Safety of Azithromycin in patients with Cardiovascular Risks

• Not contraindicated/ but as Warning and Precaution
• azithromycin (Zithromax or Zmax) can cause abnormal changes in the electrical activity of the heart that may lead to a potentially fatal irregular heart rhythm.
• a clinical QT study which showed that azithromycin can prolong the QTc interval
• Patients at particular risk for developing this condition include

- existing QT interval prolongation
- low blood levels of potassium or magnesium
- a slower than normal heart rate
- use of certain drugs used to treat abnormal heart rhythms, or arrhythmias
- Elderly patients and those at high risk for cardiovascular disease were also considered to be more susceptible to the adverse effects of azithromycin

• Alternative drugs in the macrolide class, or non-macrolides such as the fluoroquinolones, also have the potential for QT prolongation or other significant side effects that should be considered when choosing an antibacterial drug.
• The study reported an increase in cardiovascular deaths, and in the risk of death from any cause, in persons treated with a 5-day course of azithromycin (Zithromax) compared to persons treated with amoxicillin, ciprofloxacin, or no drug. The risks of cardiovascular death associated with levofloxacin treatment were similar to those associated with azithromycin treatment.

Modifiable and Non-Modifiable Risk Factors for QT-Prolongation and Torsades de Pointes

 

References

1. Cardiac Risks With Antibiotics Azithromycin, Levofloxacin Supported by VA Data http://www.medscape.com/viewarticle/821697
2. FDA Drug Safety Communication: Azithromycin (Zithromax or Zmax) and the risk of potentially fatal heart rhythms http://www.fda.gov/Drugs/DrugSafety/ucm341822.htm
3. Zithromax. http://www.accessdata.fda.gov/drugsatfda_docs/label/2013/050710s039,050711s036,050784s023lbl.pdf