What Are the Different Erythromycin Interactions?

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  • Written By: Maggie J. Hall
  • Edited By: Susan Barwick
  • Last Modified Date: 20 February 2020
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Erythromycin is an antibiotic that has been prescribed by physicians for decades, but the medication has the potential for interacting with certain beverages, disease processes, and other medications. Instructions advise taking the antibiotic one to two hours before meals, decreasing the likelihood of reduced absorption. Its action may exacerbate the symptoms of patients diagnosed with inflammatory bowel disease, liver disease, or myasthenia gravis. Patients can experience erythromycin interactions when combining the antibiotic with a number of other medications, over one hundred of which might produce serious adverse symptoms.

Besides advising against taking the medication with food, patients are also advised that grapefruit juice can cause erythromycin interactions. Taking the antibiotic with grapefruit juice increases the amount of the drug in the blood and may increase the potential for side effects associated with the medication. Alcoholic beverages, on the other hand, delay the absorption rate and action of erythromycin. Physicians advise against taking it with alcoholic beverages.

Antibiotics have a tendency to destroy bacteria that is normally present in the body along with pathogenic organisms, especially microbes found in the digestive tract. Frequently reported side effects of erythromycin include diarrhea, nausea, vomiting, and abdominal discomfort secondary to the medication's effects on the gastrointestinal system. Patients with colitis, or other gastric inflammatory disease processes, may experience mild to severe erythromycin interactions that produce increased irritation, pain and possible bloody, loose stools.


The medication might also increase the weakness experienced by patients with myasthenia gravis, as erythromycin may further inhibit acetylcholine release at neuromuscular junctions. The liver eliminates erythromycin from the body, and this process naturally increases the organ's workload and increases hepatic enzyme activity. Individuals with decreased liver function may experience an increase in symptoms and have a greater possibility of developing hepatitis.

The body produces various enzymes, which aid in the metabolism of medications. Some drugs inhibit the activity of these enzymes, increasing the actions and adverse reactions of other medications because of increased concentration in the bloodstream. Erythromycin interactions may occur because of this enzyme inhibition process. Dilitiazem, verapamil, ketoconazole, and troleandomycin are some of the medications responsible for these types of interactions.

Risks in taking erythromycin include the possibility of developing serious ventricular cardiac dysrhythmias or sudden cardiac death when taking the antibiotic with antihypertensives that include dilitiazem and verapamil. These symptoms might also occur when combining erythromycin with non-sedating antihistamines. Some of the other medications causing erythromycin interactions include astemizole, cisapride, pimozide, and terfenadine. Using the antibiotic while taking lovastatin may cause a condition known as rhabdomylosis, which triggers the destruction of skeletal muscle tissue. Proteins from this deterioration process may cause renal malfunction upon reaching the kidneys.

Erythromycin effectively eradicates many strains of gram-negative and gram-positive bacteria. It does so by interfering with the 50S ribosomal subunit of these microorganisms, which inhibits ribonucleic acid (RNA) reproduction and protein synthesis. Uses of erythromycin include the treatment of some abdominal parasites, respiratory infections, skin and structural infections, and pelvic inflammatory conditions caused by susceptible microbes.


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