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Subject Reference: Common Antibiotic May Raise Sudden Death Risk

Common Antibiotic May Raise Sudden Death RiskErythromycin May Interact With Other Drugs, Prompt Sudden Cardiac DeathBy WarnerWebMD Medical NewsReviewed By Brunilda Nazario, MDon Wednesday, September 08, 2004Sept. 8, 2004 -- A popular antibiotic may dramatically raise the risk ofsudden cardiac death when used in combination with a group of commonlyused drugs, according to new research.In a large study, researchers found the risk of sudden death caused byan abnormally rapid heart rhythm was up to five times higher in peopletaking erythromycin in combination with a group of drugs that can raisethe level of erythromycin in the blood.In the study, the risk of sudden cardiac death was also twice as highamong people using erythromycin alone.Erythromycin is an antibiotic that has been widely used to treat avariety of infections in the last 30 years and is considered relativelysafe with a low risk of side effects.Although the study suggests that the risk of sudden cardiac death ishigher among people using the drug, the overall risk of sudden cardiacdeath among healthy people is still very low. However, researchers saythe results show that erythromycin should not be used together withmedications that increase the blood level of the antibiotic.Medications that cause erythromycin to build up in the bloodstreaminclude: * The antifungal medications Nizoral and Diflucan * Some drugs that treat high blood pressure or heart disease, suchas Cardizem, Cartia, Dilacor, Diltia, Tiazac, Teczem, Calan, Covera-HS,Isoptin, Verelan, and Tarka * The anti-HIV drug Crixivan * The antibiotic drug Tao* The antidepressant SerzoneThese drugs are known as CYP3A inhibitors.Drug Interactions Raise Sudden Death RisksFor the study, published in the Sept. 9 issue of The New England Journalof Medicine, researchers reviewed the medical records of TennesseeMedicaid recipients who died from 1988 to 1993. Researchers looked forany association between the use of erythromycin and sudden cardiac deathand whether this risk was affected by use of drugs known to increase theblood level of the antibiotic.Nearly 1,500 cases of sudden cardiac death occurred during the studyperiod, and researchers found that the rate of sudden cardiac death wastwice as high among people using erythromycin.There was no increase in risk among those who had previously used theantibiotic or among those using another antibiotic, amoxicillin, whichis used in many of the same situations as erythromycin.In addition, the study showed that the rate of sudden cardiac death wasfive times as high among people who were using erythromycin and one ofthe CYP3A inhibitors. But there was no increase in risk among thoseusing CYP3A inhibitors and amoxicillin.Benefits vs. Risks Must Be WeighedResearchers say erythromycin, alone and especially in combination withthis group of drugs, may increase the risk of sudden cardiac death byslightly altering the normal heart rhythm, specifically by prolonging aportion called the QT interval. Prolonging the QT interval is known tobe associated with an increase in potentially deadly heart rhythms.In a related article published in the same journal, Barbara Liu, MD, and Juurlink, MD, PhD, of the University of Toronto, say this studyshows weighing the benefits and risks of potential drug interactions ofpotentially lifesaving drugs is a complex process.For people without other risk factors for sudden cardiac death, they saythe risk of using a single drug that prolongs the QT interval isprobably extremely low, "as evidenced by the millions of courses oferythromycin that have been taken safely during the past 30 years."However, for patients with other preexisting drug-related ornon-drug-related risk factors, QT-interval-prolonging drugs should beused very cautiously and only after the risks and benefits have beenweighed on a case-by-case basis," they write.SOURCES: Ray, W. The New England Journal of Medicine, Sept. 9, 2004; vol351: pp 1089-96. Liu, B. and Juurlink, D. The New England Journal ofMedicine, Sept. 9, 2004; vol 351: pp 1053-1056.http://my.webmd.com/content/Article/93/102516.htm?pagenumber=1--^----------------------------------------------------------------This email was sent to: juliejp61@...EASY UNSUBSCRIBE click here: http://topica.com/u/?a2iT7o.a55jXu.anVsaWVqOr send an email to: BreastImplantNews-unsubscribe@...For Topica's complete suite of email marketing solutions visit:http://www.topica.com/?p=TEXFOOTER--^----------------------------------------------------------------