From the Guidelines
Escitalopram and azithromycin should be used together with caution due to a potential interaction that may increase the risk of QT interval prolongation. When considering the combination of escitalopram and azithromycin, it's crucial to weigh the benefits against the potential risks, particularly the risk of QT interval prolongation, which can lead to serious arrhythmias and increased risk for sudden death 1. The interaction between escitalopram, an SSRI antidepressant, and azithromycin, a macrolide antibiotic, is considered moderate, not severe, but caution is still advised, especially in patients with other risk factors such as heart disease, electrolyte abnormalities, or those taking additional QT-prolonging medications. Some key points to consider when using these medications together include:
- Monitoring for symptoms like dizziness, palpitations, or fainting
- Awareness of the potential for QT interval prolongation, especially in advanced age and female sex, as implicated by recent studies 1
- Consideration of alternative antibiotics with less QT-prolonging potential if possible
- No typical dosage adjustments are required for either medication when used together, but careful monitoring is necessary. It's also important to note that macrolides, including azithromycin, can cause prolongation of the QT interval in a dose-dependent manner and should not be taken concurrently with inhibitors of cytochrome P-450 3A, such as some selective serotonin reuptake inhibitor antidepressants 1. Given the potential risks, it is recommended that patients inform their doctor about all their medications before starting azithromycin, especially if they are currently taking escitalopram, to determine the safest course of treatment.
From the Research
Escitalopram and Azithromycin Drug Interaction
- There is no direct evidence of a drug interaction between escitalopram and azithromycin in the provided studies.
- However, studies have shown that escitalopram can cause QT interval prolongation, which can increase the risk of torsades de pointes (TdP) 2, 3, 4.
- Azithromycin is a macrolide antibiotic, and while macrolide antibiotics can also cause QT interval prolongation, azithromycin is not typically associated with a high risk of TdP 5.
- Pharmacists play an important role in minimizing the risk of drug-induced QTc interval prolongation and TdP through knowledge of drugs that are associated with a known or possible risk of TdP, individualized assessment of risk of drug-induced QTc interval prolongation, and awareness of drug interactions most likely to result in TdP 5.
- The use of escitalopram and other selective serotonin reuptake inhibitors (SSRIs) has been associated with an increased risk of QTc interval prolongation, although the risk may vary depending on the specific SSRI and individual patient factors 2, 3, 4.