ERGOT DERIVATIVES AND MACROLIDES
Ergot toxicity can develop rapidly in patients taking ergotamine or dihydroergotamine if they are given erythromycin. However, in one case, the reaction occurred when erythromycin was started 3 days after the last dose of dihydroergotamine. Other cases have been reported with clarithromycin and josamycin. Toxicity is also predicted to occur with midecamycin and telithromycin.
The combination of ergot derivatives and macrolides that inhibit CYP3A4 is best avoided. Note that the macrolides differ in their ability to inhibit CYP3A4, see macrolides. No cases of toxicity appear to have been described with azithromycin, dirithromycin, or spiramycin, and none would be expected.
The combination of ergot derivatives and macrolides that inhibit CYP3A4 is best avoided. Note that the macrolides differ in their ability to inhibit CYP3A4, see macrolides. No cases of toxicity appear to have been described with azithromycin, dirithromycin, or spiramycin, and none would be expected.