensitive CYP3A4 substrates with ivosidenib or replace with alternate therapies. If coadministration is unavoidable, monitor patients for loss of therapeutic effect of these drugs.

• ixabepilone

  Serious - Use Alternative (1)erythromycin lactobionate will increase the level or effect of ixabepilone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• ketoconazole

  Monitor Closely (2)ketoconazole will increase the level or effect of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
  
  erythromycin lactobionate will increase the level or effect of ketoconazole by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.Serious - Use Alternative (1)erythromycin lactobionate and ketoconazole both increase QTc interval. Avoid or Use Alternate Drug.

• lansoprazole

  Minor (1)erythromycin lactobionate will increase the level or effect of lansoprazole by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• lapatinib

  Monitor Closely (2)erythromycin lactobionate will increase the level or effect of lapatinib by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
  
  erythromycin lactobionate and lapatinib both increase QTc interval. Modify Therapy/Monitor Closely.Serious - Use Alternative (2)lapatinib will increase the level or effect of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.
  
  erythromycin lactobionate will increase the level or effect of lapatinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• larotrectinib

  Monitor Closely (1)erythromycin lactobionate will increase the level or effect of larotrectinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• lasmiditan

  Serious - Use Alternative (1)lasmiditan increases levels of erythromycin lactobionate by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug.

• lefamulin

  Contraindicated (1)lefamulin will increase the level or effect of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated. Lefamulin is contraindicated with CYP3A substrates know to prolong the QT interval.

• lemborexant

  Serious - Use Alternative (1)erythromycin lactobionate will increase the level or effect of lemborexant by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of lemborexant with moderate or strong CYP3A inhibitors.

• lenacapavir

  Monitor Closely (1)lenacapavir will increase the level or effect of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Lencapavir (a moderate CYP3A4 inhibitor) may increase CYP3A4 substrates initiated within 9 months after last SC dose of lenacapavir, which may increase potential risk of adverse reactions of CYP3A4 substrates.

• leniolisib

  Serious - Use Alternative (1)leniolisib will increase the level or effect of erythromycin lactobionate by Other (see comment). Avoid or Use Alternate Drug. Leniolisib, an OATP1B1 and OATP1B3 inhibitor, may increase systemic exposure of these substrates

• lenvatinib

  Monitor Closely (1)erythromycin lactobionate and lenvatinib both increase QTc interval. Use Caution/Monitor. Lenvatinib prescribing information recommends monitoring ECG closely when coadministered with QT prolonging drugs.

• letermovir

  Monitor Closely (1)letermovir increases levels of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• leuprolide

  Monitor Closely (1)leuprolide increases toxicity of erythromycin lactobionate by QTc interval. Use Caution/Monitor. Increases risk of torsades de pointes.

• levamlodipine

  Monitor Closely (1)erythromycin lactobionate will increase the level or effect of levamlodipine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Coadministration with moderate and strong CYP3A inhibitors results in increased systemic exposure to amlodipine and may require dose reduction. Monitor for symptoms of hypotension and edema when amlodipine is coadministered with CYP3A inhibitors to determine the need for dose adjustment.

• levofloxacin

  Monitor Closely (1)erythromycin lactobionate and levofloxacin both increase QTc interval. Modify Therapy/Monitor Closely.

• levoketoconazole

  Monitor Closely (2)levoketoconazole will increase the level or effect of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
  
  erythromycin lactobionate will increase the level or effect of levoketoconazole by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.Serious - Use Alternative (1)erythromycin lactobionate and levoketoconazole both increase QTc interval. Avoid or Use Alternate Drug.

• levonorgestrel oral/ethinylestradiol/ferrous bisglycinate

  Monitor Closely (1)erythromycin lactobionate will decrease the level or effect of levonorgestrel oral/ethinylestradiol/ferrous bisglycinate by altering intestinal flora. Applies only to oral forms of hormone. Low risk of contraceptive failure. Use Caution/Monitor. Antibiotics may decrease hormonal contraceptive efficacy.

• lidocaine

  Monitor Closely (1)erythromycin lactobionate will increase the level or effect of lidocaine by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.

• lithium

  Serious - Use Alternative (1)lithium and erythromycin lactobionate both increase QTc interval. Avoid or Use Alternate Drug.

• lofepramine

  Serious - Use Alternative (1)lofepramine and erythromycin lactobionate both increase QTc interval. Avoid or Use Alternate Drug.

• lomitapide

  Contraindicated (1)erythromycin lactobionate increases levels of lomitapide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated. Increases lomitapide levels several folds.

• lonafarnib

  Contraindicated (1)erythromycin lactobionate will increase the level or effect of lonafarnib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated. Lonafarnib is a sensitive CYP3A4 substrate. Coadministration with strong or moderate CYP3A4 inhibitors is contraindicated.

• loperamide

  Monitor Closely (1)erythromycin lactobionate will increase the level or effect of loperamide by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• lopinavir

  Serious - Use Alternative (2)erythromycin lactobionate will increase the level or effect of lopinavir by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
  
  lopinavir will increase the level or effect of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• loratadine

  Serious - Use Alternative (1)erythromycin lactobionate will increase the level or effect of loratadine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.Minor (1)erythromycin lactobionate will increase the level or effect of loratadine by P-glycoprotein (MDR1) efflux transporter. Minor/Significance Unknown.

• lorlatinib

  Monitor Closely (1)lorlatinib will decrease the level or effect of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• lovastatin

  Contraindicated (1)erythromycin lactobionate will increase the level or effect of lovastatin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated. Strong CYP3A4 inhibitors increase systemic statin exposure and risk of myopathy, including rhabdomyolysis

• lumacaftor/ivacaftor

  Serious - Use Alternative (1)lumacaftor/ivacaftor will decrease the level or effect of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• lumateperone

  Monitor Closely (1)erythromycin lactobionate will increase the level or effect of lumateperone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Reduce lumateperone dose to 21 mg/day if coadministered with moderate CYP3A4 inhibitors.

• lumefantrine

  Serious - Use Alternative (3)erythromycin lactobionate and lumefantrine both increase QTc interval. Avoid or Use Alternate Drug.
  
  lumefantrine will decrease the level or effect of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.
  
  erythromycin lactobionate will increase the level or effect of lumefantrine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• lurasidone

  Monitor Closely (1)erythromycin lactobionate increases levels of lurasidone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Manufacturer recommends decreasing starting dose of lurasidone to 20 mg/day and maximum daily dose of lurasidone 80 mg when coadministered with moderate CYP3A4 inhibitors. Concurrent use may increase risk of lurasidone-related adverse reactions.

• lurbinectedin

  Serious - Use Alternative (1)erythromycin lactobionate will increase the level or effect of lurbinectedin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• macimorelin

  Serious - Use Alternative (1)macimorelin and erythromycin lactobionate both increase QTc interval. Avoid or Use Alternate Drug. Macimorelin causes an increase of ~11 msec in the corrected QT interval. Avoid coadministration with drugs that prolong QT interval, which could increase risk for developing torsade de pointes-type ventricular tachycardia. Allow sufficient washout time of drugs that are known to prolong the QT interval before administering macimorelin.

• maprotiline

  Serious - Use Alternative (1)maprotiline and erythromycin lactobionate both increase QTc interval. Avoid or Use Alternate Drug.

• maraviroc

  Monitor Closely (1)erythromycin lactobionate will increase the level or effect of maraviroc by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.Serious - Use Alternative (1)erythromycin lactobionate will increase the level or effect of maraviroc by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• marijuana

  Serious - Use Alternative (1)marijuana will increase the level or effect of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.

• mavacamten

  Monitor Closely (1)erythromycin lactobionate will increase the level or effect of mavacamten by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Inititiation of moderate CYP3A4 inhibitors may require decreased mavacamten dose.

• mefloquine

  Monitor Closely (1)erythromycin lactobionate will increase the level or effect of mefloquine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• mestranol

  Monitor Closely (2)erythromycin lactobionate will increase the level or effect of mestranol by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
  
  erythromycin lactobionate will decrease the level or effect of mestranol by altering intestinal flora. Applies only to oral forms of hormone. Low risk of contraceptive failure. Modify Therapy/Monitor Closely.Serious - Use Alternative (1)erythromycin lactobionate will increase the level or effect of mestranol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• methadone

  Monitor Closely (1)erythromycin lactobionate and methadone both increase QTc interval. Modify Therapy/Monitor Closely.Serious - Use Alternative (1)erythromycin lactobionate will increase the level or effect of methadone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• methylprednisolone

  Monitor Closely (1)erythromycin lactobionate will increase the level or effect of methylprednisolone by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.Serious - Use Alternative (2)erythromycin lactobionate will increase the level or effect of methylprednisolone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
  
  methylprednisolone will decrease the level or effect of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.Minor (1)erythromycin lactobionate increases levels of methylprednisolone by decreasing metabolism. Minor/Significance Unknown.

• metronidazole

  Serious - Use Alternative (1)metronidazole will increase the level or effect of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• mexiletine

  Monitor Closely (1)erythromycin lactobionate will increase the level or effect of mexiletine by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.

• miconazole vaginal

  Serious - Use Alternative (1)miconazole vaginal will increase the level or effect of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.

• microbiota oral

  Serious - Use Alternative (1)erythromycin lactobionate decreases effects of microbiota oral by pharmacodynamic antagonism. Avoid or Use Alternate Drug. Microbiota oral contains bacterial spores. Antibacterial agents may decrease efficacy if coadministered. Complete antibiotic regimens 2-4 days before initiating microbiota oral. .

• midazolam

  Serious - Use Alternative (1)erythromycin lactobionate will increase the level or effect of midazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• midazolam intranasal

  Serious - Use Alternative (1)erythromycin lactobionate will increase the level or effect of midazolam intranasal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Coadministration of moderate CYP3A4 inhibitors with midazolam intranasal causes higher midazolam systemic exposure, which may prolong sedation.

• mifepristone

  Monitor Closely (2)erythromycin lactobionate will increase the level or effect of mifepristone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.
  
  mifepristone, erythromycin lactobionate. QTc interval. Modify Therapy/Monitor Closely. Use alternatives if available.Serious - Use Alternative (1)mifepristone will increase the level or effect of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• mipomersen

  Monitor Closely (1)mipomersen, erythromycin lactobionate. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: Both drugs have potential to increase hepatic enzymes; monitor LFTs.

• mirtazapine

  Serious - Use Alternative (1)mirtazapine and erythromycin lactobionate both increase QTc interval. Avoid or Use Alternate Drug.

• mitotane

  Monitor Closely (1)mitotane decreases levels of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Mitotane is a strong inducer of cytochrome P-4503A4; monitor when coadministered with CYP3A4 substrates for possible dosage adjustments.

• mitoxantrone

  Monitor Closely (1)erythromycin lactobionate will increase the level or effect of mitoxantrone by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• mizolastine

  Serious - Use Alternative (1)erythromycin lactobionate increases levels of mizolastine by decreasing metabolism. Contraindicated.

• mobocertinib

  Serious - Use Alternative (2)erythromycin lactobionate will increase the level or effect of mobocertinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. If use of moderate CYP3A4 inhibitor unavoidable, reduce mobocertinib dose by ~50% (eg, 160 to 80 mg); closely monitor QTc interval.
  
  mobocertinib and erythromycin lactobionate both increase QTc interval. Avoid or Use Alternate Drug. If coadministration unavoidable, reduce mobocertinib dose and monitor QTc interval more frequently.

• montelukast

  Monitor Closely (1)erythromycin lactobionate will increase the level or effect of montelukast by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• moxifloxacin

  Serious - Use Alternative (1)erythromycin lactobionate and moxifloxacin both increase QTc interval. Avoid or Use Alternate Drug.

• nafcillin

  Serious - Use Alternative (1)nafcillin will decrease the level or effect of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.Minor (1)erythromycin lactobionate decreases effects of nafcillin by pharmacodynamic antagonism. Minor/Significance Unknown. bacteriostatic antibiotics may interfere with the bactericidal actions of penicillins.

• naldemedine

  Monitor Closely (2)erythromycin lactobionate increases levels of naldemedine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Monitor naldemedine for potential adverse effects if coadministered with strong or moderate CYP3A4 inhibitors.
  
  erythromycin lactobionate increases levels of naldemedine by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Monitor naldemedine for potential adverse effects if coadministered with P-gp inhibitors.

• naloxegol

  Serious - Use Alternative (1)erythromycin lactobionate will increase the level or effect of naloxegol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. If coadministation of naloxegol with moderate CYP3A4 inhibitors is unavoidable, reduce naloxegol dose to 12.5 mg qDay

• nefazodone

  Serious - Use Alternative (1)nefazodone will increase the level or effect of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• nelfinavir

  Monitor Closely (1)erythromycin lactobionate will increase the level or effect of nelfinavir by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.Serious - Use Alternative (2)erythromycin lactobionate will increase the level or effect of nelfinavir by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
  
  nelfinavir will increase the level or effect of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• neomycin PO

  Monitor Closely (1)erythromycin lactobionate will increase the level or effect of neomycin PO by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• neratinib

  Serious - Use Alternative (1)erythromycin lactobionate will increase the level or effect of neratinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of neratinib with strong/moderate CYP3A4 inhibitors.

• nevirapine

  Serious - Use Alternative (1)nevirapine will decrease the level or effect of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.

• niacin

  Monitor Closely (1)erythromycin lactobionate will decrease the level or effect of niacin by altering intestinal flora. Applies only to oral form of both agents. Use Caution/Monitor.

• nicardipine

  Serious - Use Alternative (1)erythromycin lactobionate will increase the level or effect of nicardipine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• nifedipine

  Monitor Closely (1)erythromycin lactobionate will increase the level or effect of nifedipine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Consider initiating nifedipine at the lowest dose available if given concomitantly with this medicationSerious - Use Alternative (1)nifedipine will increase the level or effect of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• nilotinib

  Monitor Closely (1)erythromycin lactobionate will increase the level or effect of nilotinib by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.Serious - Use Alternative (3)erythromycin lactobionate and nilotinib both increase QTc interval. Avoid or Use Alternate Drug.
  
  nilotinib will increase the level or effect of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.
  
  erythromycin lactobionate will increase the level or effect of nilotinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• nilutamide

  Serious - Use Alternative (1)nilutamide will increase the level or effect of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• nimodipine

  Monitor Closely (1)erythromycin lactobionate will increase the level or effect of nimodipine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• nintedanib

  Serious - Use Alternative (1)erythromycin lactobionate increases levels of nintedanib by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug. If nintedanib adverse effects occur, management may require interruption, dose reduction, or discontinuation of therapy.

• nirmatrelvir

  Monitor Closely (1)nirmatrelvir will increase the level or effect of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Monitor for increased erythromycin adverse effects, including QTc interval prolongation.

• nirmatrelvir/ritonavir

  Monitor Closely (1)nirmatrelvir/ritonavir will increase the level or effect of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Monitor for increased erythromycin adverse effects, including QTc interval prolongation.

• nisoldipine

  Serious - Use Alternative (1)erythromycin lactobionate will increase the level or effect of nisoldipine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• nitrendipine

  Monitor Closely (1)erythromycin lactobionate will increase the level or effect of nitrendipine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• nortriptyline

  Serious - Use Alternative (1)nortriptyline and erythromycin lactobionate both increase QTc interval. Avoid or Use Alternate Drug.

• octreotide

  Serious - Use Alternative (1)erythromycin lactobionate and octreotide both increase QTc interval. Avoid or Use Alternate Drug.

• octreotide (Antidote)

  Serious - Use Alternative (1)erythromycin lactobionate and octreotide (Antidote) both increase QTc interval. Avoid or Use Alternate Drug.

• ofloxacin

  Monitor Closely (1)erythromycin lactobionate and ofloxacin both increase QTc interval. Modify Therapy/Monitor Closely.

• olanzapine

  Monitor Closely (1)erythromycin lactobionate will increase the level or effect of olanzapine by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.Serious - Use Alternative (1)olanzapine and erythromycin lactobionate both increase QTc interval. Avoid or Use Alternate Drug.

• olaparib

  Serious - Use Alternative (1)erythromycin lactobionate will increase the level or effect of olaparib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. If coadministration with moderate CYP3A inhibitors cannot be avoided, reduce olaparib dose to 200 mg (capsule) or 150 mg (tablet) PO BID. Do not substitute tablets with capsules.

• oliceridine

  Monitor Closely (1)erythromycin lactobionate will increase the level or effect of oliceridine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. If concomitant use is necessary, may require less frequent oliceridine dosing. Closely monitor for respiratory depression and sedation and titrate subsequent doses accordingly. If inhibitor is discontinued, consider increase oliceridine dosage until stable drug effects are achieved. Monitor for signs of opioid withdrawal.

• olodaterol inhaled

  Monitor Closely (1)erythromycin lactobionate and olodaterol inhaled both increase QTc interval. Use Caution/Monitor. Drugs that prolong the QTc interval and may potentiate the effects of beta2 agonists on the cardiovascular system; increased risk of ventricular arrhythmias

• omaveloxolone

  Serious - Use Alternative (1)erythromycin lactobionate will increase the level or effect of omaveloxolone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. If unavoidable, reduce omaveloxolone dose to 100 mg/day. Closely monitor for adverse effects. If adverse effects emerge, further reduce to 50 mg/day.

• ondansetron

  Serious - Use Alternative (1)erythromycin lactobionate and ondansetron both increase QTc interval. Avoid or Use Alternate Drug. Avoid with congenital long QT syndrome; ECG monitoring recommended with concomitant medications that prolong QT interval, electrolyte abnormalities, CHF, or bradyarrhythmias.

• osilodrostat

  Monitor Closely (1)osilodrostat and erythromycin lactobionate both increase QTc interval. Use Caution/Monitor.

• osimertinib

  Monitor Closely (1)osimertinib and erythromycin lactobionate both increase QTc interval. Use Caution/Monitor. Conduct periodic monitoring with ECGs and electrolytes in patients taking drugs known to prolong the QTc interval.Serious - Use Alternative (1)erythromycin lactobionate will increase the level or effect of osimertinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of osimertinib with strong CYP3A4 inhibitors. If no other alternative treatment exists, monitor patient more closely for adverse effects.

• oxacillin

  Minor (1)erythromycin lactobionate decreases effects of oxacillin by pharmacodynamic antagonism. Minor/Significance Unknown. bacteriostatic agents may inhibit the effects of bactericidal agents.

• oxaliplatin

  Monitor Closely (1)oxaliplatin will increase the level or effect of erythromycin lactobionate by Other (see comment). Use Caution/Monitor. Monitor for ECG changes if therapy is initiated in patients with drugs known to prolong QT interval.Serious - Use Alternative (1)oxaliplatin and erythromycin lactobionate both increase QTc interval. Avoid or Use Alternate Drug.

• oxcarbazepine

  Serious - Use Alternative (1)oxcarbazepine will decrease the level or effect of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• oxybutynin

  Monitor Closely (1)erythromycin lactobionate will increase the level or effect of oxybutynin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• ozanimod

  Monitor Closely (1)ozanimod and erythromycin lactobionate both increase QTc interval. Modify Therapy/Monitor Closely. The potential additive effects on heart rate, treatment with ozanimod should generally not be initiated in patients who are concurrently treated with QT prolonging drugs with known arrhythmogenic properties.

• paclitaxel

  Monitor Closely (2)erythromycin lactobionate will increase the level or effect of paclitaxel by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
  
  erythromycin lactobionate will increase the level or effect of paclitaxel by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• paclitaxel protein bound

  Monitor Closely (2)erythromycin lactobionate will increase the level or effect of paclitaxel protein bound by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
  
  erythromycin lactobionate will increase the level or effect of paclitaxel protein bound by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• pacritinib

  Serious - Use Alternative (1)erythromycin lactobionate will increase the level or effect of pacritinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• palbociclib

  Monitor Closely (1)erythromycin lactobionate will increase the level or effect of palbociclib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• paliperidone

  Monitor Closely (2)erythromycin lactobionate will increase the level or effect of paliperidone by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
  
  erythromycin lactobionate and paliperidone both increase QTc interval. Modify Therapy/Monitor Closely.

• panobinostat

  Serious - Use Alternative (1)erythromycin lactobionate and panobinostat both increase QTc interval. Avoid or Use Alternate Drug. Panobinostat is known to significantly prolong QT interval. Panobinostat prescribing information states use with drugs known to prolong QTc is not recommended.

• pantothenic acid

  Monitor Closely (1)erythromycin lactobionate will decrease the level or effect of pantothenic acid by altering intestinal flora. Applies only to oral form of both agents. Use Caution/Monitor.

• parecoxib

  Monitor Closely (1)erythromycin lactobionate will increase the level or effect of parecoxib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• paromomycin

  Monitor Closely (1)erythromycin lactobionate will increase the level or effect of paromomycin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• paroxetine

  Monitor Closely (1)erythromycin lactobionate and paroxetine both increase QTc interval. Modify Therapy/Monitor Closely.

• pasireotide

  Monitor Closely (1)erythromycin lactobionate and pasireotide both increase QTc interval. Modify Therapy/Monitor Closely.

• pazopanib

  Monitor Closely (1)erythromycin lactobionate and pazopanib both increase QTc interval. Use Caution/Monitor.Serious - Use Alternative (1)erythromycin lactobionate will increase the level or effect of pazopanib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of pazopanib with strong CYP3A4 inhibitors if possible; if must coadminister, decrease pazopanib dose to 400 mg/day

• pemigatinib

  Serious - Use Alternative (1)erythromycin lactobionate will increase the level or effect of pemigatinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. If coadministration with strong or moderate CYP3A4 inhibitors is unavoidable, reduce pemigatinib dose (refer to drug monograph dosage modifications). After discontinuing the CYP3A4 inhibitor for 3 elimination half-lives, may resume previous pemigatinib dose.

• penicillin G aqueous

  Minor (1)erythromycin lactobionate decreases effects of penicillin G aqueous by pharmacodynamic antagonism. Minor/Significance Unknown.

• penicillin VK

  Minor (1)erythromycin lactobionate decreases effects of penicillin VK by pharmacodynamic antagonism. Minor/Significance Unknown.

• pentamidine

  Contraindicated (1)erythromycin lactobionate and pentamidine both increase QTc interval. Contraindicated.

• pentobarbital

  Serious - Use Alternative (1)pentobarbital will decrease the level or effect of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.Minor (1)pentobarbital decreases levels of erythromycin lactobionate by increasing elimination. Minor/Significance Unknown.

• perphenazine

  Serious - Use Alternative (1)perphenazine and erythromycin lactobionate both increase QTc interval. Avoid or Use Alternate Drug.

• pexidartinib

  Serious - Use Alternative (2)erythromycin lactobionate and pexidartinib both increase Other (see comment). Avoid or Use Alternate Drug. Pexidartinib can cause hepatotoxicity. Avoid coadministration of pexidartinib with other products know to cause hepatoxicity.
  
  erythromycin lactobionate will increase the level or effect of pexidartinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. If coadministration with strong or moderate CYP3A4 inhibitors is unavoidable, reduce pexidartinib dose (refer to drug monograph dosage modifications). After discontinuing the CYP3A4 inhibitor for 3 elimination half-lives, may resume previous pexidartinib dose.

• phenindione

  Serious - Use Alternative (1)erythromycin lactobionate increases effects of phenindione by decreasing metabolism. Avoid or Use Alternate Drug.

• phenobarbital

  Serious - Use Alternative (1)phenobarbital will decrease the level or effect of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.Minor (1)phenobarbital decreases levels of erythromycin lactobionate by increasing elimination. Minor/Significance Unknown.

• phenytoin

  Serious - Use Alternative (1)phenytoin will decrease the level or effect of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.

• pimozide

  Contraindicated (2)erythromycin lactobionate and pimozide both increase QTc interval. Contraindicated.
  
  erythromycin lactobionate increases levels of pimozide by decreasing metabolism. Contraindicated. Risk of QT interval prolongation.Monitor Closely (1)erythromycin lactobionate will increase the level or effect of pimozide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• pioglitazone

  Monitor Closely (1)erythromycin lactobionate will increase the level or effect of pioglitazone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• piperacillin

  Monitor Closely (1)erythromycin lactobionate decreases effects of piperacillin by pharmacodynamic antagonism. Use Caution/Monitor. bacteriostatic agents may inhibit the effects of bactericidal agents.

• pitavastatin

  Serious - Use Alternative (2)erythromycin lactobionate increases toxicity of pitavastatin by Other (see comment). Avoid or Use Alternate Drug. Comment: OATP1B1 inhibitors may increase risk of myopathy.
  
  erythromycin lactobionate increases levels of pitavastatin by decreasing metabolism. Avoid or Use Alternate Drug. Do not exceed 1 mg/d pitavastatin.

• pitolisant

  Serious - Use Alternative (1)erythromycin lactobionate and pitolisant both increase QTc interval. Avoid or Use Alternate Drug.

• pivmecillinam

  Minor (1)erythromycin lactobionate decreases effects of pivmecillinam by pharmacodynamic antagonism. Minor/Significance Unknown.

• pomalidomide

  Serious - Use Alternative (1)erythromycin lactobionate increases levels of pomalidomide by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug.

• ponatinib

  Monitor Closely (1)ponatinib increases levels of erythromycin lactobionate by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• posaconazole

  Monitor Closely (2)erythromycin lactobionate will increase the level or effect of posaconazole by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
  
  erythromycin lactobionate and posaconazole both increase QTc interval. Modify Therapy/Monitor Closely.Serious - Use Alternative (1)posaconazole will increase the level or effect of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• pravastatin

  Monitor Closely (1)erythromycin lactobionate increases toxicity of pravastatin by Other (see comment). Use Caution/Monitor. Comment: OATP1B1 inhibitors may increase risk of myopathy.

• prednisolone

  Monitor Closely (1)erythromycin lactobionate will increase the level or effect of prednisolone by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.Serious - Use Alternative (1)erythromycin lactobionate will increase the level or effect of prednisolone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• prednisone

  Monitor Closely (1)erythromycin lactobionate will increase the level or effect of prednisone by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.Serious - Use Alternative (2)erythromycin lactobionate will increase the level or effect of prednisone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
  
  prednisone will decrease the level or effect of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.Minor (1)erythromycin lactobionate increases levels of prednisone by decreasing metabolism. Minor/Significance Unknown. Risk of toxic steroid concentrations and altered mental status.

• pretomanid

  Serious - Use Alternative (1)erythromycin lactobionate, pretomanid. Either increases toxicity of the other by Other (see comment). Avoid or Use Alternate Drug. Comment: Pretomanid regimen associated with hepatotoxicity. Avoid alcohol and hepatotoxic agents, including herbal supplements and drugs other than bedaquiline and linezolid.

• primaquine

  Serious - Use Alternative (1)primaquine and erythromycin lactobionate both increase QTc interval. Avoid or Use Alternate Drug.

• primidone

  Serious - Use Alternative (1)primidone will decrease the level or effect of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.Minor (1)primidone decreases levels of erythromycin lactobionate by increasing elimination. Minor/Significance Unknown.

• procainamide

  Contraindicated (1)erythromycin lactobionate and procainamide both increase QTc interval. Contraindicated.

• prochlorperazine

  Serious - Use Alternative (1)prochlorperazine and erythromycin lactobionate both increase QTc interval. Avoid or Use Alternate Drug.

• promazine

  Serious - Use Alternative (1)promazine and erythromycin lactobionate both increase QTc interval. Avoid or Use Alternate Drug.

• promethazine

  Serious - Use Alternative (1)promethazine and erythromycin lactobionate both increase QTc interval. Avoid or Use Alternate Drug.

• propafenone

  Monitor Closely (1)erythromycin lactobionate will increase the level or effect of propafenone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• protamine

  Serious - Use Alternative (1)erythromycin lactobionate increases effects of protamine by decreasing metabolism. Avoid or Use Alternate Drug.

• protriptyline

  Serious - Use Alternative (1)protriptyline and erythromycin lactobionate both increase QTc interval. Avoid or Use Alternate Drug.

• pyridoxine

  Monitor Closely (1)erythromycin lactobionate will decrease the level or effect of pyridoxine by altering intestinal flora. Applies only to oral form of both agents. Use Caution/Monitor.

• pyridoxine (Antidote)

  Monitor Closely (1)erythromycin lactobionate will decrease the level or effect of pyridoxine (Antidote) by altering intestinal flora. Applies only to oral form of both agents. Use Caution/Monitor.

• quetiapine

  Monitor Closely (1)quetiapine, erythromycin lactobionate. Either increases toxicity of the other by QTc interval. Use Caution/Monitor. Avoid use with drugs that prolong QT and in patients with risk factors for prolonged QT interval. Postmarketing cases show QT prolongation with overdose in patients with concomitant illness or with drugs known to cause electrolyte imbalance or prolong QT.Serious - Use Alternative (1)erythromycin lactobionate will increase the level or effect of quetiapine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• quinidine

  Contraindicated (1)quinidine and erythromycin lactobionate both increase QTc interval. Contraindicated.Serious - Use Alternative (1)erythromycin lactobionate will increase the level or effect of quinidine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• quinine

  Monitor Closely (2)erythromycin lactobionate and quinine both increase QTc interval. Use Caution/Monitor.
  
  erythromycin lactobionate will increase the level or effect of quinine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• quinupristin/dalfopristin

  Serious - Use Alternative (2)quinupristin/dalfopristin increases levels of erythromycin lactobionate by decreasing metabolism. Contraindicated. Risk of prolonged QTc interval.
  
  quinupristin/dalfopristin will increase the level or effect of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• rabeprazole

  Minor (1)erythromycin lactobionate will increase the level or effect of rabeprazole by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

• ramelteon

  Monitor Closely (2)erythromycin lactobionate will increase the level or effect of ramelteon by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.
  
  erythromycin lactobionate will increase the level or effect of ramelteon by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• ranolazine

  Monitor Closely (1)erythromycin lactobionate and ranolazine both increase QTc interval. Modify Therapy/Monitor Closely.Serious - Use Alternative (1)erythromycin lactobionate will increase the level or effect of ranolazine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• rasagiline

  Monitor Closely (1)erythromycin lactobionate will increase the level or effect of rasagiline by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.

• repaglinide

  Serious - Use Alternative (1)erythromycin lactobionate will increase the level or effect of repaglinide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• revefenacin

  Serious - Use Alternative (1)erythromycin lactobionate increases levels of revefenacin by Other (see comment). Avoid or Use Alternate Drug. Comment: OATP1B1 and OATP1B3 transport inhibitors may increase systemic exposure of revefenacin's active metabolite. Coadministration not recommended.

• ribociclib

  Monitor Closely (1)ribociclib will increase the level or effect of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.Serious - Use Alternative (1)ribociclib increases toxicity of erythromycin lactobionate by QTc interval. Avoid or Use Alternate Drug.

• rifabutin

  Serious - Use Alternative (2)rifabutin will decrease the level or effect of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
  
  erythromycin lactobionate increases levels of rifabutin by decreasing metabolism. Contraindicated.

• rifampin

  Serious - Use Alternative (1)rifampin will decrease the level or effect of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• rifapentine

  Serious - Use Alternative (1)rifapentine will decrease the level or effect of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.

• rifaximin

  Monitor Closely (1)erythromycin lactobionate increases levels of rifaximin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• rilpivirine

  Monitor Closely (2)erythromycin lactobionate increases levels of rilpivirine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Where possible, alternatives such as azithromycin should be considered.
  
  rilpivirine increases toxicity of erythromycin lactobionate by QTc interval. Use Caution/Monitor. Rilpivirine should be used with caution when co-administered with a drug with a known risk of Torsades de Pointes.

• riluzole

  Minor (1)erythromycin lactobionate will increase the level or effect of riluzole by affecting hepatic enzyme CYP1A2 metabolism. Minor/Significance Unknown.

• rimegepant

  Monitor Closely (1)erythromycin lactobionate will increase the level or effect of rimegepant by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Avoid repeating rimegepant dose within 48 hr if coadministered with a moderate CYP3A4 inhibitor.Serious - Use Alternative (1)erythromycin lactobionate will increase the level or effect of rimegepant by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug.

• riociguat

  Serious - Use Alternative (1)erythromycin lactobionate will increase the level or effect of riociguat by decreasing metabolism. Avoid or Use Alternate Drug. Coadministration of riociguat (substrate of CYP isoenzymes 1A1, 2C8, 3A, 2J2) with strong CYP inhibitors may require a decreased initial dose of 0.5 mg PO TID; monitor for signs of hypotension and reduce dose if needed

• risperidone

  Monitor Closely (2)erythromycin lactobionate will increase the level or effect of risperidone by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
  
  erythromycin lactobionate and risperidone both increase QTc interval. Modify Therapy/Monitor Closely.

• ritonavir

  Monitor Closely (1)erythromycin lactobionate will increase the level or effect of ritonavir by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.Serious - Use Alternative (2)ritonavir will increase the level or effect of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.
  
  erythromycin lactobionate will increase the level or effect of ritonavir by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• rivaroxaban

  Monitor Closely (1)erythromycin lactobionate increases levels of rivaroxaban by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Patients with renal impairment receiving rivaroxaban with drugs that are combined P-gp and weak or moderate CYP3A4 inhibitors may have significant increases in exposure compared with patients with normal renal function and no inhibitor use, since both pathways of rivaroxaban elimination are affected. Since these increases may increase bleeding risk, use rivaroxaban in this situation only if the potential benefit justifies the potential risk.

• roflumilast

  Monitor Closely (1)erythromycin lactobionate increases levels of roflumilast by Other (see comment). Modify Therapy/Monitor Closely. Comment: Coadministration with dual inhibitors of CYP3A4 and CYP1A2 may increase systemic exposure and result in increased adverse reactions.

• romidepsin

  Monitor Closely (2)erythromycin lactobionate will increase the level or effect of romidepsin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
  
  erythromycin lactobionate and romidepsin both increase QTc interval. Modify Therapy/Monitor Closely.Serious - Use Alternative (1)erythromycin lactobionate will increase the level or effect of romidepsin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• ropinirole

  Monitor Closely (1)erythromycin lactobionate will increase the level or effect of ropinirole by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.

• rosuvastatin

  Monitor Closely (1)erythromycin lactobionate increases toxicity of rosuvastatin by Other (see comment). Use Caution/Monitor. Comment: OATP1B1 inhibitors may increase risk of myopathy.Minor (1)erythromycin lactobionate decreases levels of rosuvastatin by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

• rucaparib

  Monitor Closely (1)rucaparib will increase the level or effect of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Adjust dosage of CYP3A4 substrates, if clinically indicated.

• rufinamide

  Serious - Use Alternative (1)rufinamide will decrease the level or effect of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• ruxolitinib

  Monitor Closely (1)erythromycin lactobionate will increase the level or effect of ruxolitinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• ruxolitinib topical

  Monitor Closely (1)erythromycin lactobionate will increase the level or effect of ruxolitinib topical by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• sacubitril/valsartan

  Monitor Closely (1)erythromycin lactobionate will increase the level or effect of sacubitril/valsartan by Other (see comment). Use Caution/Monitor. The results from an in vitro study with human liver tissue indicate that valsartan is a substrate of the hepatic uptake transporter OATP1B1; coadministration with OATP1B1 inhibitors may increase valsartan systemic exposure

• saquinavir

  Contraindicated (1)saquinavir will increase the level or effect of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.Monitor Closely (1)erythromycin lactobionate will increase the level or effect of saquinavir by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.Serious - Use Alternative (1)erythromycin lactobionate will increase the level or effect of saquinavir by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• sarecycline

  Monitor Closely (1)sarecycline will increase the level or effect of erythromycin lactobionate by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Monitor for toxicities of P-gp substrates that may require dosage reduction when coadministered with P-gp inhibitors.

• saxagliptin

  Monitor Closely (1)erythromycin lactobionate will increase the level or effect of saxagliptin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• secobarbital

  Serious - Use Alternative (1)secobarbital will decrease the level or effect of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.Minor (1)secobarbital decreases levels of erythromycin lactobionate by increasing elimination. Minor/Significance Unknown.

• selpercatinib

  Monitor Closely (1)selpercatinib increases toxicity of erythromycin lactobionate by QTc interval. Use Caution/Monitor.

• selumetinib

  Serious - Use Alternative (1)erythromycin lactobionate will increase the level or effect of selumetinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. If coadministration with strong or moderate CYP3A4 inhibitors cannot be avoided, reduce selumetinib dosage (refer to selumetinib monograph for further information). After discontinuation of the strong or moderate CYP3A4 inhibitor for 3 elimination half-lives, resume selumetinib dose that was taken before initiating the inhibitor.

• sertraline

  Monitor Closely (1)sertraline and erythromycin lactobionate both increase QTc interval. Use Caution/Monitor.

• sevoflurane

  Serious - Use Alternative (1)sevoflurane and erythromycin lactobionate both increase QTc interval. Avoid or Use Alternate Drug.

• sildenafil

  Monitor Closely (1)erythromycin lactobionate will increase the level or effect of sildenafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Consider a starting dose of 25 mg in patients treated with erythromycin.

• silodosin

  Monitor Closely (1)erythromycin lactobionate will increase the level or effect of silodosin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.Serious - Use Alternative (1)erythromycin lactobionate will increase the level or effect of silodosin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• simvastatin

  Contraindicated (2)erythromycin lactobionate will increase the level or effect of simvastatin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated. Increased risk for rhabdomyolysis with drugs that increase simvastatin systemic exposure
  
  erythromycin lactobionate increases toxicity of simvastatin by Other (see comment). Contraindicated. Comment: OATP1B1 inhibitors may increase risk of myopathy.

• siponimod

  Serious - Use Alternative (2)erythromycin lactobionate will increase the level or effect of siponimod by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Coadministration of siponimod with a moderate or strong CYP3A4 inhibitor PLUS a moderate or strong CYP2C9 inhibitor is not recommended.
  
  siponimod and erythromycin lactobionate both increase QTc interval. Avoid or Use Alternate Drug.

• sirolimus

  Monitor Closely (1)erythromycin lactobionate will increase the level or effect of sirolimus by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.Serious - Use Alternative (1)erythromycin lactobionate will increase the level or effect of sirolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• sodium bicarbonate

  Monitor Closely (1)sodium bicarbonate increases levels of erythromycin lactobionate by unknown mechanism. Use Caution/Monitor.

• sodium citrate/citric acid

  Monitor Closely (1)sodium citrate/citric acid increases levels of erythromycin lactobionate by unknown mechanism. Use Caution/Monitor.

• sodium picosulfate/magnesium oxide/anhydrous citric acid

  Monitor Closely (1)erythromycin lactobionate decreases effects of sodium picosulfate/magnesium oxide/anhydrous citric acid by altering metabolism. Use Caution/Monitor. Coadministration with antibiotics decreases efficacy by altering colonic bacterial flora needed to convert sodium picosulfate to active drug.

• solifenacin

  Serious - Use Alternative (2)erythromycin lactobionate will increase the level or effect of solifenacin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
  
  solifenacin and erythromycin lactobionate both increase QTc interval. Avoid or Use Alternate Drug.

• sonidegib

  Monitor Closely (1)erythromycin lactobionate will increase the level or effect of sonidegib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Avoid coadministration of sonidegib with moderate CYP3A4 inhibitors. If a moderate CYP3A inhibitor must be used, administer the moderate CYP3A inhibitor for <14 days and monitor closely for adverse reactions, particularly musculoskeletal adverse reactions.

• sorafenib

  Monitor Closely (1)sorafenib and erythromycin lactobionate both increase QTc interval. Use Caution/Monitor.

• sotalol

  Contraindicated (1)erythromycin lactobionate and sotalol both increase QTc interval. Contraindicated.

• sotorasib

  Serious - Use Alternative (1)sotorasib will decrease the level or effect of erythromycin lactobionate by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug. If use is unavoidable, refer to the prescribing information of the P-gp substrate for dosage modifications.

• sparsentan

  Monitor Closely (1)erythromycin lactobionate will increase the level or effect of sparsentan by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. No dosage adjustment needed. Monitor blood pressure, serum potassium, edema, and kidney function regularly if sparsentan is coadministered with moderate CYP3A4 inhibitors.

• St John's Wort

  Serious - Use Alternative (1)St John's Wort will decrease the level or effect of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• stiripentol

  Monitor Closely (2)stiripentol, erythromycin lactobionate. affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Stiripentol is a CYP3A4 inhibitor and inducer. Monitor CYP3A4 substrates coadministered with stiripentol for increased or decreased effects. CYP3A4 substrates may require dosage adjustment.
  
  stiripentol will increase the level or effect of erythromycin lactobionate by P-glycoprotein (MDR1) efflux transporter. Modify Therapy/Monitor Closely. Consider reducing the dose of P-glycoprotein (P-gp) substrates, if adverse reactions are experienced when administered concomitantly with stiripentol.

• streptomycin

  Monitor Closely (1)erythromycin lactobionate will increase the level or effect of streptomycin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• sufentanil

  Monitor Closely (1)erythromycin lactobionate will increase the level or effect of sufentanil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• sufentanil SL

  Monitor Closely (1)erythromycin lactobionate will increase the level or effect of sufentanil SL by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Coadministration of sufentanil SL with any CYP3A4 inhibitor may increase sufentanil plasma concentration, and, thereby increase or prolonged adverse effects, including potentially fatal respiratory depression.

• sulbactam/durlobactam

  Serious - Use Alternative (1)erythromycin lactobionate will increase the level or effect of sulbactam/durlobactam by Other (see comment). Avoid or Use Alternate Drug. Sulbactam is predicted to have active secretion by OATP1 as a significant portion of total clearance; therefore, inhibition of OAT1 may increase sulbactam plasma concentrations

• sulfamethoxazole

  Monitor Closely (1)sulfamethoxazole and erythromycin lactobionate both increase QTc interval. Modify Therapy/Monitor Closely.

• sunitinib

  Serious - Use Alternative (2)erythromycin lactobionate will increase the level or effect of sunitinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
  
  sunitinib and erythromycin lactobionate both increase QTc interval. Avoid or Use Alternate Drug.

• suvorexant

  Monitor Closely (1)erythromycin lactobionate will increase the level or effect of suvorexant by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Decrease suvorexant starting dose to 5 mg HS if coadministered with moderate CYP3A4 inhibitors

• tacrolimus

  Monitor Closely (1)erythromycin lactobionate will increase the level or effect of tacrolimus by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.Serious - Use Alternative (2)erythromycin lactobionate will increase the level or effect of tacrolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
  
  tacrolimus and erythromycin lactobionate both increase QTc interval. Avoid or Use Alternate Drug.

• tadalafil

  Serious - Use Alternative (1)erythromycin lactobionate will increase the level or effect of tadalafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. For ED limit tadalafil to max of 2.5 mg/day (for daily use) or 10 mg dose every 72 hr (for use as needed). Avoid concurrent use of tadalafil for pulmonary HTN in patients taking strong CYP3A4 inhibitors.

• talazoparib

  Monitor Closely (1)erythromycin lactobionate will increase the level or effect of talazoparib by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Talazoparib is a P-glycoprotein (P-gp) substrate; coadministration with P-gp inhibitors may increase talazoparib systemic exposure.

• tamoxifen

  Monitor Closely (1)erythromycin lactobionate, tamoxifen. affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. CYP3A4 inhibition decreases metabolism of tamoxifen to N-desmethyl tamoxifen (active metabolite with similar biologic activity).

• tamsulosin

  Monitor Closely (1)erythromycin lactobionate increases levels of tamsulosin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Dose reduction may be needed for coadministered drugs that are predominantly metabolized by CYP3A.

• tazemetostat

  Monitor Closely (1)tazemetostat will decrease the level or effect of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.Serious - Use Alternative (1)erythromycin lactobionate will increase the level or effect of tazemetostat by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid coadministration of tazemetostat with moderate CYP3A4 inhibitors. If coadministration is unavoidable, reduce tazemetostat current dose (see drug monograph Dosage Modifications).

• tecovirimat

  Monitor Closely (1)tecovirimat will decrease the level or effect of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. Tecovirimat is a weak CYP3A4 inducer. Monitor sensitive CYP3A4 substrates for effectiveness if coadministered.

• telavancin

  Monitor Closely (1)erythromycin lactobionate and telavancin both increase QTc interval. Modify Therapy/Monitor Closely.

• temocillin

  Minor (1)erythromycin lactobionate decreases effects of temocillin by pharmacodynamic antagonism. Minor/Significance Unknown.

• temsirolimus

  Serious - Use Alternative (1)erythromycin lactobionate will increase the level or effect of temsirolimus by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• tepotinib

  Serious - Use Alternative (1)tepotinib will increase the level or effect of erythromycin lactobionate by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug. If concomitant use unavoidable, reduce the P-gp substrate dosage if recommended in its approved product labeling.

• tetrabenazine

  Serious - Use Alternative (1)tetrabenazine and erythromycin lactobionate both increase QTc interval. Avoid or Use Alternate Drug.

• tezacaftor

  Monitor Closely (1)erythromycin lactobionate will increase the level or effect of tezacaftor by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Adjust tezacaftor dosage regimen if coadministered with a moderate CYP3A inhibitor.

• theophylline

  Monitor Closely (1)erythromycin lactobionate will increase the level or effect of theophylline by affecting hepatic enzyme CYP1A2 metabolism. Use Caution/Monitor.Serious - Use Alternative (1)erythromycin lactobionate will increase the level or effect of theophylline by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• thiamine

  Monitor Closely (1)erythromycin lactobionate will decrease the level or effect of thiamine by altering intestinal flora. Applies only to oral form of both agents. Use Caution/Monitor.

• thioridazine

  Serious - Use Alternative (1)thioridazine and erythromycin lactobionate both increase QTc interval. Avoid or Use Alternate Drug.

• ticarcillin

  Minor (1)erythromycin lactobionate decreases effects of ticarcillin by pharmacodynamic antagonism. Minor/Significance Unknown.

• tinidazole

  Monitor Closely (1)erythromycin lactobionate will increase the level or effect of tinidazole by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• tipranavir

  Serious - Use Alternative (1)erythromycin lactobionate will increase the level or effect of tipranavir by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• tizanidine

  Serious - Use Alternative (1)erythromycin lactobionate will increase the level or effect of tizanidine by affecting hepatic enzyme CYP1A2 metabolism. Avoid or Use Alternate Drug.

• tobramycin

  Monitor Closely (1)erythromycin lactobionate will increase the level or effect of tobramycin by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.

• tobramycin inhaled

  Monitor Closely (1)tobramycin inhaled and erythromycin lactobionate both increase nephrotoxicity and/or ototoxicity. Modify Therapy/Monitor Closely. Avoid concurrent or sequential use to decrease risk for ototoxicity

• tofacitinib

  Monitor Closely (1)erythromycin lactobionate increases levels of tofacitinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. No specific dose adjustment recommended when tofacitinib coadministered with moderate CYP3A4 inhibitors; decrease tofacitinib dose if coadministered with both moderate CYP3A4 and potent CYP2C19 inhibitors.

• tolterodine

  Serious - Use Alternative (1)erythromycin lactobionate will increase the level or effect of tolterodine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• tolvaptan

  Monitor Closely (1)erythromycin lactobionate will increase the level or effect of tolvaptan by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.Serious - Use Alternative (1)erythromycin lactobionate will increase the level or effect of tolvaptan by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• topiramate

  Serious - Use Alternative (1)topiramate will decrease the level or effect of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• topotecan

  Serious - Use Alternative (1)erythromycin lactobionate will increase the level or effect of topotecan by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug. Product labeling for PO topotecan recommends avoiding concomitant use of P-gp inhibitors; the interaction with IV topotecan may be less severe but is still likely of clinical significance

• toremifene

  Serious - Use Alternative (1)erythromycin lactobionate increases levels of toremifene by decreasing metabolism. Avoid or Use Alternate Drug. Concurrent use of toremifene with agents causing QT prolongation should be avoided. If concomitant use is required it's recommended that toremifene be interrupted. If interruption not possible, patients requiring therapy with a drug that prolongs QT should be closely monitored. ECGs should be obtained for high risk patients.

• trabectedin

  Monitor Closely (1)erythromycin lactobionate will increase the level or effect of trabectedin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• tramadol

  Monitor Closely (1)erythromycin lactobionate will increase the level or effect of tramadol by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor. May require decreased tramadol dose or adjustment of dosing interval; increased risk for serious adverse events including seizures and serotonin syndrome

• trazodone

  Monitor Closely (1)erythromycin lactobionate will increase the level or effect of trazodone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.Serious - Use Alternative (1)trazodone and erythromycin lactobionate both increase QTc interval. Avoid or Use Alternate Drug.

• triamcinolone acetonide injectable suspension

  Serious - Use Alternative (2)erythromycin lactobionate will increase the level or effect of triamcinolone acetonide injectable suspension by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.
  
  triamcinolone acetonide injectable suspension will decrease the level or effect of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• triazolam

  Serious - Use Alternative (1)erythromycin lactobionate will increase the level or effect of triazolam by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• trifluoperazine

  Serious - Use Alternative (1)trifluoperazine and erythromycin lactobionate both increase QTc interval. Avoid or Use Alternate Drug.

• trimethoprim

  Monitor Closely (1)erythromycin lactobionate and trimethoprim both increase QTc interval. Modify Therapy/Monitor Closely.

• trimipramine

  Serious - Use Alternative (1)trimipramine and erythromycin lactobionate both increase QTc interval. Avoid or Use Alternate Drug.

• triptorelin

  Monitor Closely (1)triptorelin increases toxicity of erythromycin lactobionate by QTc interval. Use Caution/Monitor. Increases risk of torsades de pointes.

• trofinetide

  Serious - Use Alternative (1)trofinetide will increase the level or effect of erythromycin lactobionate by Other (see comment). Avoid or Use Alternate Drug. Trofinetide (an OATP131 and OATP13B inhibitor) may increase plasma levels of OATP131 or OATP13B substrates. Avoid coadministration with sensitive substrates.

• tropisetron

  Monitor Closely (1)erythromycin lactobionate and tropisetron both increase QTc interval. Modify Therapy/Monitor Closely.

• tucatinib

  Monitor Closely (1)tucatinib will increase the level or effect of erythromycin lactobionate by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor. Consider reducing the dosage of P-gp substrates, where minimal concentration changes may lead to serious or life-threatening toxicities.Serious - Use Alternative (1)tucatinib will increase the level or effect of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Avoid concomitant use of tucatinib with CYP3A substrates, where minimal concentration changes may lead to serious or life-threatening toxicities. If unavoidable, reduce CYP3A substrate dose according to product labeling.

• typhoid vaccine live

  Serious - Use Alternative (1)erythromycin lactobionate decreases effects of typhoid vaccine live by pharmacodynamic antagonism. Contraindicated. Wait until Abx Tx complete to administer live bacterial vaccine.

• umeclidinium bromide/vilanterol inhaled

  Serious - Use Alternative (1)erythromycin lactobionate increases toxicity of umeclidinium bromide/vilanterol inhaled by QTc interval. Avoid or Use Alternate Drug. Exercise extreme caution when vilanterol coadministered with drugs that prolong QTc interval; adrenergic agonist effects on the cardiovascular system may be potentiated.

• valbenazine

  Monitor Closely (1)valbenazine and erythromycin lactobionate both increase QTc interval. Use Caution/Monitor.

• valproic acid

  Minor (1)erythromycin lactobionate increases levels of valproic acid by decreasing metabolism. Minor/Significance Unknown.

• valsartan

  Monitor Closely (1)erythromycin lactobionate will increase the level or effect of valsartan by Other (see comment). Use Caution/Monitor. The results from an in vitro study with human liver tissue indicate that valsartan is a substrate of the hepatic uptake transporter OATP1B1; coadministration with OATP1B1 inhibitors may increase valsartan systemic exposure

• vandetanib

  Serious - Use Alternative (1)erythromycin lactobionate, vandetanib. Either increases toxicity of the other by QTc interval. Avoid or Use Alternate Drug. Avoid coadministration with drugs known to prolong QT interval; if a drug known to prolong QT interval must be used, more frequent ECG monitoring is recommended.

• vardenafil

  Monitor Closely (1)erythromycin lactobionate will increase the level or effect of vardenafil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Limit vardenafil dose to 5 mg/24 hr

• vemurafenib

  Serious - Use Alternative (1)vemurafenib and erythromycin lactobionate both increase QTc interval. Avoid or Use Alternate Drug. Concomitant use of vemurafenib with drugs that prolong QT interval is not recommended. Erythromycin may also increase vemurafenib levels.

• venetoclax

  Serious - Use Alternative (2)erythromycin lactobionate will increase the level or effect of venetoclax by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. If a moderate CYP3A inhibitor must be used, reduce the venetoclax dose by at least 50%. Monitor more closely for signs of venetoclax toxicities.
  
  erythromycin lactobionate will increase the level or effect of venetoclax by P-glycoprotein (MDR1) efflux transporter. Avoid or Use Alternate Drug. If a P-gp inhibitor must be used, reduce the venetoclax dose by at least 50%. Monitor more closely for signs of venetoclax toxicities.

• venlafaxine

  Monitor Closely (1)erythromycin lactobionate and venlafaxine both increase QTc interval. Modify Therapy/Monitor Closely.

• verapamil

  Serious - Use Alternative (2)verapamil will increase the level or effect of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.
  
  erythromycin lactobionate will increase the level or effect of verapamil by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.

• vilanterol/fluticasone furoate inhaled

  Serious - Use Alternative (1)erythromycin lactobionate increases toxicity of vilanterol/fluticasone furoate inhaled by QTc interval. Avoid or Use Alternate Drug. Exercise extreme caution when vilanterol coadministered with drugs that prolong QTc interval; adrenergic agonist effects on the cardiovascular system may be potentiated.

• vilazodone

  Serious - Use Alternative (1)erythromycin lactobionate increases levels of vilazodone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. If intolerable adverse effects occur when coadministered with moderate CYP3A4 inhibitors, reduce daily dose to 20 mg.

• vinblastine

  Monitor Closely (2)erythromycin lactobionate will increase the level or effect of vinblastine by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
  
  erythromycin lactobionate will increase the level or effect of vinblastine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• vincristine

  Monitor Closely (2)erythromycin lactobionate will increase the level or effect of vincristine by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
  
  erythromycin lactobionate will increase the level or effect of vincristine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• vincristine liposomal

  Monitor Closely (2)erythromycin lactobionate will increase the level or effect of vincristine liposomal by P-glycoprotein (MDR1) efflux transporter. Use Caution/Monitor.
  
  erythromycin lactobionate will increase the level or effect of vincristine liposomal by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• vinorelbine

  Monitor Closely (1)erythromycin lactobionate will increase the level or effect of vinorelbine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• vitamin K1 (phytonadione)

  Monitor Closely (1)erythromycin lactobionate will decrease the level or effect of vitamin K1 (phytonadione) by altering intestinal flora. Applies only to oral form of both agents. Use Caution/Monitor.

• voclosporin

  Monitor Closely (2)voclosporin, erythromycin lactobionate. Either increases effects of the other by QTc interval. Use Caution/Monitor.
  
  erythromycin lactobionate will increase the level or effect of voclosporin by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Reduce voclosporin daily dosage to 15.8 mg PO in AM and 7.9 mg PO in PM.

• voriconazole

  Monitor Closely (1)erythromycin lactobionate and voriconazole both increase QTc interval. Modify Therapy/Monitor Closely.Serious - Use Alternative (1)voriconazole will increase the level or effect of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Contraindicated.

• vorinostat

  Serious - Use Alternative (1)vorinostat and erythromycin lactobionate both increase QTc interval. Avoid or Use Alternate Drug.

• voxelotor

  Serious - Use Alternative (1)voxelotor will increase the level or effect of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug. Voxelotor increases systemic exposure of sensitive CYP3A4 substrates. Avoid coadministration with sensitive CYP3A4 substrates with a narrow therapeutic index. Consider dose reduction of the sensitive CYP3A4 substrate(s) if unable to avoid.

• zafirlukast

  Serious - Use Alternative (1)zafirlukast will increase the level or effect of erythromycin lactobionate by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Avoid or Use Alternate Drug.Minor (1)erythromycin lactobionate decreases levels of zafirlukast by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

• zaleplon

  Monitor Closely (1)erythromycin lactobionate will increase the level or effect of zaleplon by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• zanubrutinib

  Monitor Closely (1)erythromycin lactobionate will increase the level or effect of zanubrutinib by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Modify Therapy/Monitor Closely. Reduce zanubrutinib (a CYP3A4 substrate) to 80 mg PO BID to when coadministered with a moderate CYP3A4 inhibitor. Interrupt dose as recommended for adverse reactions. After discontinuing the CYP3A4 inhibitor, resume previous dose of zanubrutinib.

• zavegepant intranasal

  Serious - Use Alternative (1)erythromycin lactobionate will increase the level or effect of zavegepant intranasal by Other (see comment). Avoid or Use Alternate Drug. OATP1B3 inhibitors may result in a significant increase in systemic exposure of zavegepant (an OATP1B3 substrate).

• ziprasidone

  Monitor Closely (1)erythromycin lactobionate will increase the level or effect of ziprasidone by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.Serious - Use Alternative (1)erythromycin lactobionate and ziprasidone both increase QTc interval. Avoid or Use Alternate Drug.

• zolpidem

  Monitor Closely (1)erythromycin lactobionate will increase the level or effect of zolpidem by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.

• zonisamide

  Monitor Closely (1)erythromycin lactobionate will increase the level or effect of zonisamide by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Use Caution/Monitor.